what is social communication anxiety treatment

7/28/2019 What is Social Communication Anxiety Treatment

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other developmental/speech problems.These children are literally stuck in the nonverbal stage of

communication.

Selective Mutism is therefore a symptom. Children are rarely 'just mute.' Emphasis needs to be on

CAUSES of the mutism and propagating factors of mutism.

Studies have shown NO evidence that the cause of Selective Mutism is related to abuse, neglect or

trauma.

What is the difference between Selective Mutism and traumatic mutism?

Children who suffer from Selective Mutism speak in at least one setting and are rarely mute in all

settings. Most have inhibited temperaments and manifest social anxiety.For children with Selective

Mutism, their mutism is a means of avoiding the anxious feelings elicited by expectations and social

encounters.

Children with traumatic mutism usually develop mutism suddenly in ALL situations.An example would

be a child who witnesses the death of a grandparent or other traumatic event, is unable to process the

event and becomes mute in all settings.

It is important to understand that some children with Selective Mutism may start out with mutism in

school and other social settings. Due to negative reinforcement of their mutism, misunderstandings

from those around them and perhaps heightened stress within their environment, they may develop

mutism in all settings. These children have progressive mutism and are mute in/out of the home withall people, including parents and siblings.

What behavior characteristics does a child with Selective Mutism portray in social settings?

It is important to realize that the majority of children with Selective Mutism are as normal and are as

socially appropriate as any other child when in a comfortable environment.Parents will often comment

how boisterous, social, funny, inquisitive, extremely verbal, and even bossy and stubborn these

children are at home!What differentiates most children with Selective Mutism is their severe

behavioral inhibition and inability to speak and communicate comfortably in most social settings.

Some children with Selective Mutism feel as though they are on stage every minute of the day!This

can be quite heart wrenching for both the child and parents involved.Often, these children show signs

of anxiety before and during most social events.Physical symptoms and negative behaviors are

common before school or social outings.


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It is important for parents and teachers to understand that the physical and behavioral symptoms are

due to anxiety and treatment needs to focus on helping the child learn the coping skills to combat

anxious feelings.

It is common for many children with Selective Mutism to have a blank facial expression and neverseem to smile.Many have stiff or awkward body language when in a social setting and seem very

uncomfortable or unhappy.Some will turn their heads, chew or twirl their hair, avoid eye contact, or

withdraw into a corner or away from the group seemingly more interested in playing alone.

Others are less avoidant and do not seem as uncomfortable. They may play with one or a few children

and be very participatory in groups.These children will still be mute or barely communicate with most

classmates and teachers.

As social relationships are built and a child develops one or a few friendships, he/she may interact and

perhaps whisper or speak to a few children in school or other settings but seem to be disinterested or

ignore other classroom peers. Over time, these children learn to cope and participate in certain social

settings. They usually perform nonverbally or by talking quietly to a select few.Social relationships

become very difficult as children with Selective Mutism grow older. As peers begin dating and

socializing more, children with Selective Mutism may remain more aloof, isolated and alone.

Children with Selective Mutism often have tremendous difficulty initiating and may hesitate to

respond even nonverbally.This can be quite frustrating to the child as time goes by.The childs

nonverbal communication may go on for many years, becoming more ingrained and reinforced unless

the child is properly diagnosed and treated.Ingrained behavior often manifests itself by a child

looking and acting normally but communicating nonverbally.This particular child cannot just start

speaking.Treatment needs to center on methods to help the child unlearn the present mute behavior.

What are the most common characteristics of children with Selective Mutism?

Most, if not all, of the characteristics of children with Selective Mutism can be attributed to anxiety.

Temperamental Inhibition -Timid, cautious in new and unfamiliar situations, restrained, usually evident

from infancy on. Separation anxiety as a young child.

Social Anxiety Symptoms - Over 90% of children with Selective Mutism have social anxiety.Uncomfortable being introduced to people, teased or criticized, being the center of attention, bringing

attention to himself/herself, perfectionist (afraid to make a mistake), shy bladder syndrome (Paruresis),

eating issues (embarrassed to eat in front of others,)

Social Being -Most children with Selective Mutism want friends, and need friends. *Differentiates

Selective Mutism from other disorders such as the autistic spectrum disorders. Most children with Selective

Mutism have appropriate social skills, but some do not and need help in developing proper social skills.


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Physical Symptoms - MUTISM, tummy ache, nausea, vomiting, joint pains, headaches, chest pain,

shortness of breath, diarrhea, nervous feelings, scared feelings

Appearance - Many children with Selective Mutism have afrozen-looking, blank expressionless face,

stiff, awkward body language with lack of eye contact when feeling anxious. This is especially true for

younger children in the beginning of the school year or when suddenly approached by an unfamiliar

person. * They often appear like animal in the wild where they stand motionless with fear! The older thechild, the less likely they are to exhibit stiff, frozen body language..Also, the more comfortable a child is in

a setting, the less likely a child will look anxious. For example, the young child who is comfortable and

adjusted in school, yet is mute, may seem relaxed, but mutism is still present. *A hypothesis:heightened

sympathetic response causes muscle tension and vocal cord paralysis.

Emotional - When the child is young, he/she may not seem upset about mutism since peers are more

accepting. As children age, inner turmoil often develops and they may develop the negative

ramifications of untreated anxiety. (see below)

Developmental Delays - A proportion of children with Selective Mutism have developmental delays.

Some have multiple delays and have the diagnosis of an autistic spectrum disorder, such as Pervasive

Developmental Disorder, Aspergers, or Autism. Delays include motor, communication and/or social

development. Sensory Integration Dysfunction (DSI) symptoms/Processing Difficulties/Delays: For many

children with SM, sensory processing difficulties are the underlying reason for 'shut down' and mutism.In

larger, more crowded environments where multiple stimuli is present (such as the classroom setting),

where the child feels an expectation, sensory modulation specifically, sensory defensiveness exists.

Anxiety is created causing a 'freeze' mode to take place. The ultimate 'freeze mode' is MUTISM.

