Tips for Working with Children with Selective Mutism

February 4th, 2016

Selective Mutism | Cobb Pediatric Therapy Services

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:

Selective Mutism Foundation
Selective Mutism Center
Selective Mustism

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.

Related Content: A Look Into School Anxiety…Why Children Say They Don’t Want to Go to School

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.

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Key Tips and Strategies for Improving Fine Motor Skills

January 29th, 2016

Improving Fine Motor Skills | Cobb Pediatric Therapy Services

Fine motor skills are small movements that have a large impact on hand coordination and strength. Lacking the functional use of the small muscles in the hands and fingers can hinder a child’s ability to perform everyday tasks, but fine motor skills can be developed through consistent practice.

Common Fine Motor Skills Activities

  • Finger painting
  • Interlocking construction toys
  • Popping bubble wrap between two fingers
  • Playing with modeling clay
  • Squeezing sponges or water spray bottles
  • Coloring with short broken crayons
  • Paper dolls
  • Stringing beads or macaroni
  • Squeezing foam balls

Not all students will respond the same to fine motor skills development therapy. Help students gain confidence and independence by making the activities and best practices as effective as possible

Key Tips and Strategies for Improving Fine Motor Skills 

Provide Options

Make the process fun and engaging for children. The more variety in activities that is available to students, the more likely it is they will become interested and engaged in the tasks at hand. Prevent boredom by switching up the activities and rotating them out on a regular basis and having different options available at any given time. Get involved and act enthusiastic during the activities at times, rather than only evaluating and assessing.

Customize Activities

Go with the flow and observe what type of activities each student tends to gravitate toward, and rework your plan accordingly. For example, some children may be excited by creative art projects and bored by construction toys, like blocks or Legos, while others don’t enjoy crafts but like independent play. Recognize there is no “one-solution-fits all” and develop different session plans that have a focus on each individual category to provide to students with definite preferences. Think outside the box in terms of presentation – for example, perhaps incorporate a more creative twist to construction games the more art-minded student by including a variety of colors and framing it as a more artistic project.

Incorporate an Overall Experience

The more useful and applicable to everyday life you can make fine motor skills activities, the more students can eventually understand the purpose behind them. Integrate activities into every aspect of your program session. Have students sign in by writing their name on a board, hang up their jacket or sweater on a hook, or cut out and hang shapes as a way to mark their accomplishments. When developing your overall routine, brainstorm for every fine skills development activity that could be “hidden” within the session, especially for students who may be resistant to obvious strength exercises.

As a school-based therapy placement company, Cobb Pediatric Therapy Services is devoted to providing support to encourage the professional growth of our therapists. Learn more about the services we offer – contact us today.

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Managing Classroom Stress | How to Stop Sweating the Small Stuff

January 25th, 2016


Working with students can be very rewarding, but it comes with its own set of challenges and pressures that can build up and cause significant stress. From the daily in-class struggles to lack of work-life balance from evening and weekend classroom planning, the stress can serve as a major distraction from your end goal of positively affecting the lives of your students.

Left Unchecked, Classroom Stress Can Lead to:

  • Physical issues – getting sick more frequently, fatigue, headaches, upset stomach, chest pain, trouble sleeping
  • Emotional issues – irritability, anger, disorganization, feelings of hopelessness, depression

Tips to manage classroom stress effectively:

  • Determine the Triggering Issues
    Take control of your stress by systemically evaluating your classroom situations to get to the main causes. Once you narrow down what’s contributing to your stress, you can focus on the issue and figure out plausible options to help improve it.
  • Form a Support System
    Keeping all of your stress to yourself can become overwhelming and cause you to lash out at the very people whose help and attention you could use most. Reach out to other teachers so you can vent and offer advice or emotional support to one another, or have a trusted friend to confide in.
  • Incorporate Relaxation into Your Classroom
    Utilize stress reduction techniques for immediate issues at hand in the classroom. Relax your body and breathe deeply, schedule quiet break times, and focus on changing your mindset from frantic to peaceful.
  • Have a Healthy Wind-Down Ritual
    Give yourself an outlet to release your classroom stress when you get home each day. Physical activity, taking part in a hobby, or talking with family or friends can help you relax and leave school troubles behind when you leave the building. Having something enjoyable to indulge in can simply keep your spirits up.
  • Remind Yourself of Why You Do It
    Prevent yourself from getting bogged down with short-term stress and focus on the rewarding aspects of teaching that make it worthwhile. Visualize your proudest achievements and think about your goals to remind yourself of why it’s worth it – even if the stress feels overwhelming in the moment.

