Could Selective Mutism be Re-conceptualised as a Specific Phobia of Expressive Speech? An Exploratory Post-hoc Study.

BACKGROUND

Selective mutism (SM) is now widely seen as a symptom of social anxiety. However, observations of children's interactions in the natural contexts of home and school/kindergarten suggest that this may be in need of review.

METHOD

Data were available from two sources: first, interviews with six adults who had recovered from SM in childhood and adolescence; second, informal observations of five SM children in home and school/kindergarten, and semi-structured interviews with their parents and teachers. The research had three stages: (i) Data were examined for the presence of social anxiety and/or determined or stubborn behaviour, but neither provided a satisfactory explanation for the SM. (ii) The data suggested that SM could be reconceptualised as a specific phobia of their own speech. It is argued that if this is the case, SM should respond to intervention at school based broadly on a cognitive behaviour therapy methodology. (iii) A post hoc examination of observation and interview transcripts was used to test this hypothesis.

RESULTS

(i) Apart from two adults, no evidence was found of social anxiety. Determined and stubborn behaviour was observed but was inadequate as an explanation of SM. (ii) Two children recovered when exposed to classroom interactions that could be seen as consistent with the principles of graded in vivo flooding. Three children who were not exposed to similar interactions did not improve.

CONCLUSIONS

SM may be understood and treated successfully at school/kindergarten as a specific phobia of expressive speech.