Anxiety disorders are the most common psychiatric disorders affecting children and adolescents. Temporary fears and anxieties are considered part of normal development. However, for some children, these developmental expectations may disguise the presence of an emerging or existing anxiety disorder. High and stable levels of anxiety are associated with severe impairment in
High and stable levels of anxiety are associated with severe impairment in functioning of normal life. This can be identified through a child’s avoidance of several important activities such as school, peer involvement, and the attainment of stage-related developmental tasks.
One such anxiety disorder is Selective Mutism. It is a form of anxiety disorder characterized by a child’s inability to speak and communicate in a socially appropriate manner in selective social settings, such as school, birthday parties, among elders etc. These children will be able to speak and communicate well in settings where they are comfortable, secure and relaxed, such as at home.
The selectively mute child is unable to speak in at least one setting such as, school etc. The typical presentation of such a child that s/he would be ‘timid’ but can speak and act socially appropriate with family members, close peers and very familiar relatives. When compared to a timid child, a child with selective mutism will be positioned towards the extreme end of the spectrum of shyness and timidity.
Children and adolescents with Selective Mutism have an actual fear of speaking and of social interactions where there is an expectation to speak and communicate. Many children with this condition have great difficulty responding or initiating communication in a nonverbal manner; therefore social engagement may be compromised in many children when confronted by others or in an overwhelming setting where they sense a feeling of expectation.
Selective Mutism affects 0.7% of all school going children, with children between the ages 3-8 being the most commonly affected.
Children do not simply outgrow the condition; if left untreated, it can have a negative impact on developing social skills, fostering and maintaining healthy relationships and may also generalise to other forms of anxiety. It is vital to get a complete psychological evaluation done in order diagnose the problem and implement a comprehensive treatment plan.
Why does a child develop Selective Mutism?
1. Genetic Predisposition:
Majority of children with Selective Mutism have a genetic predisposition to anxiety. They inherit the tendency to be anxious from their family members.
2. Inhibited Temperaments:
Studies have shown that children with inhibited temperaments are more prone to anxiety than those with shy temperaments. A hypothesis has been made that such children have a decreased threshold of excitability in the almond-shaped area of the brain called the amygdala. During a dangerous situation the amygdala receives the signal of danger and beings to set off a series of reactions to protect.
3. Sensory Processing Disorder:
Children who suffer with Selective Mutism can have Sensory Processing Disorder which means they find it difficult to process specific sensory information. They can be sensitive to sounds, lights touch, taste or smells. They have a trouble modulating sensory input which affects their emotional responses. It can make the child to avoid or withdraw from situations which may cause anxiety.
4. Speech and/or language abnormalities:
Children can suffer with Selective Mutism due to speech and/or language abnormalities such as receptive and/or expressive language abnormalities and language delays. They may also have a learning disability which includes auditory processing disorder. The added stress of speech/language disorder or the learning disability may make the children uncomfortable and insecure in situations where they are expected to speak.
NOTE: Studies have no evidence that the cause of Selective Mutism is related to abuse, neglect or trauma.
Children with Selective Mutism can present with some or all of the following symptoms:
-
Temperamental Inhibition:
The child will be timid and cautious in unfamiliar situations.
-
Social Anxiety:
The child may be uncomfortable when introduced to people, express major discomfort when teased or criticized, have an excessive need for being the center of attention
-
Physical Symptoms:
The child may present with physical complaints like nausea, headache, tummy ache, shortness of breath etc.
-
Appearance:
The child may have a frozen-looking, blank, expressionless face and stiff, awkward body language with lack of eye contact when feeling anxious.
-
Common Symptoms:
The child may be a picky eater, have bladder and bowel issues, be sensitive to crowds, avoid bright lights or dislike loud sounds.
-
Behavioural:
The child may often be inflexible, stubborn, moody or bossy at home. He may also have crying spells and may resist change.
How can Selective Mutism be treated?
- According to Dr. Shipon-Blum’s work, the child, and parents’ interview must be able to answer three important questions:
- Why did this child develop (including influencing, precipitating and maintaining factors)?
- Why does Selective Mutism persist despite past treatment and/or parent/teacher awareness?
- What can be done at home, in school, and in the real world to help the child build the coping skills needed to overcome his/her social communication challenges?
- The child’s level of suffering must be understood. The Social Communication Anxiety Inventory (SCAI) can be used to determine the stage of social communication on the Social Communication Bridge
- A whole child approach can also be used for treatment. This means under the guidance of the treatment professional, the child, parents, and school personnel work as a team.
- Treatment includes using various combinations of psychotherapy modalities and rarely, if ever, medications. The main goals of treatment is to lower the 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.
Since every child is different there cannot be a generalized treatment plan. The child’s unique requirements must be included in the therapy.
