2011 Selective Mutism Conference: Speaking Out for Kids
The latest in SM research, treatments, and hope for a better tomorrow for our children
Child Mind Institute
Hunter College's Roosevelt House was recently the site of the first Selective Mutism Conference co-sponsored by the Selective Mutism Group (SMG) and the Child Mind Institute. Aside from attending a slate of informative sessions on selective mutism (SM) research, treatment, and outcomes, the diverse group of researchers, clinicians, teachers, and parents embodied a tight-knit community dedicated to helping every child find his or her voice.
To begin, Hunter President Jennifer Raab welcomed attendees with a quick discourse on the history of the building, including its time as home to Franklin and Eleanor Roosevelt and its relevance to the present gathering. The house has the effect, Raab said, of "infusing the conversation with the spirit of two of the greatest Americans, and two people who really focused on access and equality."
Harold Koplewicz, MD, president of the Child Mind Institute, reiterated the importance of the organization's partnership with Hunter and its mission to transform mental health care for children everywhere. Aimee Kotrba, PhD, incoming president of SMG, stressed that organization's mission of "providing information and connections for people affected by SM."
And Steven Kurtz, PhD, of the Child Mind Institute and the SMG Board of Directors, made another compelling connection between the house and the struggles of children and adolescents with selective mutism. "Eleanor was a really, really strong woman," he said. "And she had some really important quotes that relate to kids with SM. One of them was, 'You must do the thing you think you cannot do.'"
The theme of the day's presentations was a bit of "we know a lot" and a bit of "we need to know more." The conference proper kicked off with the keynote address from Deborah Beidel, PhD, a professor at the University of Central Florida and the director of the doctoral program in clinical psychology there. Dr. Beidel has made and continues to make important contributions to the study of SM and served as a mentor to many of the leading lights in the field.
Dr. Beidel presented intriguing findings on the psychophysiological response of children with SM in social situations compared to children with social phobia. The greater response from the SM kids suggests that selective mutism may have a significantly different etiology. "For these children, unlike some children with social phobia where this might have been a learned response, there's this temperamental, biological basis that is coming out and seems to be the overarching concern," she said. "Which again has some very clear clinical applications."
Of course, Dr. Beidel's assertion of a biological component to SM is already buttressed by clinical experience, which Dr. Kurtz and Roy Boorady, MD, senior director of the Psychopharmacology Service at the Child Mind Institute, made clear in a talk on "Combining Psychosocial & Pharmacological Treatments." Dr. Kurtz is pragmatic when it comes to combining behavioral and medication interventions. "As a behavioral psychologist, I would love to use only behavioral treatments," he told the audience. "But I'm also an advocate for kids getting adequate treatment, and these days that often means combining with medication for the best result."
And Dr. Boorady is philosophical. "The more the anxiety gets in the way" the less effective behavioral treatments are, he said, explaining how medication can be used to buttress other interventions. But the treatment team needs to accept a dosage high enough that the effect is beneficial, not inconsequential. "We want to instill hope," Dr. Boorady said. "And if we aren't willing to get a good response, it's a double whammy. 'Gee, thanks, Doc. I'm taking your medicine and still not talking.'"
In another breakout session, Dr. Kotrba spoke to research on SM, past, present, and future. Though we've come a long way in terms of treatment, she said, unfortunately we don't have the studies that will help us generalize gains in certain areas to others, and this is where the field must go. Still, though the research is not as robust as it could be, there is already laudable evidence of collaboration across disciplines when it comes to helping children with SM. At a conference full of teachers and parents of kids with selective mutism, the conversation often turned to how non-clinical professionals and caregivers should respond—or not—to these children.
One teacher asked Dr. Kotrba if she would be doing a "disservice" to a child with SM by calling her and putting her in the "spotlight" in the classroom. "Oftentimes we become trained to not even allow them the opportunity to speak," Dr. Kotrba replied. "But if you can give them some way of responding, perhaps non-verbally if they can't verbally respond, I think that you still need to come to them. At least give them the opportunity, because sometimes not giving them the opportunity makes them stand out more than giving them the opportunity."
Clark Goldstein, PhD, of the Child Mind Institute, described an even more in-depth approach to integrating educators into SM treatment in a wide-ranging discussion of rigorous, evidence-based approaches. Echoing and expanding on Dr. Kotrba's concept of "opportunity," Dr. Goldstein stressed that in therapy for a child with SM we should hope for the expected response—but never allow the child to fail. "This is like a ladder up a mountain," he said. "We go foothold by foothold, and sometimes we need to take smaller steps but still keep moving up the mountain."
Of course, there are hurdles that appear when trying to bring effective techniques to all areas of a child's life. "It would be best if teachers knew how to do this," Dr. Goldstein said. "You need everybody on board—the parents, the teacher, and the school administration or principal. They need buy-in." Although a small-scale study indicates that it is possible to train educators in these methods, it is a daunting task.
One of the most popular sessions of the day was a panel of three young adults who described their experiences overcoming selective mutism—whether it was caught early, late, or not at all. (Check back soon for a separate article on this panel, "Hear Our Voices.")
While all enjoyed the conference, it should be noted that the most fun was likely had by almost 2 dozen young attendees who played Halloween games under the supervision of the Child Mind Institute's Melissa Ortega, PsyD, and a group of dedicated volunteers. This program was a reminder that SM doesn't just affect individuals, it affects families, and we're happy that the conference is a family affair.
Published: November 2, 2011