Omdal Heidi, Galloway David
University of Stavanger, Centre for Behavioural Research, 4036 Stavanger, Norway. E-mail:
University of Durham, School of Education, Leazes Road, Durham, DH1 1TA, UK.
Child Adolesc Ment Health. 2008 May;13(2):74-81. doi: 10.1111/j.1475-3588.2007.00454.x.
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.
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.
(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.
SM may be understood and treated successfully at school/kindergarten as a specific phobia of expressive speech.
选择性缄默症（SM）现在被广泛视为社交焦虑的一种症状。然而，对儿童在家庭和学校/幼儿园自然环境中的互动观察表明，这可能需要重新审视。
数据来自两个来源：第一，对6名在童年和青少年时期从选择性缄默症中康复的成年人进行访谈；第二，对5名选择性缄默症儿童在家庭和学校/幼儿园进行非正式观察，并对他们的父母和教师进行半结构化访谈。该研究有三个阶段：（i）检查数据中是否存在社交焦虑和/或坚定或固执行为，但两者都不能对选择性缄默症提供令人满意的解释。（ii）数据表明，选择性缄默症可以重新概念化为对自己说话的特定恐惧症。有人认为，如果是这种情况，选择性缄默症应该在学校接受基于认知行为疗法方法的广泛干预。（iii）对观察和访谈记录进行事后检查以检验这一假设。
（i）除两名成年人外，未发现社交焦虑的证据。观察到坚定和固执行为，但不足以解释选择性缄默症。（ii）两名儿童在接触到可被视为符合分级现场暴露原则的课堂互动时康复。三名未接触类似互动的儿童没有改善。
在学校/幼儿园，选择性缄默症可以作为对表达性言语的特定恐惧症得到成功理解和治疗。
