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Mutismo selettivo: parlare di silenzio e approcci comportamentali al trattamento

Di February 4, 2014 #!31Fri, 31 Jul 2020 04:14:41 -0800p4131#31Fri, 31 Jul 2020 04:14:41 -0800p-4-08:003131-08:00x31 31am31am-31Fri, 31 Jul 2020 04:14:41 -0800p4-08:003131-08:00x312020Fri, 31 Jul 2020 04:14:41 -0800144147amFriday=3715#!31Fri, 31 Jul 2020 04:14:41 -0800p-08:007#July 31st, 2020#!31Fri, 31 Jul 2020 04:14:41 -0800p4131#/31Fri, 31 Jul 2020 04:14:41 -0800p-4-08:003131-08:00x31#!31Fri, 31 Jul 2020 04:14:41 -0800p-08:007# Non ci sono commenti

What is Selective Mutism

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5)- Fifth Edition notes that selective mutism is 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. For instance, children with selective mutism may talk with their immediate family members, but might not speak with extended relatives or at school. The DSM-5 further specifies that this disturbance, which results in impairments educationally/occupationally and/or socially, persists for at least one month, and is not better accounted for by lack of knowledge or comfort with the spoken language. Some children with selective mutism also have a communication disorder and often meet criteria for social anxiety disorder as well. However, for other children with selective mutism they do not experience social anxiety, and are comfortable in social situations where speech is not required (i.e. playing with peers on playground).

Many children with selective mutism often have engaging and enriching social relationships with their peers without verbal communication. Some children with selective mutism may not talk to their friend at school, but will talk with them in their own home. Other children will continue to experience difficulty talking regardless of the setting, but will convey their enjoyment in their interactions with others non-verbally. Frequently, peers speak for these children, such as answering for them when the child with selective mutism is called on in class, and they offer empathic reasons for why their friend may not be talking (i.e. he s just shy ). Parents also often speak for their child when he/she does not respond to questions, or in an effort to have their needs met (i.e. making decisions for them, placing orders in restaurants, etc.). These efforts may temporarily alleviate the child's anxiety, but ultimately do not allow the child to learn the skills required to cope with uncomfortable and challenging situations.

As a parent what can I do

Parents play an integral role in treatment and clinicians spend a large portion of time providing psycho-education to parents about ways that they can help increase their child's speech and lessen anxiety. Parents may unknowingly accommodate their child's anxious and avoidant behavior, and clinicians utilizing a behavioral or cognitive behavioral approach to treatment provide support to parents as they learn alternate ways of helping their child through distressing situations.

 

Un programma di trattamento comportamentale per il mutismo selettivo, guidato da un medico esperto spesso include i seguenti componenti:

Dissolvenza dello stimolo
Ad esempio, il bambino si trova in una situazione confortevole con qualcuno con cui parla liberamente (ad es. Madre o padre), e quindi gradualmente viene introdotta una nuova persona (ad es. Terapeuta o insegnante) nell'ambiente. La persona familiare (cio? il genitore) nel corso del trattamento viene gradualmente sbiadita in modo che il bambino sia in grado di parlare con la nuova persona (terapeuta, insegnante) in assenza della persona familiare (genitore).

Modellare
Un approccio graduale viene utilizzato per rafforzare gli sforzi del bambino per comunicare. Ad esempio, se il bambino non sta parlando a tutti gli sforzi terapeutici, il bambino lo rafforzer? man mano che si avvicina maggiormente al discorso udibile. Inoltre, il trattamento si concentra spesso sull'aumento del numero di enunciati nel discorso, passando da risposte di una sola parola a parlare in frasi e infine a conversazioni reciproche.

Esposizione
Gli approcci comportamentali spesso includono esposizioni o situazioni pratiche in cui i bambini sono gradualmente esposti a situazioni sempre pi? difficili man mano che il loro livello di abilit? e fiducia si rafforzano. Si ritiene che l'esposizione funzioni in parte attraverso l'abituazione, poich? l'ansia diminuisce attraverso l'esposizione ripetuta a un particolare stimolo / situazione. In genere viene creata una gerarchia di ansia con il bambino e i genitori e, a partire dal passaggio o dall'esposizione pi? semplice, il bambino sale la scala, parlando in situazioni che sono sempre pi? difficili per il bambino.

Exposures might include talking to new people, talking in new environments, and increasing the volume of the child's voice. Additionally, exposures may include allowing a new person to see them talk using technological means or be in the room while they are speaking with a familiar person. Technology is often a helpful tool with exposures. For instance, a child who is not yet speaking with his therapist may agree to allow the therapist to first watch a video of him speaking comfortably at home. Technology can also be used for exposures that address the volume of a child's speech or utterances in speech.

Tutti e due etichettatolode e programmi di incentivazione can be used to reinforce a child's effort and progress towards talking goals. With labeled praise adults provide praise that clearly identifies the desired behavior. For instance, thank you for using your words, or I love when you answer my questions. This is in contrast to non-specific praise in which one might say good job, omitting the specific behavior they are praising. Small rewards can be used as incentives as children work through anxiety provoking situations. For instance, a child may earn a point each time they speak in session, and use points to cash in for a reward on their behavior plan.

Anche i bambini ne beneficiano spesso Cognitivo comportamentale approcci, compreso l'apprendimento abilit? di rilassamento e ristrutturazione cognitiva. Il rilassamento potrebbe includere la respirazione profonda / respirazione diaframmatica e il rilassamento muscolare progressivo. Con la ristrutturazione cognitiva ai bambini viene insegnato come identificare i pensieri autolesionistici e riformulare queste cognizioni negative.

Andrea McLaughlin, Ph.D. ? una psicologa autorizzata che fornisce Cognitive Behavioral Therapy (CBT) per bambini, adolescenti e giovani adulti nella sua pratica privata a Park Slope, Brooklyn. Ha pi? di 10 anni di esperienza clinica lavorando con i bambini e le loro famiglie. Dr. McLaughlin ? specializzato nel trattamento e nella valutazione dei disturbi d'ansia. Inoltre, aree speciali di interesse e competenza includono lavorare con i giovani con mutismo selettivo, ansia e disturbi depressivi, tic / tourette e ADHD. I genitori sono spesso incoraggiati a partecipare al trattamento in modo che possano apprendere le abilit? per aiutare al meglio i propri figli e gestire le difficolt? al di fuori delle sessioni. andream@brooklynletters.com o 919-619-1061. .

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