Selective mutism exposures for telehealth

[medstudent234]

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I've been seeing a 7 year old girl for pretty severe selective mutism (ie nearly never speaks in public even to family since the age of 2, has never spoken in elementary school for the last 2.5 years, essentially does not speak with anyone but mom/dad, grandma, and 2 friends). We've made huge progress through graduated exposure and she is completely fluent with me. I can think of tons of in person exposures, but it has been challenging over Zoom.

I have been in touch with her elementary school teacher with ideas/tips and her first IEP meeting is coming up, but I would love ideas for virtual exposures. I encouraged her mom to have another relative or family friend join us on Zoom, but she has not actually ever followed through on this. I have also coached them on some exposures they can do for homework (also not the easiest during the pandemic), but I'm definitely stuck during session as she has maxed out verbally with me. Thanks so much!

 

[ClinicalABA]

Look at Thomas Kehle's (he was at UConn, but not sure if he is still there). He gave one of the most memorable presentations (at a regional ABA conference 20+ years ago) that I ever attended. It was on videotaped self-modeling for treating selective mutism. Basically, he taped interviews and conversations between the child and people they WOULD speak with, and then spliced the video of the child's responses with videos of people they WOULDN'T speak with. The end result was a video that looked like it was of the child speaking with someone they wouldn't normally speak with. I remember Kehle expressing shock at the rapid effects. In some cases, just having the child watch the "doctored" video one time resulted in them speaking to the non-spoken to person. I'd imagine this type of thing would lend itself well to zoom session. You'd have to create the videos, but tech is so much better now ( he had to use multiple VCRs back then). I've seen more recent research on video self-modeling of with children learning to generalize social skills by watching doctored videos of them responding to social cues but with the prompts removed (thus seeing themselves appear to exhibit independent skills).

 

[borne_before]

Look at Thomas Kehle's (he was at UConn, but not sure if he is still there). He gave one of the most memorable presentations (at a regional ABA conference 20+ years ago) that I ever attended. It was on videotaped self-modeling for treating selective mutism. Basically, he taped interviews and conversations between the child and people they WOULD speak with, and then spliced the video of the child's responses with videos of people they WOULDN'T speak with. The end result was a video that looked like it was of the child speaking with someone they wouldn't normally speak with. I remember Kehle expressing shock at the rapid effects. In some cases, just having the child watch the "doctored" video one time resulted in them speaking to the non-spoken to person. I'd imagine this type of thing would lend itself well to zoom session. You'd have to create the videos, but tech is so much better now ( he had to use multiple VCRs back then). I've seen more recent research on video self-modeling of with children learning to generalize social skills by watching doctored videos of them responding to social cues but with the prompts removed (thus seeing themselves appear to exhibit independent skills).

This reminds me of Harry Potter seeing himself use a patronus.

 

[CheetahGirl]

Not validated, nor researched (by me, now) but what about using puppets? Solely based on my opinion, as a parent who 'homeschooled' my kids during NYC lockdown. My youngest's 3rd grade teacher was a former Broadway actor, and she would make the most adorable 10-min video lessons, for the kids to watch, and then, they would discuss in remote learning class (although, of course, your 'discussion' would resemble something else with your client). But imagined the use of puppets in context to this article:

Behavioral intervention to treat selective mutism across multiple social situations and community settings - PubMed

We evaluated a behavioral intervention for a 9-year-old girl with selective mutism. The intervention consisted of role play and video self-modeling. The frequency of spoken initiations, responses to questions, and communication breakdowns was measured during three social situations (i.e...

pubmed.ncbi.nlm.nih.gov

Maybe you could use puppets to demonstrate interpersonal communication (in the absence of field examples), and video before & after (interventions).

Just a thought. 🤔

 

[ClinicalABA]

Here's some references to the work of Thomas Kehle that I cited above. Unfortunately, it looks like he passed away in 2018. It seems to be a promising intervention, but there really isn't much published on it. I'm not sure why that is?

The use of self-modeling as an intervention in school psychology: A case study of an elective mute. By: Kehle, Thomas J., Owen, Steven V., Cressy, Elizabeth T., School Psychology Review, 02796015, 19900101, Vol. 19, Issue 1

Augmented self‐modeling as an intervention for selective mutism. By: Kehle, Thomas J., Bray, Melissa A., Byer‐Alcorace, Gabriel F., Theodore, Lea A., Kovac, Lisa M., Psychology in the Schools, 00333085, 20120101, Vol. 49, Issue 1