Selective mutism

Selective mutism is the consistent failure to speak when it is naturally required which cannot be otherwise explained as a result of a physical impairment or lack of comprehension. There is an increased prevalence in children and infers that there is almost an element of choice in the situations where they find themselves not being able, and being able to speak. A common example is children who present themselves as talkative and sociable when at home surrounded by friends and family and are then unable to speak in school or unfamiliar environments (Cunningham, McHolm and Boyle, 2006). Selective mutism, however, presents difficulty in research as a result of its variability in speaking behaviours and therefore it has been suggested that the prevalence is higher than what is reported (Grover et al., 2006).

Additionally, the aetiology of selective mutism is a combination of factors such as unresolved internal conflicts, genetics, poor reinforcement techniques and family dysfunction (Scott and Biedel, 2011). As a result, a myriad of techniques has been developed in order to aid a child with selective mutism to speak more openly in all environments, one of which is played therapy (Fernandez and Sugay, 2016). This is the encouragement of the normative development of feelings and how they are communicated through childhood play activities. This provides both the child and the therapist a mutual environment in which they can build upon their relationship through gaining the child’s trust. In tackling these issues in an enjoyable way, enables the child to feel comfortable and supported in order to express their feelings. This can be assisted by the psychodynamic approach with places emphasis not only on what the child says but how they interact with the toys and materials made available. In interpreting through their choices, therapists are able to gather meaning from the child’s play through symbolism (Cohan et al., 2006). Whilst being acknowledged not to directly cure selective mutism, play therapy can provide the child with increased confidence and support needed to encourage them to speak.

References

Cohan, S. L., Chavira, D. A., & Stein, M. B. (2006). Practitioner review: Psychosocial interventions for children with selective mutism: A critical evaluation of the literature from 1990–2005. Journal of Child Psychology and Psychiatry, 47, 1085–1097

Cunningham, C. E., McHolm, A. E., & Boyle, M. H. (2006). Social phobia, anxiety, oppositional behavior, social skills, and self-concept in children with specific selective mutism, generalized selective mutism, and community controls. European Child & Adolescent Psychiatry Journal, 15, 245– 255

Fernandez, K. T. G., & Sugay, C. O. (2016). Psychodynamic play therapy: A case of selective mutism. International Journal of Play Therapy, 25(4), 203.

Grover, R. L., Hughes, A. A., Bergman, R. L., & Kingery, J. N. (2006). Treatment modifications based on childhood anxiety diagnosis: Demonstrating the flexibility in manualized treatment. Journal of Cognitive Psychotherapy: An International Quarterly, 20, 275–286

Scott, S., & Beidel, D. C. (2011). Selective mutism: An update and suggestions for future research. Current Psychiatry Reports, 13, 251–257