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 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
perhaps 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. Meaning, they ARE able to engage and have 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.
SO many focus on MUTISM, however, '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
ccommodations/interventions (ie. IEP or 504 plan)
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.