Common symptoms: Picky eater, bowel and bladder issues, sensitive to crowds, lights (hands over eyes,

avoids bright lights)sounds (dislikes loud sounds, hands over ears, comments that it seems loud), touch

(being bumped by others, hair brushing, tags, socks, etc), heightened senses.I.e., perceptive, sensitive,

Self-regulation difficulties, (act outing, defiant, disobedient, easily frustrated, stubborn, inflexible, etc)

Within the classroom, a child with sensory difficulties may demonstrate one or more of the followingsymptoms; withdrawal, playing alone or not playing at all, hesitation in responding (even nonverbally),

distractibility, difficulty following a series of directions or staying on task, difficulty completing

tasks.Experience at the Smart Center dictates that sensory processing difficulties may or may not

cause 'learning' or academic difficulties. Many children, especially, highly intelligent children can

compensate academically and actually do quite well. MANY focus on their academic skills, often

leaving behind 'the social interaction' within school. This tends to be more obvious as the child ages.

What is crucial to understand is that many of these symptoms may NOT exist in a comfortable and

predictable setting, such as at home.

In some children, there are processing problems, such as auditory processing disorder, that cause

learning issues as well as heightened stress.

Behavioral Children with Selective Mutism are often inflexible and stubborn, moody, , bossy,

assertive and domineering at home. They may also exhibit dramatic mood swings, crying spells,

withdrawal, avoidance, denial, and procrastination. These children have a need for inner control, order and


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structure, and may resist change or have difficulty with transitions.Some children may act, silly or act out

negatively in school, parties, in front of family and friends. WHY?These children have developed

maladaptive coping mechanisms to combat their anxiety.

Co-Morbid Anxieties - Separation anxiety, Obsessive Compulsive Disorder (OCD), hoarding,

Trichotillomania (hair pulling, skin picking), Generalized Anxiety Disorder Specific phobias, Panic Disorder.

Communication DifficultiesSome children may have difficulty responding nonverbally to others.i.e., cannot point/nod in response to a teachers question, or indicate thank you by mouthing words. For

many, waving hello/goodbye is extremely difficult. However, this is situational. This same child can not

only respond nonverbally when comfortable, but can chatter nonstop! Some children may have

Difficulty initiating nonverbally- when anxious.i.e. has difficulty or is unable to initiate play with

peers or going up to teacher to indicate need or want.

Social Engagement difficulties - When one truly examines the characteristics of a child with Selective

Mutism, it is obvious that many are unable to socially engage properly.When confronted by a stranger or

less familiar individual, a child may withdrawal, avoid eye contact and 'shut down' not only leaving a child

speechless but preventing him/her from engaging with another individual. Greeting others, initiating

needs/wants etc are often impossible for many children. Many shadow their parent in social environments

often avoiding any social interaction at all. The common example given is; 'A child in grocery story cansing, laugh and talk loudly, but as soon as someone confronts him/her, the child freezes, avoids and

withdrawals from social interaction.' As the child ages, freezing and shut down rarely exist, but the child

remains either noncommunicative or will respond nonverbally after an indeterminate amount of warm up

time.

MUTISM is just one of the many characteristics that children with Selective Mutism portray.

When are most children diagnosed as having Selective Mutism?

Most children are diagnosed between 3 and 8 years old.In retrospect, it is often noted that these

children were temperamentally inhibited and severely anxious in social settings as infants and

toddlers, but adults thought they were just very shy.Most children have a history of separation

anxiety and being slow to warm up. Often it is not until children enter school and there is an

expectation to perform, interact and speak, that Selective Mutism becomes more obvious.What often

happens is teachers tell parents the child is not talking or interacting with the other children.In other

situations, parents will notice, early on, that their child is not speaking to most individuals outside the

home.

If mutism persists for more than a month, a parent should bring this to the attention of their childs

physician.

Why do so few teachers, therapists and physicians understand Selective Mutism?

Studies of Selective Mutism are scarce. Most research results are based on subjective findings based

on a limited number of children.In addition, textbook descriptions are often nonexistent or information

is limited, and in many situations, the information is inaccurate and misleading. As a result, few people


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truly understand Selective Mutism.Professionals and teachers will often tell a parent, the child is just

shy, or they will outgrow their silence.Others interpret the mutism as a means of being oppositional

and defiant, manipulative or controlling.Some professionals erroneously view Selective Mutism as a

variant of autism or an indication of severe learning disabilities. For most children who are truly

affected by Selective Mutism, this is completely wrong and inappropriate!

Research at the SMart Center indicates that children who seem oppositiona in nature often have

parents, teachers, and/ortreating professionals who have pressured them to speak for months,

perhaps years.Mutism not only persists in these children, but is negatively reinforced.These children

may develop oppositional behaviors out of a combination of frustration, their own inability to make

sense of their mutism, and OTHERS pressuring them to speak.

As a result of the scarcity and, often, inaccuracy of information in the published literature, children

with Selective Mutism may be misdiagnosed and mismanaged.In many circumstances, parents will

wait and hope their child outgrows their mutism (and may even by advised to do so by well-meaning,

but uninformed professionals). However, without proper recognition and treatment, most of these

children do NOT outgrow Selective Mutism and end up going through years without speaking,

interacting normally, or developing appropriate social skills. In fact, many individuals who suffer from

Selective Mutism and social anxiety who do not get proper treatment to develop necessary coping

skills may develop the negative ramifications of untreated anxiety.(See below)

Why is it so important to have my child diagnosed when he/she is so young?

Our findings indicate that the earlier a child is treated for Selective Mutism, the quicker the response

to treatment, and the better the overall prognosis.If a child remains mute for many years, his/her

behavior can become a conditioned response where the child literally gets used to non-verbalizing.In

other words, Selective Mutism can become a difficult habit to break!

Because Selective Mutism is an anxiety disorder, if left untreated, it can have negative

consequences throughout the childs life and, unfortunately, pave the way for an array of

academic, social and emotional repercussions such as:

Worsening anxiety

Depression and manifestations of other anxiety disorders

Social isolation and withdrawal

Poor self-esteem and self-confidence

School refusal, poor academic performance, and the possibility of quitting school

Underachievement academically and in the work place

Self-medication with drugs and/or alcohol

Suicidal thoughts and possible suicide


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Our main objective is to diagnose children early so they can receive proper treatment at an early age,

develop proper coping skills, and overcome their anxiety.

According to the US Surgeon General, our country is in a state of emergency as far as childrens

mental health is concerned. 10% of children suffer from mental disorders, but less than 5% of thesechildren are actually receiving treatment.

Anxiety disorders are the most common mental illnesses among children and adolescents.

If parents suspect their child has Selective Mutism, what should they do?

Parents should initially remove all pressure and expectations for the child to speak, conveying to their

child that they understand he/she is scared and it is hard to get the words out and that they will

help their child through this difficult time. Praise the childs efforts and accomplishments, support and

acknowledge the difficulties and frustrations.

