Selective Mutism in Teenagers?

[shahseh22]

I'm seeing this poor kiddo who has had a lot of trauma at a very young age. She doesn't have the best family support as her dad walked out on the family. I'm mainly seeing her for medication management, but I would like to do some therapy if she opens up. However, I swear she is selectively mute and doesn't engage at all. Is there any good articles on how to approach this? I've tried doing a board game, but she seems too nervous to open up and just looks at the floor during our sessions.

Thanks

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[MedMan80]

What is her developmental history, possibly on the spectrum ?

 

[Bernardo_11]

Never treated adolescents with the condition, but for the youngers sometimes you will find the selectivity of their mutism to be interestingly specific. Example, I once had a school aged child who would not talk to anybody at school or in the clinic, but would readily talk to her teacher when she answered the phone.

So I would try to determine if there is any way the patient is willing to communicate. Tape recordings? Texting? Phone visit? Skype? And then see what you can do from there.

Nardo

 

[LadyHalcyon]

Any known trauma history such as severe neglect or early sexual molestation?

I'm seeing this poor kiddo who has had a lot of trauma at a very young age. She doesn't have the best family support as her dad walked out on the family. I'm mainly seeing her for medication management, but I would like to do some therapy if she opens up. However, I swear she is selectively mute and doesn't engage at all. Is there any good articles on how to approach this? I've tried doing a board game, but she seems too nervous to open up and just looks at the floor during our sessions.

Thanks

 

[FlowRate]

I've only done a slight amount of reading on selective mutism but it sounds like treatment in childhood is similar to other childhood somatoform disorders--incentivize the child into doing the desired behavior.

We had a bpd/complex ptsd patient in our partial program who was sort-of selectively mute but it's a lot harder to come up with behavioral rewards once someone's an adult (especially when they often use the sick role to elicit care.)

 

[MedMan80]

I’ve had patients on all different levels of mutism, I’ve heard that maybe getting them to sing might help them open up, this works for stutterers as well. Never tried it though

 

[LadyHalcyon]

In what contexts does she decide to speak?

 

[shahseh22]

Any known trauma history such as severe neglect or early sexual molestation?

sexual molestation

 

[Agrippa2]

I also found this article to be insightful.

The Importance of Hide-and-Seek

It’s a game. But it’s also what we need in life: the freedom to be found.

opinionator.blogs.nytimes.com

 

[LadyHalcyon]

I have a patient who is now 18, but had selective mutism in elementary and early middle school. She had mentioned during one session she stopped speaking because no one in her family would listen to her. Ultimately they were extremely invalidating and didn't believe she was molested by another family member.

sexual molestation