Since 1989, Cobb Pediatric Therapy Services has been providing staffing solutions for speech, occupational, and physical therapy. For more resources to make your school-based therapy practice more efficient and less stressful, review our posts or contact the Cobb Pediatric Therapy Services team today.

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Speech Therapy Apps: Comprehension Therapy

January 22nd, 2016

Comprehension therapy is a treatment for aphasia to help individuals with communication deficits by improving their learning and understanding of common words so they can express themselves. It utilizes auditory and reading exercises for building or reestablishing their knowledge base of single words, sentences, and conversational cues.

A speech therapy app, Comprehension Therapy, is available from Tactus Therapy Solutions, Ltd. It is available for purchase at $24.99 for iPhone and Android devices and may offer a valuable solution to help your students become empowered and improve their ability to communicate their thoughts and needs.


  • The Comprehension Therapy app is multi-lingual and has three different modes, Listen, Read, and Listen & Read, to help keep pace with your students’ learning styles and advancement levels.
  • Over 700 words, including nouns, verbs, and adjectives
  • Three levels of difficulty
  • Automatic data collection
  • Ability to add custom photos and words
  • Helpful hints to provide context for exercises
  • Available in five different languages – English (US or UK), Spanish, French, and German


  • Evaluates single-word comprehension in seconds
  • Includes both reading and auditory comprehension within one app
  • Replaces need for numerous photo cards
  • Eliminates manual reporting through automatic score tracking for individual sessions and overall progress
  • Can be customized in both appearance and level of difficulty for student preferences and needs
  • Built-in scoring functionality with tracking of errors, repetition, and cue usage


The Comprehension Therapy app has been documented to be effective at improving the language deficits of people with chronic aphasia. When the Comprehension Therapy app from Tactus Therapy Solutions, Ltd. was used daily for a minimum of 20 minutes over four weeks, all users experienced at least some improvement, even up to 250% higher scores than before they started using the app, according to a study from Brielle Stark at the University of Cambridge.

Get the support you need for your accomplish your speech therapy career objectives with Cobb Pediatric Therapy Services. Our team of professionals can help you access the resources needed to make your current school-based speech therapy practice as effective as possible. Read our related posts or contact us today to learn more about what Cobb Pediatric Therapy Services has to offer.

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A Look Into School Anxiety…Why Children Say They Don’t Want to Go to School

January 20th, 2016

Many children experience anxiety related to going to school, which may manifest itself as complaints of not feeling well physically or outright avoidance by expressing refusal to go. These complaints may be signs of underlying issues that need to be addressed to ensure children receive the education they need without fighting through school anxiety.

Common Causes of School Anxiety Include

  • Transitional Difficulties – the start of a new school year or returning to school after vacation may trigger feelings of nervousness about change in routine. Personal transitions, such as coping with a new divorce, can also make children nervous about going to school because they’re afraid of being away from their parents.
  • Social Challenges – not having any friends or dealing with bullying can cause children to view school as a place of loneliness or isolation, rather than learning.
  • Learning Issues – struggling to comprehend subject matter may result in frustration or feeling of self-doubt related to school and make children want to avoid it altogether.
  • General Anxiety – there may not be an obvious cause to pinpoint, but rather general anxiety. This may be specific to school, such as being afraid of getting in trouble or answering incorrectly in class, or could be part of an anxiety disorder.

Teachers Can Help Alleviate School Anxiety By

  • Meeting with Parents – invite parents for a sit-down discussion to gain their perspective and get more insight into the child’s personal circumstances. The combined knowledge of the student in both home and school environments can help get to the root cause of the school anxiety and tailor your strategies accordingly.
  • Create a Safe, Inclusive Environment – be diligent about observing signs of bullying and intervene. Incorporate social or friendships into lesson plans to help lonely students feel more confident to approach Show approval for isolated students by interacting with them and laughing with or complimenting them, which may positively influence their classmates to do the same.
  • Providing Allowances to Alleviate Anxiety – if performance issues are causing students to struggle with school anxiety, giving them extra time to work on assignments or spending more one-on-one time may help remedy their concerns.