Parents should speak with their family physician or pediatrician and/or seek out a psychiatrist or a

therapist who has experience with Selective Mutism.However, please note that having experience

with Selective Mutism does not guarantee that the treatment approach and understanding is correct.In

fact, a clinician with less experience, yet who has an excellent understanding of Selective Mutism may

be an ideal choice for your child!

What are the key questions to ask a potential therapist or physician?

Do your homework! You will have a much better idea what to look for if you understand Selective

Mutism. Educate yourself as much as possible before seeing any professional.Parents should read as

much information as they can about Selective Mutism.The SMG~CANs website at

www.selectivemutism.orghas countless pages of information and it is updated on a regular basis.

Key questions to ask include:

What are your areas of expertise?

Have you ever treated a child with Selective Mutism? If so, how many and what are your success rates?

What are your views on Selective Mutism? In other words, what are some of the reasons a child manifests

mutism?

What is your treatment approach to Selective Mutism?

What will be my role as a parent? What is the teachers role? Etc.

What is your opinion on medication in treating Selective Mutism and when do you consider medication?

Can you supply me with references of families you have worked with? KEY!!
http://www.selectivemutism.org/http://www.selectivemutism.org/http://www.selectivemutism.org/


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A key question to ask a therapist is 'HOW will you work with my child to help him/her

progress communicatively?'

Children do not progress communicatively without learning coping skills. Simply lowering anxiety is

NOT enough to enable the child to begin engaging socially, learning to progress to verbalcommunication and feeling comfortable in an environment. SKILLS must be taught.

Caution: When speaking to potential treating professionals, please be cautious of those who see

Selective Mutism as a controlling/manipulative behavior. Treatment approaches based on discipline

and forcing a child to speak are inappropriate and will only heighten anxiety and negatively reinforce

mute behavior.

How is a child evaluated for Selective Mutism?

A trained professional familiar with Selective Mutism will have a parental interview. Emphasis will be

on social interaction and developmental history, other manifestations of anxiety, behavioral

characteristics (shy temperament), home life description (family stress, divorce, death, etc.) and

medical history. From the results of the initial interview, the professional will often see the child.

Children with Selective Mutism may or may not speak to the diagnosing professional. Whether a child

DOES or DOES NOT speak to the evaluating physician does not really matter.An astute professional

should be able to assess interpersonal communication skills and build rapport quite easily and, if given

at least one session and possibly viewing videotapes from home, can rule in or out Selective Mutism as

a diagnosis.

Because 20-30% of children with Selective Mutism have an abnormality with speech and language, a

thorough speech and language evaluation is often ordered.If motor/sensory issues exist an

occupational therapy evaluation is also recommended.A complete physical exam (including hearing),

standardized testing, psycho-educational testing as well as a thorough developmental screening are

often recommended if the diagnosis is not clear.

What are the diagnostic criteria for Selective Mutism?

DSM-IV-TR (2000) Defines Selective Mutism as follows:

1. Consistent failure to speak in specific social situations (in which there is an expectation for

speaking, e.g., at school) despite speaking in other situations.

2. The disturbance interferes with educational or occupational achievement or with social

communication.

3. The duration of the disturbance is at least 1 month (not limited to the first month of school).

4. The failure to speak is not due to a lack of knowledge of, or comfort with, the spoken language

required in the social situation.


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5. The disturbance is not better accounted for by a Communication Disorder (e.g., stuttering) and

does not occur exclusively during the course of a Pervasive Developmental Disorder,

Schizophrenia, or other Psychotic Disorder.

Associated features of Selective Mutism may include excessive shyness, fear of social embarrassment,

social isolation and withdrawal, clinging, compulsive traits, negativism, temper tantrums, or controlling

or oppositional behavior, particularly at home. There may be severe impairment in social and school

functioning. Teasing or goading by peers is common. Although children with this disorder generally

have normal language skills, there may occasionally be an associated Communication Disorder (e.g.,

Phonological Disorder, Expressive Language Disorder, or Mixed Receptive- Expressive Language

Disorder) or a general medical condition that causes abnormalities of articulation. Mental Retardation,

hospitalization or extreme psychosocial stressors may be associated with the disorder. In addition, in

clinical settings children with Selective Mutism are almost always given an additional diagnosis of

Anxiety Disorder, especially Social Phobia is common. (DSM-IV-TR) (APA, 2000)

Authors note: The above criteria are quite vague/nonspecific and should not be used alone

to rule in or rule out the diagnosis of Selective Mutism. As mentioned earlier, children with

Selective Mutism manifest many behavioral characteristics other than mutism. In addition,

since children with Selective Mutism often have difficulty responding and/or initiating

nonverbally, Selective Mutism can be viewed as a communication disorder. In addition,

children with autism, PDD-NOS, Aspergers and other developmental disorders can manifest

mutism that is selective in location.

How is Selective Mutism treated?

The main goals of treatment should be to lower anxiety,increase self-esteem and increase social

confidence and communication. Emphasis should never be on getting a child to talk. ALL

expectations for verbalization should be removed. With lowered anxiety, confidence, and the use of

appropriate tactics/techniques, communication will increase as the child progresses from nonverbal to

verbal communication.

Treatment approaches should be individualized, but the majority of children are treated using a

combination of:

1. Behavioral Therapy: Positive Reinforcement and Desensitization techniques are the

primary behavior treatments for Selective Mutism, as well as removing all pressure to

speak.Emphasis should be on understanding the child and acknowledging their

anxiety.Introducing the child to social environments in subtle and non-threatening ways is an

excellent way to help the child feel more comfortable, i.e., Parents can take the child into

school when few people are around to get the child to practice speaking.Eventually, bring a

friend or two to school and allow the children to play when other children are not present.Small


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groups with only a small number of children help, as well as allowing parents to spend time

with the child within the class.After the child is speaking quite normally, the teacher, and then

the students are gradually introduced into the group setting.Positive reinforcement for

verbalization should be introduced when, and only when, anxiety is lowered and the child feels

comfortable and is obviously ready for some subtle encouragement.

2. Play Therapy, Psychotherapy, and other psychological approaches:Thesecan beeffective if all pressure for verbalization is removed and emphasis is on helping the child relax

and open up.Confronting mutism in a non-threatening way is important.These children are

SCARED, and the focus should be to help them identify their level of being scared' in a

particular situation.Helping them to realize that you understand and are there to help them

relieves tremendous pressure.

