Paeds Cases · mental-behavioural-and-psychosomatic
Selective mutism — OSCE
OSCE station: selective mutism assessment counselling and shared decision-making for behavioural-intervention-first care with the school.
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Study tools
Target exams
MRCPCH ClinicalRACP DCE
Prompt
Parent and 6-year-old attend after the teacher flagged that she has never spoken all year; the child clams up the moment she crosses the school gate but is a chatterbox at home; staff have begun treating the silence as defiance.
Objectives
- Elicit the setting-specific speaking gradient and frame selective mutism as an anxiety-driven freeze, not defiance. [14]
- Confirm hearing and language adequacy, and screen comorbidity and safeguarding. [14]
- Explain the diagnosis to the parent and teacher without stigma. [14]
- Agree a behavioural-intervention-first plan with school collaboration, and describe when an SSRI is added. [5]
References4ShowHide
- [1]Black B; Uhde TW Treatment of elective mutism with fluoxetine: a double-blind, placebo-controlled study Journal of the American Academy of Child and Adolescent Psychiatry, 1994.PMID 7961338
- [5]Cohan SL; Chavira DA; Stein MB Practitioner review: Psychosocial interventions for children with selective mutism: a critical evaluation of the literature from 1990-2005 Journal of child psychology and psychiatry, and allied disciplines, 2006.PMID 17076747
- [13]Manassis K; Oerbeck B; Overgaard KR The use of medication in selective mutism: a systematic review European child and adolescent psychiatry, 2016.PMID 26560144
- [14]Hua A; Major N Selective mutism Current opinion in pediatrics, 2016.PMID 26709680