If you are in need of assistance of resources to effectively handle anxiety in the classroom, the experts at Cobb Pediatric Therapy can serve as a knowledge base and support system for your school therapy career challenges. To learn more, read our related posts or contact us today.

Contact Cobb Pediatric Therapy Services

Tips for School Psychologists: Understanding the Early Warning Signs of Bullying

December 30th, 2015

Tips for School Psychologists: Understanding the Early Warning Signs of Bullying

Bullying causes severe emotional harm, and can destroy a child’s self-esteem and mental health. Whether it is verbal, physical or relational, bullying has equally devastating long-term results. Recent reports confirm that bullying is starting at increasingly younger ages and is more frequent and aggressive than ever before. Every day, 160,000 children skip school because they fear being attacked or intimidated by other students.

Also troubling is the fact that often, children don’t report bullying. Their reasons include embarrassment or fear of retaliation. So it’s important to recognize the early warning signs of bullying to help prevent and effectively respond to it.

Warning Signs

Students who are being bullied may exhibit these warning signs:

  • Have torn, damaged or missing pieces of clothing, books or other belongings.
  • Have unexplained cuts, bruises or scratches.
  • Have few, if any friends with whom they spend time.
  • Seem afraid of coming to school, walking home, riding the bus or taking part in organized activities.
  • Lose interest in or suddenly begin doing poorly in school.
  • Appear sad, moody, teary or depressed.
  • Complain frequently of headaches, stomachaches or other physical problems.
  • Appear anxious or suffer from low self-esteem.
  • Avoid using school bathrooms, which can be hot spots for bullying.

They may even flip their role and become the bully, with smaller or younger children as their victims.

To effectively intervene, it’s also critical to be aware of characteristics of students who bully others. These individuals may:

  • Show a positive attitude toward violence.
  • Have a strong need to dominate and subdue other students and get their own way.
  • Be impulsive, aggressive or easily angered.
  • Lack empathy toward students who are bullied.
  • Be defiant toward adults, including parents and teachers.
  • Be involved in anti-social or rule-breaking activities such as vandalism, delinquency or substance abuse.
  • Have greater physical strength than others in general and the students they bully in particular.

At the core of bullying is a power imbalance. Bullying rarely happens only once and is always intentional and mean spirited. Victims cannot hold their own, so they need therapists and other adults to restore safety, security and normalcy to their lives.

For additional information and resources to assist in your school-based therapy practice, read our related posts or contact the Cobb Pediatric Therapy Services team today. And, have a productive and successful New Year.

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Occupational Therapy in the Winter Months: 4 Areas of Activities to Improve Your Classroom

December 23rd, 2015

Winter Occupational Therapy | Cobb Pediatric Therapy Services

How can you keep your students engaged in OT during the long winter months?

Try some fun activities.

After all, play is the occupation of children. Through the creative activities of play, they can develop themselves and at the same time, explore the world around them. Here are four areas to explore, along with related OT activities:

Sensory Integration

Sensory processing challenges can often be traced to the sense of touch, which involves the tactile system. The sense of touch offers feedback, allowing children to succeed in such basic tasks as using a pencil or zipping a jacket. Use these activities to aid in sensory integration via tactile system development:

  • Students can finger paint snowflakes, snowmen and other winter scenes.
  • Take children outside to play in the snow. If you can only imagine what that would be like, make snow angels on the carpet in your classroom.
  • Create snowmen, cookies and other items out of play dough.

Vestibular System Development

The vestibular system contributes to posture and the maintenance of a stable visual field. For instance, if you close your eyes while riding a roller coaster, you are aware that you are moving, as well as being aware of the specific position of your body. To develop the vestibular system, have your students:

  • Ice skate.
  • Take a sleigh ride.
  • Pass snowballs overhead or through their legs. (If you have to improvise, use Styrofoam balls.)