3. Cognitive Behavioral Therapy: CBT trained therapists help children modify their behavior

by helping them redirect their fears and worries into positive thoughts.CBT needs to

incorporate awareness and acknowledgement of anxiety and mutism.Most children with

Selective Mutism worry about others hearing their voice, asking them questions about why

they do not talk and trying to force them to speak.The focus should be on emphasizing the

childs positive attributes, building confidence in social settings, and lowering overall anxiety

and worries.

4. Medication: Studies indicate that the most effective approach to treatment is a combination

of behavioral techniques and medication.Often behavioral techniques are used for an

indeterminate amount of time prior to the addition of medication.If children are not making

enough progress with behavioral therapy alone, medication may be recommended to reduce

the anxiety level.Serotonin reuptake inhibitors (SSRIs) such as Prozac, Paxil, Celexa, Luvox,

and Zoloft are very effective in the treatment of anxiety disorders.Similar to the SSRIs, there

are other drugs that affect one or more neurotransmitters such as serotonin, norepinephrine,

GABA, and dopamine, etc. which are also proving to be affective. Examples are Effexor XR and

Buspar.Both classes of drugs work well in children who have a true biochemical imbalance.

This seems to be the case in the majority of children with Selective Mutism.Very often, we

have seen positive effects in as little as a week! Medication is used as a jump start with the

hope that, as we lower anxiety via medication, we can implement behavioral techniques more

easily and successfully! Goals for the duration of treatment with medication are usually 9-12

months.

5. Self-esteem boosters: Parents should emphasize their childs positive attributes.For

example, if your child is artistic, then by all means show off the artwork!Have a special wall to

display your childs masterpieces; perhaps you can even have a special exhibition!Have them

explain their artwork to family members and close friends. This promotes more verbalization

practice, as well as helps with confidence!

6. Frequent socialization: Encourage as much socialization as possible without pushing your

child. Arrange frequent play dates with classmates or even small group interactions with

individuals the child knows well.The goals is for your child to feel comfortable enough with the

classmates so that verbalization will occur.Most children with Selective Mutism will talk to

friends in their own home.As the child gets increasingly comfortable speaking to one child,

invite another child over, and then have two or three children at a time!Transfer speaking into

the school via set tactics/techniques.For some children, Social Skill therapy is necessary and

often helpful in accomplishing increased communication.

7. School involvement: Parents need to educate teachers and school personnel about Selective

Mutism!You must be an advocate for your child.The school needs to understand that children


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What is Social Communication Anxiety Treatment (SCAT)?

Social Communication Anxiety Therapy (SCAT) is the philosophy of treatment developed by Dr. Elisa

Shipon-Blumand implemented at the Selective Mutism Anxiety Research and Treatment Center

(SMart Center) www.selectivemutismcenter.org.

SCAT is based on the concept that Selective Mutism is a social communication anxiety disorder that is

more than just not speaking. Dr. Shipon-Blum has created the SM-Stages of Social Communication

Comfort Scale (C) that describes the various stages of social communication that are possible for a

child suffering from Selective Mutism. The Social Communication BRIDGE (C) illustrates this concept

in a visual form.

Children suffering from Selective Mutism (SM) CHANGE their level of social communication based on

the setting and expectations from others WITHIN a setting.

Therefore, a child may have difficulty socially engaging, communicating nonverbally and perhaps

cannot communicate at all when feeling anxious or uncomfortable.

For some children, MUTISM is the most noted symptoms. Meaning, they ARE able to engage and have

astute nonverbal skills (professional mimes!).

These children are STUCK in the nonverbal stage of communication and suffer from a subtype of SM

called: SPEECH PHOBIA.

Therefore, although mutism is the most noted symptom, it merely touches on the surface of ourchildren! A complete understanding of the child is necessary to develop an appropriate treatment plan

and school based accommodations/interventions.

According to Dr. Shipon-Blum's work, after a complete evaluation (consisting of various assessment

forms-parent/teacher; parent and child interview), treatment needs to address three key questions.

--WHY did a child develop SM? (influencing, precipitating and maintaining factors)

--WHY does Selective Mutism persist despite being in active treatment and parent/teacher awareness?

And finally,

--WHAT can be done at home, the real world and within school to help the child build the coping skills

and overcome their social communication challenges?

To HELP a child suffering in silence an understanding of which stage the child is IN during particular

social encounters.

TheSocial Communication Anxiety Inventory can be used to determine the stage of social

communication.
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Treatment is THEN developed via the WHOLE child approach where, under the direction of the outside

treatment professional, the child, parents and school personnel work together.

Dr. Shipon-Blum emphasizes that although anxiety lowering is key it is often NOT enough, especially

as children age. Over time, many children with Selective Mutism no longer feel 'anxious' but mutismand often lack of proper social engagement continues to exist in select settings.

Children with SM need strategies/interventions to progress from nonverbal to spoken communication.

This is the TRANSITIONAL stage of communication and interestingly enough, It is this aspect that is

often missing from most treatment plans. In other words, HOW do you help a child progress from

NONVERBAL to verbal communication?

Quite frankly, time in the therapy office is simply NOT enough. The office setting is used to help

prepare the child for the OUTside world. To develop the strategies to help the child unlearn their

conditioned behavior. THEN, in the REAL WORLD and within the SCHOOL setting, the

strategies/interventions are implemented.

Strategies and interventions are developed based on WHERE the child is on the SOCIAL

COMMUNICATION BRIDGE and are meant to be a desensitizing method as well as a vehicle to

UNLEARN conditioned behavior.

SCAT incorporates anxiety lowering techniques, methods to build self-esteem and

strategies/interventions to help with social comfort and communication progression, such as 'Bridging'

from shut down to nonverbal communication and then TRANSITIONING into spoken communication viaverbal intermediaries, ritual sound shaping and possibly the use of augmentative devices etc.

The KEY concept that children with SM need to understand, feel in control and have choice in their

treatment (age dependent) are a critical component of SCAT.

SCAT provides CHOICE to the child and helps to transfer the child's NEED for control INTO the

strategies and interventions!

Therefore GAMES and GOALS (based on age) via the use of ritualistic and controlled methods (I.e., use

of strategy charts: Example 1, Example 2) are used to help develop social comfort and progress into

speech.

Silent goals (environmental changes) and active goals (child directed goals based on CHOICE and

CONTROL) are used within the SCAT program.
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Every child is different and therefore an individualized treatment plan needs to be developed that

incorporates HOME (parent education, environmental changes), Addressing the child's unique needs

and SCHOOL (teacher education, accommodations/interventions).

