Helping children with selective mutism can be arduous and challenging. It can be difficult to grasp why a child does not talk in certain situations – and desperation and frustration may follow treatment attempts.
Seek first to understand – and effective strategies for making progress will follow.
Selective Mutism Defined
Selective mutism is a psychiatric diagnosis that applies to children who have a persistent failure to speak in school and social settings, despite being verbal elsewhere.
- Selective mutism occurs in up to 2 percent of early elementary school children, at a rate of 7.1 per 1,000 students in the U.S. Though it typically appears before the age of five, a firm diagnosis may not be made until a child is seven or eight.
- Characteristics of selective mutism include fear of social embarrassment, social isolation and withdrawal, negativism, temper tantrums and in some cases, disguising of voice or speech. Children with selective mutism may also have difficulty responding nonverbally, be slow to respond, or have an excessive tendency to worry or be fearful. They may exhibit a blank facial expression, appear to be staring into space, make reduced eye contact, or have a frozen or “deer in the headlights” look.
Children with selective mutism do not lack language skills, but they are unable to execute them in certain situations. Your role as a speech-language pathologist is to:
- Accurately assess a child’s communication level.
- Educate and counsel parents, family members and teachers.
- Design and implement treatment based on your assessment.
Treatment and Interventions
A wealth of information on working with children who suffer from selective mutism is available:
Therapeutic intervention may include:
- Play therapy for young children. Utilize games, pretend situations and coloring materials to allow children to feel comfortable without initial communication.
- Allowing a student to take the lead. Do not focus exclusively on verbal responses until a child feels secure and comfortable.
- Music and art. These can be wonderful tools for promoting interaction and communication.
- Successive approximations. As treatment progresses, use sign systems, verbal cues and one-word responses leading to full sentences.
- Relaxation, breathing and positive imagery techniques. These will help ease anxiety, which can be a major underlying factor in selective mutism.
It is important that a school considers a child’s needs throughout the day.
- Make sure that all adults who work with a child are aware of their difficulty. Provide them with accurate, up-to-date information about selective mutism and how to deal with it.
- Work to decrease a student’s anxiety. Keep them in mainstream classes, but don’t force them to speak. Give them opportunities for alternate activities, such as silent reading, writing and board games.
- Help children with selective mutism to communicate nonverbally. For example, they may use symbols, cards, email or gestures. For verbal reports, they might tape themselves at home and then bring the tape into school. Use a peer that a child can talk to as a bridge for initial communication and for need situations such as medical issues or use of the restroom. As much as possible, make sure the child is included in teams and groups. Provide plenty of praise for any attempt at communication.
As you design and implement strategies to help students overcome their speech/language challenges and build your school-based practice, call on the experts at Cobb Pediatric Therapy Services to enhance your toolkit of resources. Contact us today to learn more.