I would like to say that once I graduated college and begun my speech therapy career, I was an expert in everything related to speech therapy, but that is not the truth for any of us. One speech-language disorder that I had not heard much about was selective mutism. A colleague of mine had a child on her caseload with selective mutism and completed her research project on it, so when I ended up having a child on my caseload with selective mutism a year later, I turned to her for knowledge.
What is Selective Mutism?
Selective mutism is prevalent in 18 out of 10,000 people. According to the DSM-IV, diagnostic criteria for selective mutism include the following:
- The child does not speak in certain situations, environments, or around certain people/groups of people; however, the child speaks in other situations in which he or she is comfortable
- This language disorder negatively impacts his or her ability to function in educational and/or social settings
- The child’s selective mutism has persisted for a period of at least one month and is not a result of another communication disorder
Children who have selective mutism may appear stubborn, controlling, and disrespectful due to the fact that they may not speak in stressful situations. A child who has selective mutism may become so anxious in a certain situation that the child show characteristics such as freezing in place, not being able to speak, breaking eye contact, or shaking.
How Can I Help?
After months of research and a year’s worth of experience working with a child who has selective mutism, here are my top 10 tips for working with a child who has selective mutism:
- Gain rapport with the child. Spend time getting to know the child who has selective mutism, his or her likes and dislikes, and engage in fun as well as relaxed activities.
- Do not force the child to speak. Do not coax, bribe, single the child out, use demanding phrases, reward, threaten, or punish the child for speaking or not speaking.
- Let the child know that he or she will be able to speak when he or she is ready. Even though you are not expecting verbalization at first, that is the goal of speech-language therapy for the student. There are different stages of communication that progress towards vocalization:
- Stage 0: No responding/no initiating/frozen
- Stage 1: Nonverbal communication through pointing/nodding/writing/raising hand
- Stage 2: Verbal communication through sounds/grunts/whispering/getting someone’s attention (Shipon-Blum, 2002).
Make sure that the child knows that the goal is that he or she will be able to speak eventually without anxiety, but do not force it upon them.
- Educate staff about selective mutism. Hold an in-service at your place of work to discuss what selective mutism is, how to communicate with a child who has selective mutism, and how to help the child make gains in an educational environment without the pressure of speaking.
- Learn the situations in which the child feels comfortable and those where he or she feels uncomfortable speaking. Once you determine situations in which the child is comfortable/uncomfortable speaking, you have a starting point for speech therapy. Build off of situations that the student is comfortable speaking in and slowly add elements or peers in a safe environment to encourage verbal communication.
- Have a structured routine. Unstructured situations may cause a child with selective mutism to become anxious. Let the child know ahead of time of any changes in routine, visitors, or presentations.
- Designate a safe place. Have a safe place in your classroom or home, such as a beanbag, where the student can go to take a break.
- Teach strategies. Teach the child strategies such as using notecards, visual aids, thinking about answers in your head, telling the teacher if you need thinking time, and tell the child ahead of time if you might ask the child a question so he or she has time to think about it.
- Do not force the child to speak as part of an assignment. Give credit for written work, allow the child to create a PowerPoint for a presentation, have the child record in front of a camera in a calm environment so he or she does not have to present in front of classmates and let the child use gestures or nonverbal communication to answer questions.
- Do not allow others to speak for the child. Sometimes it is okay to let a friend speak for the child with selective mutism if the child gives permission or whispers to another child. It is better that the child with selective mutism speak through another than not speak at all. However, if other children are jumping in to respond for the child all of the time, teach them that the child with selective mutism is learning to use his or her own voice more often and tell you himself or herself what he or she needs.
A career in speech therapy may help with the diagnosis of selective mutism and can be worked with a team including teachers, family and the individual.
Shipon-Blum, E. (2002). Understanding selective mutism as a communication anxiety disorder. Retrieved from http://www.selectivemutism.org/resources/library/SM_General_Information/Stages_of_Communication_Comfort.pdf
About the Author: Jessica Chase, M.A. CCC-SLP received her bachelor’s degree from Central Michigan University and her Master’s degree in Speech-Language Pathology from Western Michigan University. She currently works at a K-12 public school and also writes for her website Consonantly Speaking.
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