Elective Mutism: special treatment of a special case

A fourteen-year-old boy, who had stopped using verbal language outside his home at the age of four, was diagnosed as electively mute in connection with a epidemiologicallongitudinal research programme (Rutter, 1982) conducted in Norway during 1989--92. The treatment programme based on principles for contingency management, was carried out in school by the class teacher, instructed and supervised by the project leader, who also saw the boy and his mother regularly. The boy was compliant and cooperative in following the treatment procedures, but he was strongly resistant to behavioural interventions aimed at initiating verbal responding (Labbe & Williamson, 1984). The treatment became a 'game' where he was always the winner, with an adverse reinforcing effect (Sluckin et al., 1991). New approaches had to be tried, and finally an escape procedure (Piersel & Kratochwill, 1981) released the first verbal responding outside his home. After a couple of weeks he had achieved normal speech at school and also in his social life.