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Behavioral Techniques in the Treatment of Selective Mutism Aimee Kotrba, Ph.D.

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Behavioral Techniques in the Treatment of Selective Mutism Aimee Kotrba, Ph.D.
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Page 1: Behavioral Techniques in the Treatment of Selective Mutism Aimee Kotrba, Ph.D.

Behavioral Techniques in the Treatment of Selective Mutism

Aimee Kotrba, Ph.D.

Page 2: Behavioral Techniques in the Treatment of Selective Mutism Aimee Kotrba, Ph.D.

Can you identify the child with selective mutism?

Page 3: Behavioral Techniques in the Treatment of Selective Mutism Aimee Kotrba, Ph.D.

DSM-IV Criteria

Consistent, ongoing failure to speak in specific social situations

Interferes with education or social communication Not due to lack of language skills Other disorders (e.g., stuttering, PDD) have been

ruled out A relatively rare childhood disorder, affecting

approximately 1% of children in elementary school settings

Page 4: Behavioral Techniques in the Treatment of Selective Mutism Aimee Kotrba, Ph.D.

Assessment of Selective Mutism History Behavioral observations Cognitive functioning Language functioning

Page 5: Behavioral Techniques in the Treatment of Selective Mutism Aimee Kotrba, Ph.D.

Psychological Treatment of Selective Mutism Education Medication Desensitization Hierarchical exposure Relaxation techniques Shaping speech Generalization

Page 6: Behavioral Techniques in the Treatment of Selective Mutism Aimee Kotrba, Ph.D.

Psycho-education of Child Bibliotherapy Cat’s Got Your Tongue: A Story for

Children Afraid to Speak Written by Charles Schaefer Published by Magination Press in 1992

Treatment is explained in age-appropriate language to child

Child is assured that the therapist will practice with them in becoming braver and stronger.

Page 7: Behavioral Techniques in the Treatment of Selective Mutism Aimee Kotrba, Ph.D.

Psycho-education of Parents Selective mutism is conceptualized as a

social anxiety disorder Behavioral techniques are explained Describe ways parents could prevent

inadvertently reinforcing mutism Pediatrician discusses role of medication

Anti-depressants have been found to produce beneficial effects for children with selective mutism.

However, research demonstrates that the most effective treatment is cognitive-behavioral therapy.

Page 8: Behavioral Techniques in the Treatment of Selective Mutism Aimee Kotrba, Ph.D.

Treatment Package

Behavior modification

&Contingency management

Relaxation techniques/Post. self talk

Consultation with

Teachers and other

professionals

RegularBehavioral contracting

Self modeling(via video editing)

Graduated exposure

to fear

Development of Fear hierarchy

Treatment package

components

Individual work with child

Work with parent present

Training parents

Collaboration with otherprofessionals

Implementation Flowchart

Page 9: Behavioral Techniques in the Treatment of Selective Mutism Aimee Kotrba, Ph.D.

Fear Hierarchies

Maintain eye contact for 5 second count

Imitate simple body movements

Imitate sounds made with instruments

Imitate sounds made with the mouth

Imitate words, then phrases

Answering questions with head nod

Answering yes/no questions (audible)

Answer novel “Wh” questions

Ask spontaneous questions

Expanding stimulus & response classes

•Expand hierarchy to include other adults and children

•Increase volume requirements for speech

•Decrease latencies to responding

•Utilizing shaping and fading principles

Example Fear Hierarchy

Page 10: Behavioral Techniques in the Treatment of Selective Mutism Aimee Kotrba, Ph.D.

Self Modeling

Page 11: Behavioral Techniques in the Treatment of Selective Mutism Aimee Kotrba, Ph.D.

Case Example 1Alone with Mother

6 year old (Annie) diagnosed with selective mutism

2nd session of treatment

Early treatment on her fear hierarchy

Page 12: Behavioral Techniques in the Treatment of Selective Mutism Aimee Kotrba, Ph.D.

Escape Contingency

Required to nod head Yes or No as a response to the question posed by the therapist

Posture, facial expression, and demeanor changes when therapist enters the room

Page 13: Behavioral Techniques in the Treatment of Selective Mutism Aimee Kotrba, Ph.D.

Relaxation Techniques Deep breathing exercises Positive self-statements Visualization

Page 14: Behavioral Techniques in the Treatment of Selective Mutism Aimee Kotrba, Ph.D.

Shaping Techniques One word spoken simultaneously with

therapist One word spoken alone Repeated a short sentence Answered questions Gradually increased voice volume

Page 15: Behavioral Techniques in the Treatment of Selective Mutism Aimee Kotrba, Ph.D.

Generalizing Behavior to School Teachers are given information concerning

the present step on the heirarchy. Importance of practicing heirarchy in the

school setting Steps are only added when they were

“cleanly” demonstrated in the therapy session

Page 16: Behavioral Techniques in the Treatment of Selective Mutism Aimee Kotrba, Ph.D.

Generalizing Behavior to Public Gradually increasing proximity to peers Working with peer dyad in the clinical

setting Parents asked child questions in public Parents arranged play dates

Page 17: Behavioral Techniques in the Treatment of Selective Mutism Aimee Kotrba, Ph.D.

Post treatment with Therapist

Hierarchical steps have been accomplished with the therapist

Future goals will include expanding the response class to include additional adults and children in a variety of settings

Page 18: Behavioral Techniques in the Treatment of Selective Mutism Aimee Kotrba, Ph.D.

Termination Achieving spontaneous speech across

multiple settings Booster sessions will likely be necessary


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