Cool, Confident and Courageous (CCC) Kids Programming for Children and Adolescents with Selective Mutism
Selective Mutism (SM) is an anxiety disorder that has a significant impact on a child’s life. Children with SM are often observed to be “chatty” or talkative in situations where they are comfortable, whereas they demonstrate minimal or no speech in the specific situations that they experience anxiety. This lack of speech can interfere with academic achievement (for example, the inability to demonstrate their knowledge through reading aloud, giving presentations, or answering teacher questions). SM can also impact the development of age appropriate social relationships with peers, teachers, and the community. It can impact other important areas like the ability of the child to seek help and express needs and wants to others.
The major goals of our SM program are to expand the variety of situations and conditions under which children are able to speak, as well as the quality of that engagement (for example, voice volume, elaboration, spontaneity, and self-advocacy). We strive to increase the child’s confidence and sense of mastery across situations. Effective treatment for SM usually requires a combination of services so that children are supported across contexts. We offer weekly groups (8-week semesters), peer dyad practice, parent coaching, school observations, school training and consultation, half-day intensive groups, and our intensive summer camp program.
Changes to SM Services Due to Covid-19: We continue to offer services for Selective Mutism through telehealth sessions during physical distancing due to Covid-19. Online sessions allow for children to continue to work on brave talking in situations such as remote learning experiences and virtual playdates. Parent consultations and skills training are also available via telehealth sessions.
Our program is grounded in the Parent-Child Interaction Therapy as modified for SM (PCIT-SM) model developed by Steven Kurtz, Ph.D. Traditional PCIT has been proven effective in encouraging positive child behavior and adult-child interactions in numerous large-scale studies. In the PCIT-SM approach, PCIT skills are utilized with the unique goals of positively reinforcing children’s engagement and speech and minimizing factors that discourage verbal responding. Caregivers, counselors and school staff learn to use a high “dose” of positive attention, including specific praise, descriptions of the child’s actions, and reflections of the child’s verbalizations. Adults are coached to avoid leading the interaction through commands or questions to reduce pressure for speech. These specialized interaction strategies are referred to as the Child-Directed Interaction (CDI). The PCIT-SM approach also includes Verbal-Directed Interaction (VDI) strategies to help adults encourage speech when children are ready, with careful consideration of the timing, context and delivery of each prompt to speak and consistent reinforcement for verbal responding.
Individual Therapy, Groups, and Intensive Camp Experience
Treatment targets the expansion of the child’s rules and boundaries around speech through step by step challenges that are individually tailored. We use specialized behavior therapy strategies to encourage and reinforce speech and brave interactions. We craft engaging and fun activities, simulate typical classroom and social environments, and use frequent praise and reward systems to encourage and increase brave talking. We encourage the generalization of speech by taking our practice outside the clinic to parks, playgrounds, libraries and other community locations. We provide intensive and hands on supervision to each individual counselor in our groups and camp experience. Our mentorship model allows for increased treatment success as each child gets one to one support with a counselor in working on their treatment goals when practicing in a group.
Through didactic training and hands-on feedback during play with their child, we coach parents on how to use an effective approach for encouraging speech and brave behavior. We also help parents develop appropriate treatment goals and effective reward systems for their child with SM. Parents utilize these techniques to increase speech and brave behavior in the community, such as in restaurants, on playdates, the playground and at school.
Teacher/School Training and Consultation
We think that it is critical for teachers, school counselors and any other individuals interacting with children with SM at school to have an understanding of SM and evidence-based strategies for encouraging speech. Education and consultation is provided to the school team in the form of school observations, school meetings, and/or videoconference/phone sessions with individual team members. We provide guidance in implementing and adjusting goals throughout the treatment process. We also participate in IEP and 504 Plan meetings to establish and refine appropriate accommodations and intervention plans for children with SM. Our goals are to support the school in using skills to help children make systematic progress in the areas of speech and social interactions at school.