Children with selective mutism (SM) suffer from a communication difficulty that makes it impossible for them to speak in certain social situations. This disorder is not the result of a physical inability to speak or understand language, although 35 to 75 percent of children with SM also present with language impairments, and 30 percent are bilingual. SM may develop in such cases because children recognize that they are having difficulty being clear, so they become mute as a means of self-protection.

Essentially, SM is a specific anxiety disorder that renders children unable to speak due to a fear of embarrassment and/or excessive shyness. It affects only about one percent of elementary school students, but for its victims, life can become devastating.

The Role of the SLP

To effectively address selective mutism, you need to think beyond the spectrum of physical speech output. This means helping children to phonate, articulate, and make sentences. It is best done in incremental steps to help them overcome the burden of SM.

According to the American Speech-Language-Hearing Association (ASHA), speech-language pathologists should be involved in the diagnosis and treatment of SM as part of a team that also includes a child’s pediatrician and psychologist or psychiatrist.

Teamwork is critical to an accurate diagnosis.

As the SLP, your evaluation should consist of an educational history, a hearing screening, an oral-motor exam, a parent/caregiver interview, and an assessment of speech and language skills.

Work with a child’s parents.

Ask them to help with your assessment by engaging in structured storytelling or verbal discourse on video. Simply playing and pretending with kids also can be helpful. Another tip: Receptive language may be easier to gauge, as responses often can be obtained through pointing or multiple-choice questions.

Take a behavioral approach to treatment.

Primary interventions found to be most effective include stimulus fading, shaping and self-modeling.

If there are speech/language difficulties, begin by focusing on positive reinforcement of speech production.

Gradually work to strengthen these skills. A coordinated home program is a big plus. You may want to check out this related online CEU course. Another excellent information source – along with the ASHA – is the Selective Mutism Foundation.

Cobb Pediatric Therapy Services is another terrific source for tips, tools and resources to build your school-based SLP practice. We’re therapists ourselves, so we have truly walked in your shoes. Read our related posts or contact us today to learn more.


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