Brittany and Selective Mutism Functional Assessment Graduate Student A

Characteristics Selective Mutism Academic Behavioral Cognitive Family

Characteristics Rare disorder affecting fewer than 1% of school age children (Dow, Et Al., 1994) More common in girls Onset in the preschool years, ages 3-5 Seem generally to learn, retain and use skills in a normal way (Lumb & Wolf, 1988) Often show oppositional behaviors, refusing to participate in any activities suggested by teachers or adults Unresponsive, negativistic, manipulative, spoiled, relaxed, stubborn, & passive-aggressive

Not Speaking in at least one Social Situations (usually classroom) Temperament (shy & anxious) Developmental Delay (elimination problems) Speech and Language LD (20%) Family psychopathology (mother) and father shy temperament Experience of Trauma Versus Contributors Presenting Problem Contributors

Family Dynamics (Cline & Baldwin, 1994) Play a crucial role Close alliance with one parent, usually mother Family history of shyness Communication difficulties within home

More on Family Dynamics (Cline & Baldwin, 1994) MothersFathers Form an abnormally strong bond with their mute child Both mom and child feel that they cannot live without the other Seen as overprotective Depressed and emotionally immature Seen as detached from the issue Tend to communicate in the home on a limited basis My react to situations with angry outbursts Possibly strict

Brittany Caucasian Female 11 years old 5 th grader at Wea Ridge Elementary Emotionally Disabled Two parent household One younger brother

Positive Attributes “Chatterbox” and compliant at home Completes homework Girl Scout Enjoys school and is eager to attend Sings in school choir Has a few close friends Good relationship with school principal Smiles occasionally Quiet, not disruptive

Triggers Will DoWon’t Do Copy Draw Listen Write on self selected topic Select answers to recognition type questions (Multiple choice, T/F, etc.) Read aloud to teacher Verbalize answers to questions Write answers to recall questions (short answer, essay)

Payoffs Does not have to verbalize, interact (avoid relatedness) Does not have to produce (avoid task) Gets what she wants (Get control, self-determination)

Summary of Payoffs

Possible Disorders Social Phobia ODD Elective Mutism

DSM-IV Definition of Selective Mutism Consistent failure to speak in specific social situations (in which there is an expectation for speaking, e.g., at school) despite speaking in other situations. The disturbance interferes with educational or occupational achievement or with social communication. The duration of the disturbance is at least 1 month (not limited to the first month of school). The failure to speak is not due to a lack of knowledge of, or comfort with, the spoken language required in the social situation. The disturbance is not better accounted for by a Communication Disorder (e.g., Stuttering) and does not occur exclusively during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder.

Brittany Appears To Meet Criteria Brittany fails to speak in social situations, specifically in academic settings. She speaks at home. Her educational achievements are of concern. Relationships with others are minimal. Brittany has had these characteristics for several years. She has good verbal language. Brittany does not have a Communication Disorder, and her behavior cannot be better accounted for under another mental disorder.

Four Underlying Dynamics (Rosenberg & Lingblad, 1978 in Harris, 1996) A strong determination to maintain silence and fight off those who try to coerce them to speak An overwhelming need to control A passive aggressive relationship with parents A home atmosphere that does not welcome the expression of feelings

Treatments (Harris, 1996) (Dow et al., 1994) Behavioral –Stimulus fading –Shaping –Punishment Psychodynamic Family therapy Combination Behavioral and Family Therapy Pharmacotherapy School Based Multidisciplinary Individualized Treatment Plan

What I Have Done Communicated with Mom Utilized nonverbal Changed settings Changed instructors Provided choice of activities Peer involvement Utilized a tape recorder Read aloud children’s literature Banged my head against a brick wall

What I Am Going To Do Remember that I will not change Brittany Change task Provide a less formal, unstructured setting Discover what she wants Use what she wants and likes