Therefore, by lowering anxiety, increasing self-esteem as well as increasing communication and socialconfidence within a variety of REAL WORLD settings, the child suffering in silence will develop

necessary coping skills to enable for proper social, emotional and academic functioning.

Frequently Asked Questions

Topics:

At the SMart Center

Initial Consultations

School Services -- In-office and on-site evaluations, development of accommodations, & interventions(IEP/504 Plan)

Treatment Follow-Ups and Convenience Consultations

Medication Questions

Learning more about Selective Mutism!

At the SMart Center

The treatment used at the SMart Center is: Social Communication Anxiety Therapy (SCAT) that has

been used successfully on 1500+ children/teens. SCAT evolved over time while working with

children/teens with SM. Dr. E's belief that SM is "more than just not speaking" has fueled the

development of SCAT. We encourage you to read aboutour philosophy of treatment.

What is the success rate of SCAT?

Based on patient data, for ALL children who go through the complete course of recommended

treatment that includes:

1. Consistent recommended follow-ups.

2. Parent education

3. Education of school personnel about SM and individual child's needs4. Development of school accommodations and interventions (Note: Academic achievement is

dependent upon the correct placement and appropriate accommodations)

5. Child involvement and willingness to receive help.
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Over 95% of patients have overcome their silence, are verbal communicators and are now significantly

more comfortable socially. Most no longer require school accommodations to aid in communication!

What is Social Communication Anxiety Therapy (SCAT)?I have taken my child to many other professionals and not one has used SCAT with my child. Why is

this?

Quite simply, Dr. E has developed SCAT from the multitude of data and clinical information gathered

from working with so many children with SM. Since clinical experience precedes research, it is common

for clinical efficacy to exist prior to documented research. Fortunately, research is presently being

done via the SMRI that is confirming SCAT's effectiveness!

Understand that SCAT is not ONE type of therapy technique but involves various types of treatment

strategies and interventions that are proven within the scientific literature. For example: Systemic

desensitization, modeling, fading, positive reinforcement, etc. etc. that enable the child to

development social engagement skills and to progress communicatively in a stepwise manner in the

'real world' and within the school setting. Treatment is individualized and based on the child's

particular needs.

SM Conferences, workshops, professional trainings are done throughout the year to help educate

parents, treating professionals and educators about SCAT. Dr. E also trains treating professionals

regularly via teleconference and in-person direct trainings. Fortunately, SCAT Is becoming more

popular and more professionals are realizing the effectiveness!

As more research is published, many more professionals will begin to understand and adapt SCAT as a

form of treatment!

I am interested in references from families who have gone through treatment at the SMart

Center. Is this possible?

Absolutely! Please contact us directly at: [email protected] and place 'references'

on the subject line.

Another option is to post on the forum of the SMG~CAN or any of the Yahoo e-groups. Since Dr. E is

well known in the field and has treated so many children & teens you are certain to encounter otherswho have gone through or are going thru treatment at the SMart Center!

Your office is located in the NE suburbs of Philadelphia, PA. Do you treat children from

other locations?

Absolutely! The average distance to our office is over 2 1/2 hours...with many traveling via train or
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plane to reach our location. We are proud to state that we have treated children and their families

from almost every continent in the world!

In addition, we perform many long distance teleconferences or video conferencing for families unable

to present for an in-person consultation and school personnel from out of state.

We do not live close to the SMart Center. can my child still be seen for an evaluation and

treatment?

Absolutely! Over 3/4 of the families travel long distance to the SMart Center!

We can do evaluations either in-person or via teleconference. Please see our initial consultation

information.

If we live out of state or quite far from the SMart Center, how are follow-up appointments

arranged. We can't possibly be traveling to the office every week!

Since most families are seen every two weeks to every month, you could schedule follow-ups in a

variety of different ways. Some families present for the initial appointment (for long distance families,

we recommend a two-day initial appointment that consists of 2 hours the first day and 1-2 hours the

second day). Follow up can begin with a teleconference approximately 3-4 weeks later. We often

recommend a 30-60 minute teleconference with school personnel as well. Depending on the treatment

approach recommended you can present monthly or every 3 months..or possibily consult via

teleconference ongoing (When this is done, we recommend that you have a local clinician who you and

your child can work with to follow up and implement strategies)

What is the average range of the children that receive treatment at the SMart Center?

The age range for children/teens in our practice is 3 years old to 19 years of age. In rare and unusual

situations, we have worked with young adults.

How long do most children receive treatment at the SMart Center?

This question is impossible to answer. However, based on patients who have been seen at the SMart

Center over the past many years, the average time frame for treatment is approximately 6-12 visits or

every two- four weeks for 7-12 months. For less impaired children treatment has been as short as 4-6

visits. For more impaired children, especially older children, some have needed every two to four week

treatment for up to or more than a year.

Approximately 1 in 10 children require more than a year of treatment.

Therefore, most children are discharged from the SMart Center after an average of 10-12 sessions.
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Also note that the more consistent parents are in follow-up appointments, the more involved the

school is in our efforts and the more a child is willing to partake in treatment, the easier and faster the

child progresses communicatively and feels more comfortable socially.

We have had mildly impaired children who have had sporadic and poor follow-ups and therefore needsignificantly more treatment then a more severely impaired child who attended treatment regularly

and did their goals/games in between treatment sessions consistently.

Keep in mind that every child is different and many children who are seen at the SMart Center have

already seen multiple professionals in the past. Also note that if a patient begins at an every two week

appointment interval, this does not mean that your child will be seen that often throughout the course

of treatment. Patients usually 'graduate' to monthly approximately half-way through treatment.

Please describe the typical treatment course for a child who receives treatment at the

SMart Center:

(View Typical Treatment Course)

Results from your initial consultation will help our professionals develop a unique treatment plan for

your child that is based on SCAT.

Families leave the SMart Center at their first visit with beginning treatment recommendations. Based

on whether your initial appointment was a Comprehensive or Per Service consult will dictate what you

will be provided.

Most families consult again approximately 4 weeks after their initial appointment. This gives families

time to implement treatment recommendations and for school personnel to begin with

recommendations.

You will receive a confirmation email for your scheduled follow-up appointment prior to your next appt

that will include access to the SM Follow-up Questionnaire (c) and the SM -School Evaluation Form(c).

