We are pleased to distribute our monthly SMG Connection to the selective mutism community. We hope you enjoy the article. Summer Planning for Children with Selective Mutism How to maximize the benefits of summer activities to help your child with Selective Mutism I will start this article by talking about a mom (I will call her Maria) that I had the pleasure of working with this last summer. This is not just one mom but a fictitious combination of a few moms (and dads) with whom I have had the pleasure to work over the last 10 years. It was almost the end of the school year when Maria and John (dad) contacted me with questions about Selective Mutism when they talked about their little girl, Emily (a fictitious name), who was finishing preschool. When I first observed Emily at school, she showed a sad face (flat affect), she did not speak with anyone at school, she did not use the bathroom, and she was also inhibited nonverbally (she did not run and play during recess). I am sure you can visualize the childs face (who never smiled for pictures that teachers took at school). The teachers and educational staff at the school received me very well with open arms for a collaborative meeting when I provided an educational session about Selective Mutism (SM). Summer arrived and we had meetings to make plans for Emily for interventions and for activities that could be used for behavioral exposure exercises. The parents quickly learned the principles of Cognitive Behavior Therapy, and Behavior Therapy: Some of these are contingency management (rewarding specific little steps towards speaking with a normal volume voice); stimulus fading (when the child transitions from communicating with a familiar person to a new one), and shaping (when a child is reinforced for every higher step that she takes in the social-communication ladder). As the child experiences the interventions above, she/he then starts replacing the fearful experience when communicating with others to a positive emotional experience instead. In addition, Maria learned some of the skills of P.C.I.T. (Parent Child Interaction Therapy, see reference below) that were helpful for children with SM. Once we had meetings in my office, Maria started learning the skills of modeling, shaping, and fading. For instance, we had a few group sessions, and the mother was present at first, then she observed how I was working as an intermediary between the child and other children, and how I faded away from the situation when the child started talking to other children in the group. Maria started using these skills during play dates when she would participate in the interactions between her daughter and with another child, and then she would fade away from the activity. Maria was a super learner and also a super planner. We made goals for every week (and days) for Emily to meet with other children during the summer, and to go to various activities as well (such as gymnastics) with some of her peers. There were always a couple of behavioral goals for her daughter in her social communication chart (and they were always associated with rewards). Emily had play dates, swimming pool dates, picnics, and other activities as well (they even went to Disney World with a family from school). Swimming pool, the beach, being around animals, and the trampoline were the best avenue for feeling more comfortable with playing with her potential classmates. Emilys mom invited one child first to have a play date, then another child, and suddenly, Emily was having play dates with several children at one time, and she started talking to all children that had been in her classroom the year before in places where she felt comfortable speaking, such as home, at the swimming pool, and at the park. This was accomplished because Emilys mother, Maria, learned the basic principles of behavioral and of cognitive behavioral therapy. Not only that, but Maria also planned and she was persistent in putting into action the goals and plans. Emily also participated in a summer camp for children with Selective Mutism (The Yellow Brick Road to Brave Talking, a Summer Camp in Florida that I run for children with SM during the summer). This was a small group of children who met a few times during the summer and also for a week before school started. The children participated in activities such as art projects, cooking and decorating, and they each wrote a book about Selective Mutism, and how they were going to face their fears on a weekly basis. Each child wrote (or drew) a goal for the week, and when they met again, they congratulated each other in their successes and for their courageous behaviors. Later on in the summer, the team made plans for meeting Emilys new teacher for the upcoming academic year. The team had meetings at school with the principal, the educational coordinator, and with the teacher that was chosen to work with Emily. Then, three or two weeks before school started, Emily started going to school to meet with her teacher on a one-to-one situation. Emily loved art, and she would go early to school to help her teacher decorate for the new classroom. Emily felt comfortable in that classroom and with the new teacher as well. The above story was told