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"Molly with Mutism" 8 y.o. girl with selective mutism…

- - - - (Chvira et al., 2007)
- - - - Does not value familial interactions outside of those with mom.
      - Does not value social interactions
    - - Believes her mother is the only person she should talk to
    - - Higher level cognitive
        
        Executive functioning
        
        Self-awarenss
        
        Metacognition
        
        Problem solving
        
        Praxis
      - Thought (logical)
      - Emotional regulation
  - - - Inquires
      - Notice/responds
    - - Approaches/starts
      - Produces speech
      - Replies
      - Discloses
      - Accommodates
      - Benefits
      - Heeds
  - - - Cooperative play affected as a result of social/communication deficits
    - - Lack of progress in school
      - Does not engage with teacher or students
        
        Results in being treated as though client has an intellectual deficit, which has not been previously shown to be true.
    - - Does not interact with peers
        
        Victim of teasing/bullying
      - Does not interact with teacher
      - Does not speak to any family besides mother, occasionally makes eye contact with other family members
- - - - During lunch, recess, or other opportunities with social interactions
      - During classwork
    - - Interactions with other family members
      - Interactions between the client and the mother
    - - Interactions with new/unfamiliar people
  - - - Successful in following directions, physical abilities, and comprehending school material
    - - Roles: Daughter, student, classmate
      - Routine: school attendance, family functions
    - - Holistic understanding of child and family and guides client-centered care
        
        Mary is more willing to socially participate when in her home.
    - - Child values communication with mother
    - - Desired outcomes
        
        Improved social participation
        
        Increased education participation
        
        Communicate with classmates/teacher
        
        Develop stress management/anxiety coping techniques
      - Priorities
    - - Vocal/communicative and social participation prior to age 3
    - - Environmental supports include her mother's presence.
      - Environmental barriers include unfamiliar or socially demanding settings.
- - - - This approach is appropriate because the client used these skills until the age of 3, when she began to speak only with her mother. Restoring this skills will help with the client's social participation at home and at school.
      - Shaping: "a process in which a child is slowly first encouraged to communicate nonverbally, then make certain sounds, then whisper, then finally speak a word or a sentence" (Hung et al.., 2012, p. 223)
        
        Vocalization ladder
      - Social Skills training (O'Brien & Case-Smith, 2015)
        
        Rehearsal
        
        Social stories
        
        Power cards
  - - - This intervention approach is appropriate because it is a skill that the client has not yet developed. Since anxiety and selective mutism are linked, stress management and anxiety coping are useful skills to develop.
        
        Systematic desensitization: "a process in which an individual learns to cope with and overcome fear in small steps, which then allows him or her to take greater steps towards self-reliance. This technique helps to mitigate or extinguish the stress and fear responses to those specific situations that are more anxiety provoking" (Hung et. el., 2012, p. 223)
        
        Intervention address anxiety regarding social participation and communication
        
        Simulus fading
        
        process of reducing the control of a stimulus on a
        certain behavior (Busse & Downey, 2011)
        
        Controlled environment with comfortable stimulus (mom) in which she is able to talk to, gradually adding peers/teacher to the situation, and gradually distancing the mom to fade out.
        
        Intervention for social skills and social participation
        
        Relaxation therapy (Busse & Downey, 2011)
        
        Keeping a diary of situations that are stressful or in which she feels most anxious
        
        Intervention for executive functioning
        
        Progressive muscle relaxation
    - - This intervention approach is appropriate because utilizing positive reinforcement promotes positive behaviors
      - Intervention for school participation, social skills, and process skills
    - - Provide education regarding selective mutism, home/school interventions, and how to best facilitate Mary's progress.
        
        Intervention to address social participation, communication, and stress management via educating those who will be helping Mary along the way
  - - - Communication boards for school
        
        Low-tech
        
        High-tech
        
        Self modeling (Busse & Downey, 2011)
        
        Can use video or audio devices to record her speaking and then using recording in situations or environments in which she does not speak
- - - - PEOP fits with this client because there will need to be a harmony between the personal factors, the environmental conditions, and the occupations themselves in order to promote occupational performance (Cole & Tufano, 2008).
        
        Person
        
        Client's possible anxiety and social skills will be taken into account.
        
        Occupation
        
        The affected occupations, such as school/social participation will be addressed whether that is through modifications or adaptations.
        
        Environment
        
        Environmental changes, mainly the social and school environments, will be addressed via this model.
  - - - CBT frame of reference focuses on how psychological barriers impede participation/success in occupations.
        
        Anxiety, a common source of selective mutism, would be considered a psychological barrier for the client's participation in school and social settings.
        
        Functionality is defined by a client's ability to use cognitive reasoning in self-perception, stress management, thoughts, & feelings (Cole & Tufano, 2008).
        
        For SM, CBT strategies include: contingency management, shaping, social skills training, stimulus fading, systematic desensitization, relaxation training, and selfmodeling.
        
        (Busse & Downey, 2011)
    - - 5 SEL comptetencies
        
        Self management
        
        Social awareness
        
        Relationship skills
        
        Self-awareness
        
        Responsible decision making
      - Evidence within school setting promotes improved behavior, academic performance, and social skills
      - (AOTA, 2013)
      - Collaboration with teachers and family
      - Teaching specific behaviors, pro social skills, and advocacy strategies
      - Develop groups that emphasize social and emotional skills
      - Can be used with CBT strategies