Selective Mutism

2 October, 2013

Selective mutism (formerly known as elective mutism) usually happens during childhood. A child with selective mutism does not speak in certain situations, like at school, but speaks at other times, like at home or with friends. Selective mutism often starts before a child is 5 years old. It is usually first noticed when the child starts school.

What are some signs or symptoms of selective mutism?

Symptoms are as follows:

consistent failure to speak in specific social situations (in which there is an expectation for speaking, such as at school) despite speaking in other situations
not speaking when it interferes with school or work, or with social communication
when it lasts at least 1 month (not limited to the first month of school)
when failure to speak is not due to a lack of knowledge of, or comfort, with the spoken language required in the social situation
not due to a communication disorder (e.g., stuttering)
it does not occur exclusively during the course of a pervasive developmental disorder (PPD), schizophrenia, or other psychotic disorder

Children with selective mutism may also show:

anxiety disorder (e.g., social phobia)
excessive shyness
fear of social embarrassment
social isolation and withdrawal
not due to a communication disorder (e.g., stuttering)
it does not occur exclusively during the course of a pervasive developmental disorder (PPD), schizophrenia, or other psychotic disorder

A child with selective mutism should be seen by a speech-language pathologist (SLP), in addition to a paediatrician and a psychologist or psychiatrist. These professionals will work as a team with teachers, family, and your child.”

What we do…

The assessment process is very important and includes:

gathering a complete background history
an educational history review
hearing screening
oral-motor examination
parent/caregiver interview
perform a speech and language evaluation

The educational history review seeks information on:

The hearing screening seeks information on:

The oral-motor examination seeks information on:

The parent/caregiver interview seeks information on:

any suspected problems (e.g., schizophrenia, pervasive developmental disorder)
environmental factors (e.g., amount of language stimulation)
child's amount and location of verbal expression (e.g., how he acts on playground with other children and adults)
child's symptom history (e.g., onset and behaviour)
family history (e.g., psychiatric, personality, and/or physical problems)
speech and language development (e.g., how well does the child express himself and understand others)

The speech and language evaluation seeks information on:

expressive language ability (e.g., parents may have to help lead a structured story telling or bring home videotape with child talking if the child does not speak with the SLP)
language comprehension (e.g., standardised tests and informal observations)
verbal and non-verbal communication (e.g., look at pretend play, drawing)

Once assessment is complete our speech and language Pathologist will  offer intervention. This may be a combination of strategies including;

A behavioral treatment program may include the following:

Stimulus fading: involve the child in a relaxed situation with someone they talk to freely, and then very gradually introduce a new person into the room
Shaping: use a structured approach to reinforce all efforts by the child to communicate, (e.g., gestures, mouthing or whispering) until audible speech is achieved
Self-modeling technique: have child watch videotapes of himself or herself performing the desired behavior (e.g., communicating effectively at home) to facilitate self-confidence and carry over this behavior into the classroom or setting where mutism occurs

For specific speech and language problems our therapist can:

Working with the child’s teachers includes:

encouraging communication and lessening anxiety about speaking
forming small, cooperative groups that are less intimidating for your child
helping your child communicate with peers in a group by first using non-verbal methods (e.g., signals or cards)
gradually adding goals that lead to speech

What you can do….

Working with your child, our therapist, and teachers to generalise learned communication behaviours into other speaking situations is essential for the success of intervention.