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슬롯 사이트
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주자이모의 주례는 두 사람의 관계를 철저히 해명한 것이라고 볼 수 있다.
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온라인 슬롯 머신 게임
“믿을 수 없다면 Lao Fang에게 물어보십시오. “Zhu Houzhao는 초조하게 발을 밟았습니다.
마블 슬롯
Zhu Houzhao는 다시 고개를 끄덕였습니다. “지시를 따르겠습니다.”
슬롯 게임 무료
그가 말하면서 Fang Jifan은 몸을 숙이고 Concubine Fang의 귀에 몸을 기울였습니다.
하이브 슬롯
하지만 자신의 자식이나 손주들이 그에게 선물을 주면 느낌이 달라진다.
더 도그 하우스 메가웨이즈
이 오스만 대사관은 결국 오스만이 큰 나라이기 때문에 규모가 가장 큽니다.
꽁 머니 슬롯
그들은 현자와 현자의 도를 세상에서 가장 고귀한 지식이라고 칭찬했습니다.
프라 그마 틱 슬롯 사이트
하지만 Fang Jifan이 2년 후라는 말을 들었을 때 약간의 아쉬움을 금할 수 없었습니다.
안전한 슬롯 사이트
“최선을 다하겠습니다.” Fang Jifan은 여전히이 기회를 위해 싸우고 싶었습니다.
파워 오브 토르 메가웨이즈
때때로 Zhu Houzhao는 선형 사상가입니다.
오공 슬롯
모두가 고맙게도 Ouyang Zhi를 바라볼 수밖에 없었습니다.
더 도그 하우스 메가웨이즈
Hongzhi 황제는 안도감을 느끼지 않을 수 없었고 단호했습니다.
문 프린세스
“정말요?” Zhu Houzhao는 믿을 수 없다는 표정을 지으며 의심스러운 표정을 지었습니다.
에그 카지노
Hongzhi 황제는 평소와 같이 Nuan Pavilion에서 여러 장로를 소환했습니다.
에그벳 스포츠
막대기는 Yang Biao의 어깨를 세게 쳤고 Yang Biao는 고통스러워했습니다. “어머니, 제가 틀 렸습니다.”
에그슬롯
분명히 Fang Jifan이 우리를 자극했는데 어떻게 그를 자극 했습니까?
카이센 윈즈
Hongzhi 황제는 놀랐습니다. “정말? 누구야?”
파워 오브 토르 메가웨이즈
Zhu Houzhao는 좌절감을 느꼈습니다. 다른 사람들은 왜 그렇게 빨리 살았습니까?
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“베테랑도 무연탄이 좋다고 생각했다.” 이번에 일어선 것은 시에첸이었다.
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このトピックについてよく研究されていて、非常に参考になります。
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“나도 보고 싶어.” Fang Jifan이 유쾌하게 말했다.
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Fang Jifan은 “폐하, 자신을 해치지 마십시오, 폐하 … 무슨 일이 있었습니까?”
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Zhu Houzhao는 매우 기뻐했고 며칠 후 Fang Jifan을 다시 소환했습니다.
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이 황실 법원은 황제의 움직임에 대해 가장 많이 묻기를 좋아합니다.
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ユニークな視点で、非常に啓発されました。ありがとうございます。
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Zhu Houzhao는 더 이상 감히 그를 반박하지 않고 순종적으로 말했습니다. “내 목사는 명령에 따릅니다.”
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꼬마야, 이 줄을 낚아챌 자격이 있느냐?
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슬롯 사이트
잠시 생각한 후 그는 “이것이 선생님의 좋은 가르침입니다. “라고 말했습니다.
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“할 말이 있으면 말하세요.” 홍지 황제의 얼굴에 엄숙함이 스쳐지나갔다.
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Xiao Jing은 도울 수 없었지만 “케이크를 줘, 뭘 숨기고 있니? “라고 말했습니다.
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이때 닝보에서 배를 만들고 있던 왕시주오도 베이징으로 부름을 받았다.
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Zhu Houzhao는 무정하고 크게 웃었습니다.
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Taikang 공주가 반응하기 전에 Fang Jifan은 이미 떠났습니다.
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그래서 그는 웃으며 홍지 황제에게 다가가 말하려고했습니다.
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Zhu Houzhao는 자연스럽게 그것을 원했고 그는 어린 아이처럼 들떠있었습니다.
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Hongzhi 황제는 손을 눌렀습니다. “죽음이라고 말하지 마십시오. 운이 좋지 않습니다.”
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Fang Jifan은 “남편을 위해 말했지만 여왕 어머니에게 말할 수 없습니다. “라고 말했습니다.
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오스만 제국은 상대적으로 새로운 포병을 도입하기 시작했으며 포위 공격을 위한 날카로운 무기가 되었습니다.
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