with the intention to help parents make plans for their children (with SM) for summer and for late summer/early fall. Remember, your child is more than SM; your child is a unique individual who wants to play, to run, to have a great time during summer. Some children like art camp, others like sports, and others like chess. However, whatever you plan for your child for the summer, you may want to think about two elements: 1) How can I make plans for my child so that she/he will experience situations that will help decrease the symptoms of SM and not increase the probability of continuing to sustain the symptoms of SM? 2) What are some elements that I need to take into consideration when making plans for the summer? The following is a very practical and simple suggestion for parents who are making plans for their children: You can think of three elements that are important to keep track of when you are developing plans for your childs summer camp: PLACE, ACTIVITY, and PERSON. If you can enroll your child in a camp that is in the same PLACE as school (such as private school, a preschool, or a public school that has camp in the summer), it will be helpful to plan for your child to be in that camp at least for part of the summer. Why? If you work with a clinician who is specialized in BT (behavior therapy) and/or CBT (cognitive-behavior therapy) and who is experienced in SM, then this clinician can help train the teachers and the staff at camp to facilitate the experience at camp. Why is it better to go to camp in your own community (even if it is not at the specific school that your child will go)? Because your community is more likely to have the children and teachers (PERSONS) who will be in your childs life during fall and during other times of her/his life. In addition, you can meet parents as well and make play dates with the children after camp as well. Thus, the closer to home the treatment and camp is, the more likely those children will be more comfortable generalizing the levels of comfort that they develop during summer into the next academic year at school (assuming, of course, that you have appropriate guidance and treatment from a professional who is specialized in this area). In addition, if you have play dates, you can strategically choose to plan for an activity (ACTIVITY) that your child with SM likes and feels comfortable doing. Examples may be playing house, playing make believe, playing games that your child knows and loves to play, such as dress up among others. Note that the activities are chosen based on your childs high level of comfort with them, and they should not be competitive, and they may not require speaking at first. For instance, dress up may not involve verbalizations right away, but once the child starts playing, the familiar situation and activity may help your child feel more comfortable in using her verbal communication. Other games such as Guess Who, Head bands are also very helpful. Of course, you need to take into account the age and the childs developmental stage, or just pay attention to your childs favorite activities at home and in other places. I cannot emphasize enough how important it is for parents to engage children who are showing symptoms of SM in appropriate treatment. The most indicated treatment protocols are Behavior Therapy and Cognitive Behavior Therapy. Also, it is of most importance that the people you work with in school, camp, and other activities are open to learning about SM, and to learning about the strategies and approaches that are proven to work best with this condition. So, if you are choosing a camp, summer classes, or even a school for your child for this coming academic year, one of the considerations would be to make sure that the educational staff is open to working collaboratively as a team. It is also important that educational professionals are willing to have you (and a clinician) go to their site and talk about SM and how they too can help facilitate your childs experience in their setting from the start. It is really important to prepare the environment for a new year, and especially if your child will be going to a new school. I hope this article was helpful to you. I am a proud member of the Board of Directors of SMG, and I will be leading an Expert Chat in the next few weeks and during the summer to discuss the above topics. We will post the date and time of the Expert Chat on our website. Being a member of SMG provides parents and others with a great source of resources and information about SM. Please visit thewebsite selectivemutism.org for more information. Please do not hesitate to contact us with any topics you want to hear, discuss, or learn. Sincerely, Vera Joffe, Ph.D. Licensed Psychologist (FL, NY) verajoffe Member, Board of Directors of SMG Author: Sophies Story: A Guide to Selective Mutism available at the SMG bookstore Zisser, A., & Eyberg, S.M. (2010). Treating oppositional behavior in children using parent-child interaction therapy. In A.E. Kazdin & J.R. Weisz (Eds.) Evidence-based psychotherapies for children and adolescents (2nd ed., pp. 179-193). New York: Guilford.
Posted on: Sat, 17 May 2014 15:09:12 +0000
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