What is Social Communication Anxiety Treatment (S-CAT)®?


Social Communication Anxiety Treatment (S-CAT)® is evidenced-based the treatment developed by Dr. Elisa Shipon-Blum and implemented at the Selective Mutism Anxiety Research and Treatment Center (SMart Center).

S-CAT® is based on the concept that Selective Mutism (SM) 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© that describes the various stages of social communication possible for a child suffering from Selective Mutism. The Social Communication BRIDGE® illustrates this concept in a visual form.

Children suffering from Selective Mutism (SM) change their level of social communication based on the setting as well as the expectations from others within a setting. As a result, social comfort and communication will change from setting to setting and person to person.

For example, a child may be 'chatting up a storm' with their friend or family member in one setting, yet see that same person in another setting (such as at school or perhaps at a family function) and the child may have difficulty socially engaging, communicating nonverbally and perhaps the child cannot communicate at all!

For some children, they appear very comfortable and mutism is the most noted symptom. This usually means they are able to engage nonverbally with others via astute nonverbal skills (professional mimes!) in most, if not all settings. These children are stuck in the nonverbal stage of communication (Stage 1) and suffer from a subtype of SM called Speech Phobia.

Although mutism is the most noted symptom of SM, 'not speaking' merely touches on the surface of our children! A complete understanding of the child is necessary to develop an appropriate treatment plan for home and in the real world, as well as in school by developing accommodations and interventions (ie., IEP or 504 Plan).

According to Dr. Shipon-Blum's work, after a complete evaluation (consisting of various parent and teacher assessment forms and parent and child interviews), treatment needs to address three key questions:
Why did this child develop SM? (This includes influencing, precipitating and maintaining factors)
Why does Selective Mutism persist despite past treatment and 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?

To help a child suffering in silence, an understanding of which stage the child is in during particular social encounters must be developed. The Social Communication Anxiety Inventory can be used to determine the stage of social communication on the  Social Communication BRIDGE®

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 their mutism and lack of proper social engagement continue to exist in select settings.

Children with SM need strategies and interventions to progress from nonverbal to spoken communication. This is the Transitional Stage of Communication; an aspect missing from most treatment plans. In other words, how do you help a child progress from Nonverbal to Verbal communication?

Time in the therapy office is simply not enough. The office setting is used to help prepare the child for the school and real world environments by developing strategies to help the child unlearn his or her conditioned behavior. Then, in the real world and within the school setting, the strategies and interventions are implemented.

Strategies and interventions are developed based on where the child is on the Social Communication Bridge in a particular setting and are meant to be a desensitizing method as well as a vehicle to unlearn conditioned behavior.

S-CAT® incorporates anxiety lowering techniques, methods to build self-esteem, and strategies and interventions to help with social comfort and communication progression. This may include '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.

Children with SM need to understand, feel in control and have choice in their treatment (age dependent). These are critical components of Social Communication Anxiety Therapy (S-CAT)® provides choice to the child and helps to transfer the child's need for control into the strategies and interventions!
Games and goals (based on age) are used to help develop social comfort (and ultimately progress into speech via the use of ritualistic and controlled methods. 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 some of the other tools used within the S-CAT® program.

Every child is different and therefore an individualized treatment plan needs to be developed to incorporates home (parent education, environmental changes), the child's unique needs, and school modifications (teacher education, accommodations and interventions).

By lowering anxiety, increasing self-esteem, and 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.