Social Communication Anxiety Therapy (SCAT) is the philosophy
of treatment developed by Dr. Elisa Shipon-Blum and 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 our children! 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.
The
Social Communication Anxiety Inventory can be used to determine the
stage of social communication.
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 mutism and 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 via verbal 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.
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 social confidence 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.
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