Psych CASC / OSCE · General adult psychiatry — anxiety disorders
Explain selective mutism and a school speech plan (not forced assembly talking) — CASC communication station
MRCPsych/FRANZCP-style communication station: explain anxiety-based selective mutism, school-inclusive behavioural plan, accommodation reduction, benzodiazepine limits, optional SSRI framing, and check understanding.
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Target exams
Station brief
Format. Communication station, approximately 7–10 minutes active time after reading. You are the psychiatry registrar in the child outpatient clinic. [1]
Candidate instructions. Explain selective mutism in plain language (anxiety-related difficulty speaking in some places despite speaking in others), why "stubborn elective silence" is not the modern framing, the rationale for graded practice speaking at school with teacher involvement, why public forced talking is not the plan, optional medicine discussion at high level, expected hard work and benefits, and safety-netting. Check understanding and invite questions. The examiner plays a parent. [1][2][3]
Candidate scenario
Your patient meets criteria for selective mutism with home speech and prolonged school silence. School staff answer for her; parents fear she will be shamed. You plan collaborative hierarchy work, reduced accommodation, school liaison, and discussion of SSRI only if severity or limited response warrants specialist care. [1][2]
Marking domains
- Empathy, structure and agenda-setting
- Accurate plain-language explanation of selective mutism as anxiety-based
- Clear distinction from pure naughtiness without dismissing school impact
- Graded school speech plan and accommodation reduction explained without jargon overload
- Forced public speaking declined without shaming parents
- Optional SSRI framed with monitoring language when appropriate
- Checks understanding and collaborates with school plan [1][2][3]
Reveal assessor key
Open and agenda-set. Name time; ask parents' main fears (being blamed, forced assembly talking, medication side-effects). [1]
Explain diagnosis. "Selective mutism means a child can speak in some places — for your daughter, at home — but gets stuck and cannot get the words out in other places where speaking is expected, like school. We understand this as anxiety, not choosing to be difficult." [1]
Explain the plan. "The treatments with the best support use small steps to practise speaking where it is hard, including at school, while we coach adults not to always answer for her so she gets chances to try. We do not put her on a stage and force a public performance." [2][3]
Medicine discussion. "Tablets are not usually the first or only step. If anxiety is still severe after skills work, specialists sometimes consider an SSRI such as fluoxetine carefully, watching for side-effects including feeling more agitated early on — not a guarantee of instant speech next week." [4]
Close. Summarise, teach-back, written step plan with school, follow-up booking, who to contact if mood worsens or school crisis escalates. [2][3]
References
- [1]Muris P, Ollendick TH Children Who are Anxious in Silence: A Review on Selective Mutism, the New Anxiety Disorder in DSM-5 Clin Child Fam Psychol Rev, 2015.PMID 25724675
- [2]Bergman RL, Gonzalez A, Piacentini J, Keller ML Integrated Behavior Therapy for Selective Mutism: a randomized controlled pilot study Behav Res Ther, 2013.PMID 23933108
- [3]Oerbeck B, Stein MB, Wentzel-Larsen T, et al. A randomized controlled trial of a home and school-based intervention for selective mutism Child Adolesc Ment Health, 2014.PMID 32878377
- [4]Black B, Uhde TW Treatment of elective mutism with fluoxetine: a double-blind, placebo-controlled study J Am Acad Child Adolesc Psychiatry, 1994.PMID 7961338