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
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:
- academic reports
- parent/teacher comments
- previous testing (e.g., psychological)
- standardized testing
The hearing screening seeks information on:
- hearing ability
- possibility of middle ear infection
The oral-motor examination seeks information on:
- coordination of muscles in lips, jaw,and tongue
- strength of muscles in the lips, jaw, and tongue
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;
- creating a behavioural treatment program
- focusing on specific speech and language problems
- working in the child's classroom with teachers
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:
- target problems that are making the mute behaviour worse
- use role-play activities to help the child to gain confidence speaking to different listeners in a variety of settings
- help those children who do not speak because they feel their voice "sounds funny"
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