March 28, 2013 (selective mutism guest speaker).docx

7 Pages

Family Relations and Human Development
Course Code
FRHD 3150
Michelle Preyde

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March 28, 2013 (selective mutism guest speaker) FRHD 3150  Helping children overcome selective mutism: behaviour strategies at work o Guest speaker: Angela McHolm  Objectives for today o To introduce you to a special population of youth described as "selectively mute" o To overview the epidemiology of selective mutism and its anxiety-based underpinnings o To demonstrate the utility of behaviour principles/ strategies for intervention o To briefly overview a school-based behavioural approach to intervention  What's selective mutism? o They are all different; heterogeneous o Case #1 (not selective mutism)  Mark is a 9 year old boy who has always been moody, slow-to-warm and tends to be a worrier  Although a bright boy, he is reluctant to attend school and his parents have significant difficulty getting him to school in the morning  In terms of his communication patterns, Mark speaks to his teachers some days and yet other days, is completely shut down – refusing to do his work and is non-communicative o Case #2 (would not be described as selectively mute; could be driven by trauma)  Dana is a twelve year old girl who is an average student and well liked by her peers  Until recently, Dana has been actively involved in a variety of sports and extracurriculars  In terms of her communication patterns, Dana abruptly stopped speaking to her peers and teachers following a tragic car accident in which her sister was killed  History of the Diagnostic Term o Aphasia voluntario  Kussmaul (1877) o Elective mutism  Tramer (1934) o Elective mutism  DSM-III- R (1987) o Selective mutism  DSM- IV (1994)  What is the difference between selective mutism and "extreme shyness"? o Selective mutism is a diagnosable mental health condition whereas shyness is a personality or temperamental trait o Children with selective mutism are often characterized as shy, but the vast majority of shy children do not develop selective mutism o A shy child will eventually 'warm up' to a social situation and speak; children with SM do not start to speak in anxiety-provoking situations simply because time passes  Common features of selective mutism o A discrepancy in speaking patterns across settings or circumstances  Ie. Speaks comfortably at home vs restricted speaking at school o Fearful of being heard and/or seen speaking o Anxiety-prone  High physiological arousal levels  Emotion regulation issues o Parent-child dynamic is unique o Progresses academically (do ok academically) o Positive relations with peers, yet social skills deficits  Epidemiology study o Research questions posed  Is SM associated with anxiety or oppositional behaviour?  Is SM associated with parenting and family dysfunction?  Will the child with SM fail academically?  Will the child with SM fail socially? o Results  Anxiety  Parent reports indicated that children with sm exhibited > anxiety and >somatic complaints than controls  Teachers rated children with SM as more anxious than controls  Oppositionality  Based on both parent and teacher reports, children with SM were not characterized as more oppositional than controls  See chart on slides  Family dysfunction  Based on parent reports, parenting practices (ie. Permissive parenting) did not differ  Similarly, general family functioning did not differ  Differences in parenting style o Compared parent-child interactions of SM children (n = 21), anxious children (n = 17) & community controls (n = 25) o Average age = 7.8 years o Videotaped parent-child interactions o Observations of interactions during unstructured and high demand speaking situations o Coded parent (& child) behaviours; interested in parental warmth & control (e.g., direct/manage child behaviours) o SM children spoke less & produced less spontaneous speaking with parent o Parents of children with SM demonstrated similar warmth as others but more control (vs. parents of anxious or comparison group children) o Frequency of unsolicited speaking, observable child anxiety, and self-reported parent anxiety predicted likelihood of parent control  Will the child with selective mutism fail academically? o See chart on slide  "reading vocabulary standard score"  "math standard score"  "general academic rating"  Social skills ratings: parent and teacher reports o SSRS (Gresham- Elliot, 1990)  Social responsibility/ social control/ social cooperation/ social assertiveness  Teachers only rated children with SM as weaker terms of their social assertiveness skills  Parents, however, rated children as having weaker social skills across all 4 domains assessed (both verbal and nonverbal skills) o See chart on slides  "are children with selective mutism victimized by peers?"  How common is selective mutism? o See chart on slides  "prevalence of selective mutism studies from 1998 and 2002"  "selective mutism in more common among girls"  "age of onset for selective mutism"  Typically in preschool years  Selective mutism: possible primary contributers o Shy temperament- behavioural inhibition  Ie. Steinhausen and Juzi, 1996: ~85% of SM cases o Family characteristics  Ie. Family history of shyness, anxiety, and/or SM o Speech and language difficulties  Come with about 1/3 of these children o Adjustment to a new culture  Ie. Toppleberg et al, (2005) o Disconnect between home and school peer networks  Unlikely primary contributers o Early trauma  Ie. Highly stressful early life events o Family dysfunction  Ie. Family conflict, communication, cohesion o Poor parenting  Ie. Permissive or coercive parenting o Oppositionality  Conditions associated with SM o Other anxiety-related issues  Social phobia or social anxiety  Ie. ~68% of SM vs 0%  Separation anxiety  Ie. ~30% of SM vs 3%  Obsessive-complusive symptoms or perfectionistic tendencies  Ie. 5% of SM vs 0% o Speech and language difficulties o Enuresis--> wetting themselves during the day; afraid to tell someone that they had to go to the washroom  Ie. ~30% of SM vs 7% of controls  Longitudinal research findings o Very limited systematic research has followed SM children over time o Occasional case studies or small samples described in the literature at 2 points in time  Difficult to generalize findings to other cases  Remschmidt et al (2001) o A follow-up study of 45 German SM children o 23 boys/ 22 girls o SM first appeared at approx. 3-4 years of age o Average age of at time of referral: ~8 years o Followed-up on average 12 years later  (ie. Average age= 20.5 yrs) o Intervention between t1 and t2  17 cases had received inpatient therapy  6 cases received outpatient individual tx  22 cases had received family counselling o See chart on slides  "Mutism at Time2" o Results  No mutism or significant improvement (28/41 cases)  Duration of mutism was on average 9 + 4 years  No improvement at t2 (5/41 cases)  Duration of mutism was on average 20+ years  Partial or complete remission (89% of cases)  19% showed an abrupt remission  81% showed a gradual, step-by-step improvement  Mutism within immediate family at t1 best predicted a poor outcome at t2  Comparison between SM and matched sample for those older than 18 (n=18)  Significantly differed from comparison group for:  Decreased sociability/ social activity; stress tolerance; extroversion  Formerly mute participants described themselves as "less self-confident" and "less independent"  Assessment and diagnosis o Whereas the primary feature of selectiv
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