These should be filled out prior to each follow up visit to enable Dr. E to be updated so that time during

your consultation is spent on treatment not "catch-up." In addition, results of the questionnaires help

Dr. E develop a treatment focus for your upcoming session.

Note: The SM - School Evaluation Form should be filled out at least every other visit or per your

clinicians' request.

During your in-person visit at the SMart Center, your child's session will usually begin with the

parent(s) present. Parents will have the opportunity to meet with the clinician at each visit to discuss

questions/concerns.


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During each follow-up visit, your doctor or therapist will work with your child (and YOU) to develop

games/goals that will be worked on during the time between treatment sessions. Parents will be

provided with anAPPOINTMENT SUMMARY, accompanying handouts and other printed material when

necessary. Since the school is so key in the treatment, you will often get information for school

personnel to update school based interventions.

Your child is given rewards (small toys, stickers, candy, etc) after each visit to reward him/her for their

hard work during their session.

You are encouraged and your child is encouraged to write us emails as often as you like but at a

minimum of once weekly in the beginning of treatment.

Your child's teacher, school psychologist, etc are encouraged to update your doctor or therapist by

email as often as they like.

Back to Top

Initial Consultations

For immediate information on fees/services-->GOOR contact us via email or phone: 215-887-5748 for information on fees for the

services listed below!)

I am not sure which consultation format to choose. Any advice?

There are Four types of initial appointments for child/teen evaluations.

1. Comprehensive: In-Person only

2. Per Service: In-Person, Teleconference

3. School Evaluations

4. Ask the Doc: NON patient consultation.

ALL initial consultations include evaluation of various parent/teacher assessment forms, review of past

(relevant) records, parent Interview, child evaluation (In person/Video) and, in some cases, IEP/504

review and/or discussion with outside treatment professionals and/or school personnel.
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1) Comprehensive Evaluation: This format is for children who require a full evaluation and

comprehensive report.

Ideal for children who have never been diagnosed, for children who have been diagnosed but past

treatment has failed or minimal progress has been made and parent would like another fullevaluation/report. This is also IDEAL for families who are NOT able to present to the SMart Center for

ongoing Follow-UP appointments.

The comprehensive report is an excellent way to provide detailed information to other treating

professionals and/or school personnel working with your child.

Comprehensive Evaluation appointments include time spent evaluating multiple parent/teacher

assessment forms, a 2-hour office visit and the development of a comprehensive report.

The Comprehensive Report consists of: Summary of relevant history, summary of child evaluation

results, explanation of child's stages of social communication from setting to setting, Assessment

results (explanation of results of SM CDQ, and symptom inventory, multiple 'anxiety' forms

(parent/teacher), summary of etiology (causes), precipitating and propagating factors, Diagnosis (if

applies) and specific recommendations for home/school, approach to treatment, Multiple handouts

with beginning goal/game charts and treatment follow-up recommendations. The average length

report (not including multiple handouts/game/goal charts) is 10-16 pages in length.

2)Per Service Consultation: This format is ideal for:

A. Families who are searching for "additional recommendations" and a different treatment

approach and simply need to "just begin" a new treatment or need treatment advice.

B. For school personnel in need of advice on their students current social communication status

and recommendations for school based accommodations and interventions.

C. Second opinions, evaluations to rule in/out SM, evaluations without a "detailed report." school

accommodation recommendations, (504 plans, IEP plans, school oriented questions) or

treatment recommendations/questions, letter writing, expert testifying, etc.

This consult is ideal for children who have already had comprehensive evaluations/report and

treatment in the past.

Following the evaluation, families or school personnel will receive a written or grid-like Appointment

Summary

that depends on the format most relevant to the child or student.

Per Service consultations are based on time and includes the evaluation of multiple assessment forms,

review of relevant past records, and the development of the appointment summary. The average time


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in the office is usually two hours, but one hour appointments can be arranged. The average time within

the school is usually two hours, one hour observing the child and 1-2 hours consulting with school

personnel. The average length report (not including multiple handouts/game/goal charts) is 3-5 pages.

3) School evaluations can be in the form of:Per Service Consultations or

School on-site evaluations. SMart Center staff will present at the child's school, observe the child and

meet with school personnel to discuss findings and suggest school based accommodations,

interventions. If requested, our staff can be present for 504 and IEP meetings either at the school or

via arranged teleconference. ** Similar to Per Service Consultation above.

4) Ask the Doc consult A nonpatient consultation that is ideal for parents, school personnel or

treatment professionals who are interested in a Question/Answer type consultation.

This format is ideal for:

A. Parent are in active treatment with a local therapist but have unanswered questions or need

more advice.

B. School personnel who have specific questions related to a student with SM.

C. Treatment professionals who are working directly with a child or teen with SM and are in need

of advice on treatment strategies and direction.

The Ask the Doc format includes a the assessment of a brief questionnaire. There are no reports or

summaries following the Ask the Doc consultation; however, handouts may be provided.

There is NO Doctor/Patient relationship established with an ASK THE DOC consult.

What is the process for scheduling an appointment?

Please review information on services/fees.

If you would then like to schedule an appointment, contact our office via email:

[email protected] or call our front desk at: 215-887-5748 . Provide your email and

other contact information. We will then contact you back via EMAIL or phone depending upon your

requests.

Once we schedule you an appointment we will send you an email (or letter if requested) that will

include ALL of your appointment details. You will be given instructions on what is required for your

consultation in terms of specific assessment forms, etc.

Due to the tremendous demand on our services, we require a $100 deposit to hold your scheduled

appointment.
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This deposit is refundable if you cancel your appointment prior to 2 weeks of your scheduled date. If

you cancel within 2 weeks, you forfeit your initial deposit regardless of the reason. If your child is ill or

you have another urgent situation, we will do our best to reschedule you however, we cannot

guarantee a time frame for rescheduling. NO-SHOW appointments forfeit their deposit with no chance

for rescheduling.

Your Deposit must be received within ONE week of scheduling (postmarked). This is the families

responsibility. Your deposit guarantees your appointment slot.

Please note that if you schedule an appointment and we need to make a change in the professional

performing your consultation or the date of your appointment, we will inform you of the change ASAP.

You can then decide if you would like to keep your appointment or change to an alternative date. If

requested, we will return any deposits regardless of the time frame prior to the appointment.

What if after I choose the Ask the Doc initial format, I decide to pursue regular treatment?

This happens often. Families will need to fill out the SM-CDQ, the SM School Eval form and perhaps

other recommended assessment forms. Depending upon what was accomplished during the Ask the

Doc consultation, will dictate the level of service to begin treatment.

