All questions on this form are considered required, meaning you will not be able to move forward in the Brief SMCDQ if you do not answer a question.  If you do not feel a question relates to your child or you are not comfortable answering the question, please put "N/A" if it is a free response question, or select "No," or "None," if it is a check box/radio button question.

Brief SMCDQ

The Brief SMCDQ is used to help in the evaluation of the child with symptoms of Selective Mutism to help develop a diagnosis and treatment plan for the home, real world and school.

Demographic Information

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 Copyright © 2013 Dr. Elisa Shipon-Blum and Selective Mutism Anxiety Research and Treatment Center, Inc. (SMart Center) – www.selectivemutismcenter.org.  215-887-5748 
All rights reserved.
This material is part of Dr. Elisa Shipon-Blum’s Social Communication Anxiety Treatment® (S-CAT)® and is used under license.