A theoretical framework for the use of music therapy in the treatment of selective mutism in young children: multiple case study research

Introduction: Selective Mutism (SM) is an anxiety disorder that affects some children when they begin school. If left untreated the long-term impact can include complex, debilitating mental health conditions. The usual presentation is lack of speech in the education setting, contrasting with confident speech at home. Prevalence is estimated at 0.7% but can be three times higher for children who are immigrant second language learners. There is some evidence to suggest that music therapy is helpful but a deeper understanding is needed. This study aims to develop a new theoretical framework for the use of music therapy for young children with SM. Methods: The paper reports on multiple case study research of music therapy for 6 children with SM aged 3-5. Template analysis combining inductive and deductive enquiry is used to revise and develop the framework. Results: The six case studies describe contrasting paths into speech. Four key domains - Approach; Therapeutic Process; Interconnected Elements of Music Therapy; Context - were necessary to clinical practice across cases, and are presented in detail in the final theoretical framework. Music therapists bring many useful skills, with musical communication established as an empowering tool for alleviating SM. Discussion: The framework provides the theoretical basis for comprehensive guidance for music therapy with young children with SM. An open, flexible, multi-modal approach, integrating teamwork and considering transdisciplinary practice, is indicated. The need for SM training for music therapists and the potential role of music therapy on the care pathway for SM is demonstrated.