Can I schedule and appointment with a particular doctor or therapist?

You can certainly make a request for a specific treatment professional however, based on scheduling

and a professional's availability will dictate whether we can honor your request. You will be informed at

the time of appointment scheduling who you will be seeing at the SMart Center. If a staff change needs

to occur, we will inform you as soon as possible.

I am very interested in speaking to parents who have gone through treatment at the SMart

Center. Is this possible?

Very possible and also highly recommended! Dr. E and our other clinicians have wonderful

relationships with the children and parents she works with and most are more than happy to

correspond with another parent who is "in the same shoes" they were in not too long ago. Please

speak to your doctor or therapist about this during your consultation. She will match you with another

parent or a few parents with a child similar to yours.

We encourage patients to communicate with other children/teens who have had SM or who are still

undergoing treatment. Your therapist or doctor will mention this to you during your consultation. if

your child desires a pen pal, we will do our best to find a match for your child!

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School Services

(For immediate information on fees/services-->GO

OR contact us via email or phone: 21... for information on fees for the services listed

below!)

We have a student who we believe has SM. Can we send the child to your center or do you

do on-site evaluations?

Fortunately we do both! You can certainly send the family to the center, do a phone consultation or

perhaps hire our staff to come to your school to do a full evaluation. Please note that school on-site

evaluations are limited to: PA, NJ, NY, DE

We would like to hire your staff to come to our school to consult about a student. We need

help with the development of accommodations and interventions. What is the process?

SMart Center staff will present at the child's school, observe the child and meet with school personnel

to discuss findings and suggest school based accommodations, interventions. If requested, our staff

can be present for 504 and IEP meetings either at the school or via arranged teleconference. (Similar

to Per Service Consultation, above.)

Our staff needs help in implementing interventions. Can the Smart Center help?

Absolutely! Our staff can consult with school personnel either via PHONE or on-site. On an as-needed

or scheduled consultant basis our staff can present regularly to work directly with the student and

school staff! Some of the services we provide are: Direct staff training, friendship-based groups, social

pragmatic work with students during scheduled small group time, facilitation of communicationstrategies during class time, One on one work with the student to work on specific interventions both

in-class and out-of-class, Buddy-work, etc. You may also consider on-site trainings for staff such as

workshops and webinars!

Accommodations (IEP/504 Development)

I am not sure whether my child/STUDENT needs anIEP or a 504 plan. How do I know which,
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No, we ask that you schedule a short phone call with our scheduling department. Our Professional

staff's intense schedule does not allow for 'sudden' calls unless there is a true emergency. Again,

based on reasons for the call, the family will be billed for any time spent consulting.

What is the SM - School Evaluation form

?This is the questionnaire that Dr. Shipon-Blum developed to help assess the child social comfort,

communication level, academic performance, overall anxiety level, etc within the school environment.

Teacher's should fill out this form as often as your therapist or doctor needs. Information submitted

helps inform your clinician of your child's situation in school. This information is then used to plan for

your upcoming consultation which will then enable for updated school based interventions. View SM-

School Evaluation Form

Professionals are welcome to use the SM School Eval form to assess child's social, communication,

response to accommodations/interventions and academic status within the school environment.

Respect to copyright is required.

Back to Top

Follow-Up Consultations

How often are children/teens seen for follow-up visits?

Most children/teens are seen every 4-6 weeks with Dr. Shipon-Blum. For children/teens who need more

frequent follow-ups visits can be scheduled every 2 weeks. Associates at the Smart Center are also

available for clinicial follow-ups for families who request more frequent visits.

What is included in a follow-up consultation?

Evaluation of the SM Follow-Up Form for parents to fill out.

Evaluation of the SM School Eval form for teacher(s) to fill out. This is usually done prior to each

appointment

Evaluation of older child/teen Follow-Up form (*When appropriate)

Unlimited email updates to Dr. E or other staff members.

15-30 min meeting with Intake coordinator to review progress (this can be done on the phone prior to

appointment as well)

55-60 min office visit (or teleconference)
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Written appointment summary that includes new or tweaked games/goals, recommendations for school

staff

Why is my child NOT seen weekly or multiple times weekly?

Dr. E's clinical experience dictates that children need time in-between sessions to work on treatment

goals/games both at home and within the school setting. Therefore, children are seen every two-four

weeks at the SMart Center.

What If I want my child to be seen more frequently or I feel I need more help with the

games/goals can this be done?

Of course. When you consult with Dr. E (or associates) please mention this. We will then schedule

accordingly.

For many patients, in-between visits with Dr. E, they see one of our associates for in-person or Real

World appointments (helping the child with games/goals within the real world). Also, teleconferencing

is available on a scheduled basis.

Bottom line, Your needs will be met at the Smart Center. We are conscious of the varied needs of our

families. We will do our best to accommodate all!

What If I feel I need an appointment outside of my regular scheduled appointment. Ie,

some issues have come up or I have additional questions. How is this handled?

No worries. We offer our patients the flexibility of what we call, 'Convenience Consultations.' These are

appointments that are scheduled no more than two weeks in advance and are on a first come/first

served basis. These appointments are prior to our regularly scheduled appointments. These

appointments range from 10-30 min. If more time is needed, we can extend assuming time is

available. These appointments are usually a teleconference consutlation, but in-person consultations

are available for those who request.

If interested in a Convenience Consutlation, Please call our Direct Patient Line (supplied to all our

patients and located in the Established Patient Section of our website) or email us at:

[email protected].

We will then schedule you accordingly.

Where can I locate the Follow-Up forms that need to be filled out and how do I submit

them?

All follow up forms are located at the following link:

http://www.drelisashiponblum.citymax.com/AllForms.html

Directions on submission are indicated on the link above.
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You will also be supplied the link to the SM- Follow Up Forms when our office sends you an email

confirmation. This is approximately 3-7 days prior to your appt.

You can also access the SM-Follow Up Questionnaire directly from the first page of our website. Simply

click on 'Smart Center patients---> Established patients--> You will see the link to the FOLLOW-UPforms on the top right side of the grid.

How do I schedule my Follow-Up appointments?

Please email our scheduling dept at: [email protected]. We will then contact you

back by email and begin the scheduling process. We usually schedule out approximately 3 months to

ensure that you are in our schedule.

If you prefer telephone correspondence, please call our Direct Patient Line (Provided to all our

established patients and located in the Established Patient section of our website). You can reach our

Front Desk Call Center at: 215-887-5748 .