Proprioceptive Progress

Body position sense involves sensation derived from movement, muscle and joint perception. For instance, you are aware of which items you are holding in your hand, even with your vision obstructed. To assist students in this area; for example, to help them better climb playground equipment or hold a utensil, use these activities:

  • Shake a heavy snow globe.
  • Roll our cookie dough.
  • Dig snow tunnels.
  • Make a snowman.

Praxis Improvement

Many activities that help strengthen the tactile, vestibular and proprioceptive systems also aid in developing motor skills. Also known as praxis, this is the ability of the brain to conceive of, organize and carry out a sequence of unfamiliar actions. These activities help improve praxis:

  • Playing with constructional toys, such as Legos. Or, make a cookie house out of gingerbread.
  • Coloring and cutting shapes for winter pictures.
  • Creating an obstacle course in the snow to crawl under, over and through.

For additional ideas and tips to improve your school-based therapy practice, contact the team of OT experts at Cobb Pediatric Therapy Services. We’re therapists ourselves – and we offer a wealth of career and practice development updates and resources. Read our related posts or reach out to us today.

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Speech Therapy Apps: Naming Therapy

December 18th, 2015


Anomia, the inability to recall words and names, is one of the most common and frustrating results of aphasia for students who have suffered a related brain injury. The Tactus Therapy Solutions, Ltd. app Naming Therapy is designed for them: individuals who can’t find the words they need to effectively communicate their thoughts and needs.

You can significantly enhance the quality of your students’ lives by helping them recall items and develop the skills to describe them, if their names cannot be immediately retrieved. Priced at $24.99 for download on the App Store, Naming Therapy is a valuable addition to your speech therapy toolkit as you work toward achieving this goal.


Research has shown that the daily use of Naming Therapy significantly improves aphasia. The app includes four activities using nouns, verbs and adjectives and featuring 700 full-color photographs.

The activities, described in more detail, include:

  • Naming practice: More than 400 nouns are pictured. Each offers an evidence-based cueing hierarchy and optional self-scoring. The app records which cue was used to reach the correct answer and produces a score report, which can be emailed. You can use different cues to target confrontation naming, responsive naming, phrase completion, repetition and oral reading.
  • Describe: More than 580 pictures with four to six semantic and four phonemic questions prompt for feature analysis, phonological components analysis and expanding expression skills. You can add your own words and select from 25 prompts to accompany them.
  • Naming test: This includes a presentation of 30 pictures with scoring and a report. It provides a non-standardized test intended for screening students’ ability to name common items.
  • Flash cards: More than 700 full-color pictures include verbs and adjectives. You can touch the screen to hear a spoken word describing each picture, or actually see the word. You also have the ability to add your own pictures.

Additional features include:

  • The ability to limit words by syllable length, practice only the short ones, or target the long ones.
  • A recorded male voice that provides a neutral accent in five languages, with slow, natural speech for easy comprehension.
  • A child-friendly mode that turns off any references to alcohol or violence and deactivates links to outside sites on the home screen.
  • A database that enables you to turn each word on or off for further customization.

Five Stars!

Naming Therapy has been described as “great, fantastic” and “very practical” by therapists who have used it on a trial basis. Designed by a speech-language pathologist for use in homes, schools and clinics, the app was described by one professional as “very helpful for multiple children on my caseload who have difficulty using expanded descriptive language. Five stars!”

The Cobb Pediatric Therapy Services team of professionals can help you access the resources and tools you need to enhance your current school-based speech therapy practice – or take your career to the next level in the New Year. Read our related posts or contact us today to learn more.

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How to Maintain Classroom Attention with Winter Break Approaching

December 11th, 2015

childhood, family, education and people concept - smiling little girl and mother or teacher drawing with coloring pencils indoors

The countdown to winter break is on! It’s hard to stay focused yourself, much less keep your students’ minds on their work. This valuable December learning time doesn’t have to be wasted. Use these tips to keep classroom energy alive with some pre-holiday fun:

Maintain Basic Rules

How you close out 2015 will set the tone for your students’ return in January. Don’t let discipline go out the window.

  • Plan engaging projects. Include more independent work, which you can oversee while avoiding aggressive pressure on your students. These periods also will help you make the most of your remaining time at school before break.

Lead by Example

Let’s be honest: You, too, are counting down the days till winter break. There’s nothing wrong with that. But it’s not the attitude you want to convey to your students.

