Article by Dr Margaret Scorpiniti
Psychologist
TITLE: A developmental anxiety disorder: selective mutism.
Abstract This article summarizes the state of the art of selective mutism describing, in addition symptoms, even those research activities by school staff and therapists aiming to identify new methods and techniques of intervention. Introduction
disorder called "selective mutism" has flourished in many studies by the scientific research. Only a few current research has identified novel aspects of this problem and proposed the original method of treatment.
According to the DSM - IV-TR selective mutism is the inability to speak one or more important in social situations, like at school, in spite of speech, development and understanding of language is adequate, although they can be used other means of communication minutes. Is not due to another disorder or mental incapacity related to the development, although it was reported the incidence of delayed development of speech or difficulty of articulation.
The diagnosis of selective mutism is excluded if the problem is not due to the embarrassment of having a disorder of speech or language. Today this is no longer seen as a disorder caused by persistent refusal to speak, but by continuing inability to speak due to fear or anxiety. Another requirement of silence is that it can not be due to a lack of fluency in the language required by the social situation. The disturbance must be severe enough to interfere with progress in school or working, the symptoms must persist for at least a month, excluding the first month of school. If your child is diagnosed with one of these disorders: communication disorders, severe or profound mental retardation, Pervasive Developmental Disorder, Schizophrenia, or Psychotic Disorder, is excluded then the diagnosis of selective mutism.
Compared with Major Depressive Disorder, Oppositional Defiant Disorder or anxiety disorder, selective mutism is most commonly seen in a significant lack of language.
Content
Selective mutism is a childhood anxiety disorder characterized by the inability of the child to speak in various social situations. The child with MS does not usually so oppositional / defiant but is literally so anxious that I could not speak. Most children with selective mutism studied, with genetic predisposition to anxiety disorders even if environmental conditions may increase stress (E. Shipon-Blum).
About 90% of children with MS analysis (percentage taken from article by C. Stanley) meet the diagnostic criteria of DSM-IV social phobia is a persistent fear of situations and social benefits. Many children with selective mutism feel observed in every minute of the day, so I'm so anxious and fearful that literally can not answer if you try to communicate with them.
Segal In a study that analyzes the similarities and differences between identical twins raised together, describes the twins at the age of four years developed selective mutism. The disease manifested itself, for example, when they were in school and communicate only among themselves, while, with their teacher, were made to understand non-verbal means. At home they spoke normally, but if you entered a person unknown to them they did not hear from her. Only around eight years exceeds the silence with their classmates who had attended out of school. One of the twins, the more timid, one more than the suffering of his selective mutism and showed more fear and nightmares and bedwetting. Segal's study allows us to highlight who had selective mutism course was different in the two twins who were suffering.
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Selective mutism affects not only physicians but also psychologists and teachers.
A second case that we cite here, in fact, learned from the work of 'G. Kervatt teacher support to read and to the question of selective mutism in a child for five years, both at school and in other situations social, did not communicate verbally with anyone.
He was not just so, he suffered from a genuine social phobia became clearly evident at the school in the world. The Teacher Kervatt in his self-publishing told through his reports (observations for seven months) of how she and others on the staff of the school, were able to implement a plan of action for Nick. Through research on the topic and working with a psychologist, members of the study group (class teachers, parents, teacher support) which dealt with the case of a child with MS, came to organize a systematic therapy that has led him gradually out of its silence. The Kervatt directed the working group with immense patience and creativity, while maintaining a high sensitivity in Nik support in times of uncertainty and fear in communicating. The treatment was made on the case Nik specific, and has allowed a progression towards achieving the goals over seven months. In addition to presenting a very interesting story, the work of Kervatt constitutes a 'useful guide for all people who struggle to help children overcome their selective mutism. The Kervatt recognizes that each child is different and does not claim that its program of work can be good for everyone, but is convinced that its results, teachers, parents and psychologists can find more ideas and encouragement to persevere in seeking solutions to the silence.
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'm not clear about the roots of selective mutism, but is assumed to be determined by various genetic and environmental contributing factors.
conclude the list of research cited here with the latter study conducted on 19 pairs of parents of children with selective mutism that starts from a systemic perspective, setting the goal of studying family-relational aspects involved in the process of maintaining the characteristic symptoms of MS in childhood. Several empirical findings show that MS is a disorder belonging to the "cluster" anxious. The research started from the results of those studies (Beebe & Lachmann) have shown that as the ability of parents to understand the mental states of the child is adversely affected by emotional state experienced by the parent. In line with these studies, this research analyzed the action 1) the emotional reaction to the diagnosis of MS and 2) family cohesion on parental understanding of the behavior of selective mutism the child in terms of anxious emotional state. The research sample consisted of 19 pairs of parents with children affected by MS (DSM-IV).