What is the office policy for appointment canceling?

Families must let us know about cancellations within 3 days of a scheduled appointment. Obviously

children will get sick, travel may be difficult due to weather, etc. However, we ask that if you need to

change or cancel an appt that you give us as much notice as possible. As you know, we have a long

waiting list for appointments and the sooner you let us know, we can inform another patient in need

that an appt space has opened up.

If a parent has cancelled with minimal notice more than 50% of the time, we will ask for paymentupfront and patients will be responsible for an office visit charge.

If a new patient (a patient scheduled for an initial consultation or a patient who has been under our

care for less than 2 months) does not show-up for a confirmed appt, no new appointments will be

scheduled unless full payment is made in advance.

Our policies are strict since Dr. E has limited office time and our demand for services is high.

Back to Top
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Medication Questions

** For those with many questions on medication, we suggest the NEW CD-ROM/Audio CD's presented

by Dr. E.,Medication: Why, When and HOW to use Safely and Effectively in the Treatment of

Selective Mutism.

What percentage of patients at the SMart Center are placed on medication?

Based on our present patient population, for approximately 30-40% of patients, medication is

recommended as an adjunct. However, please keep in mind the following:

1. Since children/teens with SM are our entire focus, we see patients of varying degrees of

severity. Due to Dr. Shipon-Blum's specialty, many families who present to the Smart Center

have been to multiple treatment professionals in the past and minimal progress has been

made. By the time many present at the Smart Center, they have exhausted many forms of

treatment.

2. The older the child, The more severe and co-morbid problems that exist, the more likely

medication may be recommended.

3. The younger the child, the less co-morbid problems that exist the less likely medication will be

recommended.

If my child needs medication, can our child receive medication and monitoring at the SMart

Center.

Absolutely! Dr. Shipon-Blum is a medical doctor. Therefore in addition to providing SCAT, she will

prescribe medication if necessary. Monitoring is individualized and done carefully and ranges from

every two weeks/once per month in the beginning of treatment to every three months once stable.

Monitoring is done very carefully. Dr. E requires parents to update via email or phone (to staff) every

week (in beginning of medication usage) to indicate child's tolerance and response to medication.

What if we are against medication, but Dr. E recommends medication, will my child not be

treated at the SMart Center?

Dr. E respects your decision whether to use or not to use medication as an adjunct to treatment.

However, many parents are uninformed about 'medication' and form opinions without completely

understanding. If Dr. E recommends medication and a parent is against medication, Dr. E will simply

ask the parent to read about the medication and to ask her about the questions they may have. IF

after a thorough understanding, parents are still against the use of medication, treatment will continue

without medication being used.

What types of medication are used at the SMart Center?

If medication is recommended, 99% of patients are placed on a Selective Serotonin Reuptake Inhibitor

(SSRI) (i.e., Prozac, Zoloft, Paxil, Celexa, etc) or a medication very closely related to an SSRI (I.e.,

Effexor)
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Why is medication recommended?

Medication is used as an adjunct to help lower anxiety just enough to do the necessary behavior

therapy necessary to build coping skills. For some children/teens, anxiety is so high, that a short

course of medication enables for the lowered anxiety needed to accomplish therapy.

How long does a child remain on medication?

The goal is 6-12 months depending upon clinical response.

How does Dr. E monitor medication?

Very Carefully! Dr. E believes that 'less is more.' and manages 95% of her patients on less than the

equivalent of 20mg of Fluoxetine (Prozac). Prior to using medication, Dr. E will ask a series of questions

to be sure medication is safe to use with your child. She will exam your child, supply you with a

handout, answer your questions about medication and will explain to you the purpose and how

medication will be used. Side effects will be discussed in detail. Your child will return within 2 weeks of

beginning medication.

Dr. E will ask you to email her after the first few days of beginning medication. Prior to your follow-up

visit, you will be asked to fill out the SM-Follow-Up Eval that assesses your child's treatment progress

and clinical response to the medication. At your visit, after treatment status and degree of progress

has been determined, Dr. E will exam your child and determine whether to continue present dosage,

increase or decrease the dosage. It is very rare to have to decrease dosage.

Back to Top

Learning about Selective Mutism!

There are multiple ways to learn more about Selective Mutism.
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Children/teens with Selective Mutism are consistently asked why they do not speak.

Individuals often believe that if they continuously ask these children to speak or question them over

and over that they will automatically begin speaking. The assumption here is that these children CAN

speak, re perhaps being stubborn and if continuously questioned and told what to do, these childrenwill eventually speak. Unfortunately, the individuals who believe this tactic will work are hugely

mistaken and are only propagating mutism and inner anxiety.

Children with Selective Mutism do not automatically begin speaking when prompted. If they do

eventually utter a sound or whisper from coercion the anxiety that is created is often so tremendous

that more internal anxiety is created which in turn, propagates mutism.

Has anyone ever wondered how a child/teen with Selective Mutism truly feels when he/she is in school

or other social situations where mutism is evident?

Having asked hundreds of children with Selective Mutism how they feel when uncomfortable has

elicited interesting responses.

Out of 100 children with SM, below is the term used by children/teens that indicate how they feel when

in school or other settings where mutism is evident.

SCARED - 50% of the time,

DONT KNOW - 25% of the time

'IT'S Hard or Difficult' - 15% of the time

DONT WANT TO -10% of the time

Varied answers come up 5% of the time

The responses of these children from all over the world should indicate that these children are fearful

when confronted with social situations.

Being scared and nervous (75%) of the responses elicited are typical feelings of anxiety that come

over these children. IF these children are anxious, then how would frequent questioning, asking and

insisting that these children speak help SM children? It wont.


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It should be obvious that treating these children from an anxiety perspective using various behavioral

techniques would be the best way to help a child suffering from SM.

IF this is all true, then why are so many children still suffering in silence????

ANSWER: Not enough Parents, teachers and treating professionals truly understand Selective Mutism.

The SMART-CENTER and the Selective Mutism Group Childhood Anxiety Network (SMG~CAN) are trying

to educate and promote the public awareness of Selective Mutism in order to RID THE SILENCE of

Selective Mutism. Please help us disseminate information to educate teachers and treating

professionals in order to help SM children overcome their anxiety.

www.selectivemutism.org

[email protected]
http://www.selectivemutism.org/mailto:[email protected]://www.selectivemutism.org/mailto:[email protected]

what is social communication anxiety treatment

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