  • Maintain a positive attitude. Even if you’re already mentally on vacation, dig deep and find your professional self. If you have a new idea, approach or technical tool in your back pocket, pull it out and give it a try. It will keep things fresh for both you and your students.

Keep Expectations Realistic

Appreciate the extra energy students may have this month, and the fact that their focus may not be primarily on their work. Anticipate that they will need to blow off some steam.

  • Work some additional talk and movement into your plans. You can’t allow excessive rowdiness, of course. Students need periods of calm. But it may be unrealistic to expect them to stay quiet for long, extended periods. Plan for partner “chats” and alternate quiet times with activities.
  • Use that energy to your advantage. Build extra choreographed physical movement into your therapy sessions. Most children will find it invigorating. In fact, it may become one of your most effective ways of keeping them centered … whether you use hand clapping, foot stomping, singing, dancing or other methods. Create as much variety as possible to rein in those shortened attention spans.

Deck the Halls

An inviting classroom or work area with fun decorations creates an enjoyable environment. Get your students involved and brainstorm ideas around politically correct, school approved holiday themes.

  • Add seasonal notes to your lessons. For instance, you might identify the traits of evergreen trees, holly, snow or stars into your practices and activities. (Hint: Like most of these tips, this one is not limited only to this “most wonderful time of the year!”)
  • Have fun! Schedule interactive work at whatever time works best for you; for example, midway through or at the end of a therapy session. Use these times to reward students for staying focused. Acknowledge that you understand how tough it can be to concentrate on schoolwork with winter break imminent.

Work Smart Versus Hard

Give yourself a pre-holiday gift. You, too, deserve a life beyond work. This doesn’t mean dropping the ball – just working smart, versus overly hard.

  • Don’t load yourself up with work to do during your holiday break. You need to come back refreshed. Make this your New Year’s resolution.

At Cobb Pediatric Therapy Services, we’re therapists ourselves – so we know first-hand the challenges you face as you grow and advance your career. In 2016, we can help you take that career to the next level, or optimize your tools and resources in your current position. Read our related posts or contact us today to learn more.

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Depression Management: Understanding Emotional Development

November 25th, 2015

Depression Management: Understanding Emotional Development in Children

As a school-based therapist, part of your responsibility is accurately identifying students who show signs of depression – as well as making their loved ones aware and helping to steer them in the proper treatment direction. Accurately diagnosed, depression can be successfully managed. But left unattended, its consequences can be devastating or even fatal.

Signs of Depression

Children with symptoms of depression show behaviors that cause them severe distress and can manifest as problems in social relationships and difficulties at school. Watch for:

  • Intense sadness, irritability, anger or grouchiness. Sadness may be expressed through frequent bouts of crying or tearfulness.
  • Loss of interest in friends or daily activities that they formerly enjoyed. Difficulty with relationships may intensify into extreme emotions or hostility.
  • Hopelessness, persistent boredom, guilt, or low self-esteem or energy.
  • Extreme sensitivity to rejection or failure.
  • Frequent complaints of feeling ill, especially with a stomach or head ache. High absenteeism.
  • Unusually poor concentration or academic performance.
  • Talk of running away from home or resorting to suicide or other self-destructive behavior.

What You Can Do

When compared to their peers, students suffering from depression are not only more prone to being self-destructive, but they also are more likely to have unprotected sex or become substance abusers.

All children are naturally sad sometimes, but when their symptoms last for an unusually long time and interfere with their normal functioning, it’s time to step in and take action. Learn to identify their cries for help – and when they need immediate attention from you and/or other mental health specialists.

  • Actively observe the behavior of students whom you suspect may have depression. Consider how they behave alone and with peers, inside the classroom and on the playground.
  • Provide resources. Work with teachers, parents and other adults significant in the lives of your students. As you guide them down a treatment path, you can utilize and offer resources such as, the American Academy of Child & Adolescent Psychiatry at, the National Association of School Psychologists at www.nasponline,org, and the National Institute of Mental Health at

For additional resources to add to your school-based therapy toolkit, or to take your career to the next level as you plan ahead for the future, contact the Cobb Pediatric Therapy Services team. We’re therapists ourselves – and we can assist as you realize your ongoing career goals.

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