Parents were assessed using the Family Adaptability and Cohesion Evaluation Scales (FACES) III version el'Hadley Questionnaire.
The results show that the angry emotional reaction to the diagnosis of MS el'invischiamento family may hinder the understanding of parental disorder of the child in terms of "anxious mental condition." From here, the authors have derived the implications of the findings on clinical practice is based on psychopathological concepts with the development of psychological treatments familiar in cases of MS in children (Compare, Gorla, Molinari).
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The prevalence of selective mutism gave results ranging from 0.08% (8 children out of 10,000) to about 0.1% (or 1 child in 1000). The changes may be due to the research methodology adopted, at the age of children in the sample population, or an erroneous recognition of symptoms by parents, doctors and educators.
The idea that argues that these children may be victims of violence is poorly founded. There is no reason to assume that such violence occurs more often on them rather than all the other children. Epidemiological studies have shown a high incidence of social anxiety and / or depression in family members of these subjects, but there is evidence of a family pathology causing the symptoms of selective mutism. If the selective mutism is a fear of language, it is not surprising that people with MS seem so obstinate in resisting attempts to make them talk. If the treatment of selective mutism is as if it was just an anxiety disorder, several children make excellent progress. Some cases suggest, however, that early diagnosis and treatment are crucial to have the best chance of success (C. Stanley).
Conclusion Children with MS should not be forced to talk because they live otherwise serious and crippling anxiety, however, should enable them to communicate non-verbally.
Sometimes, children with MS are confused with children with autism.
Instead, autism disorders and selective mutism are different. Autism behavior is not variable with the situation, the environment or people around you. Most of the doctors who work with children with MS tend to believe that they have an intelligence above the average and that many of them are gifted (C. Stanley). The selectively mute children have excellent opportunities to overcome their disorder when there is a collaboration between parents, teachers and therapists.
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A new approach to the problem is offered by strategic therapy that offers teachers and those who are working with children with this diagnosis to avoid:
- direct requests to speak and communicate in general;
- explanations of distress ;
- an increase of attentions;
- creation of the case.
In fact, the child with the disorder gets more attention than it prevents.
This therapy, however, offers some strategies and original techniques:
- give little frustrations through bias, or
- use of the technique of "As if", etc ...
In essence, it is recommended to reverse completely the details of the report, from a perception that the 'teacher follows the student to make him talk, to one where the student must be to feel the need to chase them to the teacher talk. In practice this can be constructed through the technique of frustration of the symptom (Haley 1987, 1988). This technique consists of making mistakes in a systematic manner on the child (name, age, color of clothing, etc. ..) without giving him time to respond to bring the fixes. The teacher so be corrected quickly jump to another topic or away from the child. Pushing, so he wanted to speak to the student to correct it, but prevented from doing so, puts it in front of the little frustrations that cause you to react and was taken down from its rigid position of silence (Nardone-Fiorenza-1995).
Alternatively, or in some cases at the same time, you use the positive connotation for restructuring and the requirement (in detail see Brief therapy-strategic).
To prevent relapse, before the good results we help with a game called "Guess it is true or false." This explains
the child may choose not to speak at your convenience for a short time only, or even for a whole day. The others (peers and teachers) are invited to guess whether his silence is true, that is beyond his control or if it's false, that is, if he chose.
In this way the child does not feel under pressure and can choose to change their attitude
or less. By adopting these techniques are also respected his personal time.
In conclusion, there are now various approaches to selective mutism, although some of them do not always manage to bring those affected to unlock and then to communicate verbally with everyone.
In these cases, we recommend solutions groped more to the original problem, such as that proposed strategic intervention in educational contexts, as it requires a reversal of optics which deals with the trouble and try to take him to overcome it.
Author Dr. Margaret Scorpiniti - Psychology of Development and Education
Website: http://web.i2000net.it/mscorpinitipsicologo/
Bibliography
only online presentation of the book appears
A., C. Gorla, E. Molinari, Family and selective mutism: relational and psychopathological
A. Fiorenza, G. Nardone, the strategic intervention in educational contexts. Communication and problem-solving for problems at school- Giuffrè Editore, Milan 1995.
C. Stanley, Ten clichés about selective mutism, http://www. selective-mutism.com
E. Shipon-Blum, Understanding the Selective Mutism - A guide to help teachers understand
http://www. selective-mutism.com
G. Kervatt, The Silence Within - A Teacher / Parent Guide to Helping selectively Mute and Shy Children
http://www. selective-mutism.com
NL Segal, Indivisible by Two: Lives of Extraordinary Twins, Cambridge, MA, Harvard University Press
V. Andreoli, GB Cassano, R. Rossi-DSM-IV-TR, Diagnostic and Statistical Manual of Mental Disorders. Text Revision. Ed Masson, Milano.
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