Online Publication of Undergraduate Studies 2018, Volume 9, Issue 2
Parental Behavior and SM
The Effects of Parental Behavior on Selective Mutism Symptomatology Shira Richards-Rachlin
Selective Mutism (SM) is a rare childhood anxiety disorder, occurring in 1% of children under five-years-old, characterized by a lack of speech in multiple settings (e.g., unfamiliar settings) where speech is normally expected (Muris, Henriks & Bot, 2015; Wong, 2010). Symptoms of SM include an inhibited and silent presentation outside comfortable social situations, where failure to speak is due to anxiety, rather than a lack of knowledge surrounding the language (Carpenter, Puliafico, Kurtz, Pincus, & Comer, 2014). For example, children with SM typically withhold speech at school or with unfamiliar adults, but engage fully at home with parents and siblings (Wong, 2010). Since parents serve a critical role in their children’s development, many experts agree that parental behaviors influence the symptomology presentation and severity in children with SM (Cunningham, McHolm, Boyle, & Patel, 2004). More specifically, parental behaviors that reinforce children’s verbal or non-verbal behaviors may encourage children to either speak or remain silent in unfamiliar social situations (Alyanak et al., 2013; Wong, 2010). Due to little psychoeducation or knowledge surrounding SM, parents may unintentionally reinforce their children’s silent behaviors in unfamiliar settings by responding inappropriately to children’s non-verbal behaviors (Alyanak et al., 2013; Wong, 2010). Thus, to better treat those with SM, it is important to study the link between parental behavior and SM symptoms in children, as parents model behaviors which children may adopt (Alyanak et al., 2013; Carpenter et al., 2014; Cohan, Chavira, & Stein, 2006; Manassis et al., 2003; Wong, 2010). Therefore, this literature review aimed to answer the following question: how does parental behavior reinforce the symptoms of children with Selective Mutism? Family Context To understand the influence of parental behavior on children’s SM symptoms, it is necessary to first examine the family context in which a child interacts with his or her parents, since this is the environment in which certain messages, behaviors, and values are modeled and taught by parents (Bronfrenbrenner, 1977). Family contexts may result in parental behaviors that influence the severity and frequency of a child’s verbalization (Cunningham et al., 2004). Research shows that certain family contexts characterized by trauma, stress, or little parental support, may lead to children withholding speech as a protective or coping factor (Manassis et al., 2003; Wong, 2010). Additionally, family transitions, another type of family context 18 | Literature Reviews
characterized by a recent change in family structure, are more difficult for children with SM because change may indicate new threats in the environment (Cohan et al., 2006). Thus, these children receive signals for anxiety-reducing physiological responses, including decreased verbalization or inhibited behaviors (Cohan et al., 2006; Manassis et al., 2003; Wong, 2010). Because coping behaviors are reinforced and modeled by parents, if a parent ignores anxiety inducing situations (e.g., social situations), the child learns to do the same (Cunningham et al., 2004; Wong, 2010). How a parent responds to stressful changes or times of unease in the home has the potential to both diminish and increase a child’s anxiety in social situations, as the child often follows the parent’s lead in times of stress (Alyanak et al., 2013; Cunningham et al., 2004; Wong, 2010). Furthermore, parents of children with SM report a greater number of stressful life events than parents of children with other or no anxiety disorders (Capozzi et al., 2017). These reported household events may activate the child’s adaptive response to decrease anxiety (Wong, 2010). In this population specifically, a child decreases verbalization in order to adjust to environmental stresses and cope with their anxiety (Alyanak et al., 2013; Capozzi et al., 2017). Without parent-induced buffers (e.g., bringing a child to therapy) to protect an anxious child from stress in the home environment or increased language expectations outside of the home, a child’s nonverbal behaviors are positively reinforced by a temporary reduction in anxiety (Alyanak et al., 2013; Yeganeh, Beidel, & Turner, 2006). Parents who are unaware of the appropriate anxiety management tools (e.g., due to lack of psychoeducation or knowledge about SM) in these times of heightened anxiety, may unintentionally leave their child to cope by him- or herself, and thus reinforcing nonverbalization (Manassis et al., 2003). Parental Adjustment Parents may also reinforce non-verbalization through their different parenting styles, including their sensitivity and ability to adjust to their child’s needs, which may influence the behaviors they use to encourage or discourage a shy or anxious child to verbalize (Cunningham et al., 2004). Parental sensitivity encompasses the ways in which parents adapt their behavior to meet their child’s needs; extreme insensitivity, and, conversely, extreme sensitivity may both contribute to the development of SM symptoms (Alyanak et al., 2013; Yeganeh et al., 2006). Parents who set appropriate expectations for their children’s verbalization (e.g., by only accepting verbal
