TPC-Journal-V1-Issue1

52 The Professional Counselor \ Volume 1, Issue 1 be multifaceted, address anxiety in a variety of settings, and involve teachers, peers, parents, and other family members during the treatment process. Therefore, an eclectic approach is the most common treatment option currently used by counselors. Countless researchers have successfully combined psychodynamic, behavioral, cognitive-behavioral, pharmacological, and/or family counseling interventions. An example of a successful eclectic treatment approach was described by Wright, Cuccaro, Leonhardt, Kendall, and Anderson (1995) in a preschool-aged child. This treatment included behavioral interventions, play therapy, family therapy, and pharmacotherapy. Jackson, Allen, Boothe, Nava, and Coates (2005) also used a multifaceted approach consisting of shaping, systematic desensitization, play therapy, parent journaling, and relaxation training to successfully treat a six-year-old boy with selective mutism. While this type of treatment approach has consistently appeared to be effective in published case studies, more research is needed to reveal which components of these programs are essential. Importance of Early Diagnosis and Intervention Early, accurate diagnosis and intervention are crucial to overcoming selective mutism regardless of the type of treatment program. Research suggests that treatment for this disorder is most effective if it begins as soon as symptoms of the disorder become apparent, thus minimizing the amount of negative reinforcement for these behaviors (e.g., Schwartz et al., 2006; Stone & Kratochwill, 2002). Shipon-Blum (2007) explains: “The earlier a child is treated for selective mutism, the quicker the response to treatment and the better the overall prognosis. If a child remains mute for many years, his or her behavior can become a conditioned response where the child literally becomes accustomed to nonverbalization as a way of life” (p. 5). Shipon-Blum (2007) warns that if selective mutism is left untreated, the academic, social, and emotional repercussions may include depression, social isolation, poor academic performance, self-medication with drugs and alcohol, and suicide. Furthermore, Chansky (2004) points out that untreated anxiety associated with selective mutism also can lead to adverse health effects including cardiac, immune, and respiratory problems. Thus, early intervention provides more opportunity for successful treatment and, in the long term, a healthier, more functional child. Role of School Personnel in Treatment School personnel, especially teachers, play crucial roles in the treatment of selective mutism. Because the symptoms of this disorder are more evident once the child begins school, teachers often become responsible for making a referral for diagnosis. Most school personnel do not have the expertise or experience to deal with this disorder single-handedly, but it is important that teachers recognize anxious tendencies among these children and solicit the help of a school psychologist or counselor in order to make prompt referrals. Once an accurate diagnosis is made, studies (e.g., Kumpulainen, 2002; Lescano, 2008; McHolm et al., 2005) have shown that the willingness of the teacher and other school personnel to collaborate with the parent(s) and counselor affects the outcome of the treatment program. A multidisciplinary team that includes the child’s teacher, principal, school counselor, and/or school psychologist may collaborate with the parent and contribute observations and feedback to the counselor (Lescano, 2008; McHolm et al., 2005). Vecchio and Kearney (2007) indicated that this team approach may be helpful in treatment “because of the widespread nature of the child’s [speech] avoidance” (p 41). Teachers may assist in reinforcing behavioral treatment techniques as well. For example, a teacher may provide positive reinforcement for verbalizations in school or participate in a video recording which the child will use to practice formulating verbal responses to questions. The teacher also may help to minimize anxiety while the child is in school. Shipon-Blum (2003) emphasizes the importance of a caring classroom teacher who understands the behavioral characteristics of the disorder and allows the child to communicate by nonverbal means as long as necessary. A nurturing, comforting classroom environment and flexibility within the classroom setting and schedule also are important factors in a multifaceted treatment program (Shipon-Blum, 2003). Overall research, therefore, supports both an individual and systematic approach that includes school personnel for the treatment of selective mutism. Summary and Commentary As described in this article, selective mutism is a complex psychological disorder with an unknown origin. There is general agreement that selective mutism is characterized by a child’s inability to speak in certain social settings despite