The client is an 8-year-old girl with selective mutism. Selective mutism started around the age of 3. The client does not have cognitive limitations, can follow directions, and is physically able. Selective mutism is a childhood anxiety disorder that impedes a child's ability to communicate in situations that the child does not feel safe and comfortable (Shipon-Blum et al., 2020). The prevalence of selective mutism is less than 1% of children in the United States (National Organization for Rare Disorders, Anagnostou, 2016). The prognosis of selective mutism is best when treated early, and, if left untreated, the client's ability to interact can decline. With proper treatment, clients can overcome selective mutism (Shipon-Blum et al., 2020).
Problem: The client's anxiety leads to avoiding social interactions with those who are not her mother.
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Approach: Establish
Intervention: When at a restaurant, client will give cashier the money and take the receipt (Spillman-Kennedy and Gordon, 2012). This type of intervention is an occupation (AOTA, 2014).
Outcomes: One expected outcome is improvement of occupational performance as the client's confidence will increase with more practice. Another expected outcome is increased role competence and well-being as the client should increase her independence, self-esteem, and confidence in social interactions.
LTG: Within 4 weeks, the client will independently give cashier money and take the receipt at a restaurant, as reported by the caregiver, to increase opportunities for social interaction with unfamiliar individuals.
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Problem: The client's inability to participate in classroom lectures, activities, and inquire when unsure, fails to meet the client's educational needs.
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Problem: The client's social anxiety inhibits her ability to communicate distress or discomfort when students are bullying her.
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Approach: Establish
Intervention: Repetitive practice on writing a note to the teacher when peers are making her uncomfortable or when her peers are bullying her (Spillman-Kennedy and Gordon, 2012). This type of intervention is self-advocacy as it increases participation in communicating the support she needs (AOTA, 2014).
Outcomes: One expected outcome is an improvement in occuaptional performance as the teacher will be alerted if the client needs help and the client is able to express her wants and needs. Another expected outcomes is improvement well-being as the client will improve their self esteem and personal causation.
LTG: Within 4 weeks, client will independently write and deliver a note to the teacher concerning harassment or bullying as reported by the teacher.
Problem: Differential treatment from peers and teachers creates an environment that highlights the client's limitations and hinders social inclusion.
Assessment: The Occupational Therapy Psychosocial Assessment of Learning (OT PAL) would be a beneficial assessment for this client. This assessment evaluates a clients volition, habituation, environment and performance capacities. Additional information about environmental contexts that benefit or limit social inclusion could help the therapist and teacher make the necessary changes to improve social participation. Additionally, improving the environment and incorporating interest of the child, could decrease the stigmatization the client is experiencing.
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