Social Communication Anxiety Treatment® or S-CAT® is the philosophy of treatment created by Dr. Elisa Shipon-Blum and implemented at the Selective Mutism Anxiety Research and Treatment Center (SMart Center).
S-CAT® is an evidenced-based treatment that 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©, which describes the various stages of social communication that are possible for children suffering from Selective Mutism.
The Social Communication Bridge® illustrates this concept in a visual form.
Children suffering from Selective Mutism change their level of social communication based on the setting and expectations from others within that setting. Therefore, a child may have difficulty socially engaging, communicating nonverbally, or perhaps cannot communicate at all when in one setting, but could be completely verbal and socially appropriate when they are in a familiar setting with people they are comfortable with.
For some children, mutism is the most noted symptom, which means they are able to engage and have excellent 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 and/or 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?
- 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?
Treatment is then developed via the whole child approach. Under the direction of the outside treatment professional, the child, parents, and school personnel work together.
Dr. Shipon-Blum emphasizes that although lowering a child’s anxiety level is key, it is often not enough, especially as children get older. Over time, many children with Selective Mutism no longer feel anxious, but mutism and lack of proper social engagement continues to exist in select settings due to conditioned behavior.
Children with SM need strategies and/or interventions to progress from nonverbal to spoken communication. This is the Transitional Stage (Stage 2) of communication, and this aspect is often missing from most treatment plans. In other words, how do you help a child progress from Nonverbal to Verbal communication? (hint: Stage 2)
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 and 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 intervention 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.
S-CAT® incorporates anxiety-lowering techniques, methods to build self-esteem, and strategies/interventions to help with social comfort and communication progression. This may include “Bridging” from shutdown → nonverbal communication → transitioning into spoken communication via verbal intermediaries, ritual sound shaping, and possibly the use of augmentative devices.
The key concept is that children with SM need to understand, feel in control, and have choices in their treatment (age dependent). This is a critical component of S-CAT®.
S-CAT® provides a choice to the child and helps to transfer the child’s need for control using the strategies and interventions! Therefore games and goals (based on age) via the use of ritualistic and controlled methods (e.g., use of strategy charts) are used to help develop social comfort and ultimately progress the child/teen into speech.
Silent goals (environmental changes) and active goals (directed goals based on choice and control) are used within the S-CAT® program.
Every child is different and therefore an individualized treatment plan needs to be developed that incorporates home life (parent education, environmental changes), the child’s unique needs, and the school (teacher education, accommodations/interventions).
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 proper social, emotional and academic functioning. Over time, with the use of these strategies, speech will come. However, the focus of S-CAT® is on making small, incremental, strategic improvements that allow the child to feel in control. Eventually, speech will just be the next step across the bridge in all settings and will occur with the proper facilitation.