Authors (including presenting author) :
Chan KLP(1), Chan SM, Chau WM, , Sze CY(1), Tjota E1, Chan WP(1), Chung YM(1), Chan FC(1)
Affiliation :
(1) Department of Psychiatry, Queen Mary Hospital
Introduction :
Selective Mutism (SM) is an anxiety disorder characterized by a consistent failure to speak in social situation in which there is an expectation to speak, e.g. at school, although the child speaks in other situations. SM affects approximately 0.71–2% of children in which it is commonly onset at age 2 to 5 years old. SM interferes with child’s educational or occupational achievement by impaired social communication, with a mean duration of disturbance for 9 years. Adoption of an integrated approach including pharmacological intervention, behavioral training, cognitive training and psychoeducation have been found to be beneficial to children with SM and were introduced in this workshop, with the goals of enhancing their understanding on SM and decreasing their speech anxiety. With its unique design, it is the first ever workshop introduced in Hong Kong.
Objectives :
1. To provide psychoeducation on SM for the children and their carers 2. To reduce the anxiety level of children with SM in social context 3. To improve verbal and non-verbal communication of the children 4. To facilitate carers to develop appropriate ways to reinforce child’s speaking behavior 5. To liaise with school personnels on the behavioral modification and adjustments needed, providing appropriate service to support students with Special Education Needs (SEN) at Tier two level.
Methodology :
The workshop included 1 session of individual baseline assessment and 4 sessions of parallel group. 5 families of children with SM and their caregivers were recruited. By collaborating with Speech Therapist, the workshop was carried out in the form of mini-lectures, group discussion, role-play and in-class functional communication practices. Individualized talking maps and talking ladders were developed by parents with their children for graded exposure practice in school and community settings. Appropriate parenting skills in handling speaking anxiety and school accommodation were introduced to carers. Tele-care between sessions was also provided to support parenting and the implementation of the talking ladder at different settings. The topics of the group sessions were: 1) Understand SM and talking ladder, 2) Skill training on Graded Exposure technique (Talking map and strengthening Communication Skills), 3) Review talking ladder and talking map / Anxiety management, Communication Skills, and 4) Skills Consolidation and Future Preparation, Relapse Prevention. Pre and post questionnaires (Selective Mutism Questionnaire and Liebowitz Social Anxiety Scale) were given to participants to measure child’s severity of SM and their level of anxiety. Satisfaction Surveys of the workshop were also completed by the participants, so as to evaluate the effectiveness of the group.
Result & Outcome :
Two out of five families had completed the workshop, whereas the other families dropped out due to COVID-19 condition. By comparing the pre-and-post SMQ, there was a slight increase (7%) of the level of children’s speaking behavior across school and social settings. When evaluating the pre-and-post LSAS, Child 1 reported a decrease in anxiety level by 33% over the social situations, while Child 2 reported an increase in anxiety level by 23%. It could possibly be explained by the building up of anxiety after starting exposure practice and increased awareness on own anxiety after the workshop. All parents and children were satisfied with the workshop with a mean satisfaction score of 4.9 out of 6.
Conclusion: The SM workshop demonstrated positive effects on children’s speaking behaviors and their understanding towards SM. Long term follow-up on their exposure practice is recommended to alleviate their speaking anxiety and facilitate their functional communication as well as social development in the future.
