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

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 a lack of speech in the education setting, contrasting with confident speech at home. Incidence rates are estimated at around 0.7% but can be three times higher for children with immigrant backgrounds. A review of Music Therapy case studies suggests Music Therapy is helpful but a deeper understanding is needed. This study asks: Does a theoretical framework, developed in single-case study research (Jones 2012), explain the process of Music Therapy across a number of cases of children with SM? If not, how can the framework be revised to reflect improvements proposed as a result of the study? A pragmatic mixed methods approach is used. A survey of Music Therapists (n=75) identifies the range of Music Therapy practice for SM in the UK. Six semistructured interviews with Music Therapists explore this practice in more depth. The main investigation is multiple case studies (n=6) of Music Therapy for children with SM aged 3-5. An abductive template analysis approach is used to synthesise data sets and revise the theoretical framework. The survey describes Music Therapy with a range of ages and presentations of SM. The interviews highlight how improved understanding of SM would enhance Music Therapy practice. The six case studies describe Paths into Speech that confirm, reconfigure and expand the theoretical framework. Music Therapists bring many useful skills, with musical communication established as an invaluable, empowering tool for alleviating SM. The revised theoretical framework provides the evidence base for comprehensive guidance for Music Therapy with young children with Selective Mutism. An open, flexible, multi-modal approach, integrating teamwork and considering transdisciplinary practice, is indicated. The need for improved training for Music Therapists and the potential role of Music Therapy on the Care Pathway for Selective Mutism is demonstrated.