SELECTIVE MUTISM
Selective Mutism (SM) is an anxiety disorder
that typically appears before the age of 5.
Many children are not diagnosed until they begin school, as they
typically talk to immediate family members living in their household. These children present as extremely shy, and
find themselves unable to talk in social settings. It is not a refusal to talk, but an emotional
inability to talk. Some of these
children struggle with maintaining eye contact or even giving non-verbal
responses to other people, such as nodding their head in response to a
question. Progress can be fast or very
slow, and must be measured by very small gains.
Children with SM are sometimes misdiagnosed with oppositional defiance,
but it is not an oppositional disorder.
Their inability to communicate in social settings stems from
anxiety. Often children with SM are also
diagnosed with social anxiety. Language
skills typically develop normally.
Academic skills are more difficult to determine due to the fear of
speaking, and as such, I have included some recommended accommodations that that
might be both helpful for the child’s academic advancement and academic
assessment.
When I read Individualized Education
Plans (IEP) and 504 plans, I have often noticed that the child’s behavior is
frequently characterized in terms of a refusal to engage in certain
behaviors. These children do not refuse
to engage in behavior, they are fearful of engaging in certain behaviors. Anything that draws attention to them or
makes them feel like they are standing out or targeted, will activate the
SM. Even being taken out of the class to
work with an individual that focuses specifically on them and that they may not
have developed a relationship with, will make the child shut down, a common
aspect of SM. Some children are even very
uncomfortable being pulled out of class for testing and may do much better
being allowed to take all tests in class.
If the teacher determines the child is not coping well with the testing
in class, the teacher can recommend that the child be pulled out at that
time.
Some IEP and 504 plans suggest that
the child avoids other children and does not make friends. I find that to be contrary to what many
children and their parents have shared with me. These children often have
friends in the neighborhood or through family that they play with, even if they
are not verbal. Again, it is not that
these children refuse to talk or engage in group activities, they are afraid to
talk or engage in certain group activities.
If gently guided to a group activity, some of these children will sit
with the group, and when comfortable, will interact nonverbally. Children that
have trouble gathering information they need for class activities may
benefit from being provided with a class
‘buddy” or having instructions written
down for them. Providing the child with their own white board to use for
written communication can also be very helpful. This way the child has the
opportunity to respond to written directives and can write a question if they
require more information to complete an activity. At some point, when the child is ready, they
can be recorded by a parent while reading so the teacher can assess their
reading. This can gradually be phased in
to the child being present while the teacher listens to the tape.
Some of these children are even very
uncomfortable showing their work, which is another manifestation of their
anxiety. It is not an oppositional
behavior. The child is very uncomfortable when they feel people are looking at
them, and this includes knowing that someone is looking at their work.
Given what I have read in many IEP
and 504 records over the years and some possible confusion about the nature of
SM and the best accommodation options for these children, the following
accommodation recommendations are provided as a guideline for your
consideration:
1.
Use the least
restrictive environment possible. It is
important for the child to feel part of the group.
2.
Allow nonverbal
communication such as pointing, head nodding, shaking head yes or no, thumbs up
or down to indicate yes or no. Using one finger for yes and two fingers for no
can also be very helpful.
3.
Use both verbal
and written alternatives for presentation of class material.
4.
Use video and/or
audio taping at home. This works better when set up and monitored with a
therapist.
5.
Place the child
in small work groups even if they do not appear to be participating.
6.
Use testing
accommodations such as taping reading fluency lessons at home with video or
audio tape as you work on a gradual introduction to verbalization in the
classroom. The following steps might
help in this process:
a.
Allow the child
to tape their lessons at home when they have reached a solid comfort level with
the teacher. They may refuse at first,
so give it time.
b.
Allow and
encourage the child to tape a verbalization with a parent present in the school
setting, maybe when their classroom in empty.
c.
Encourage the
child to tape part of a lesson on tape followed by whispering the lesson to her
teacher or mother within the class setting without other students present.
d.
Have the child
whisper the entire school lesson in the classroom with only the teacher present
and maybe a parent in the hallway or back of the classroom.
e.
Then have the
child whisper part of a lesson to another student they are comfortable with in
addition to the teacher.
f.
Attempt to have
the child verbalize an entire, but brief, lesson to the teacher.
Each individual step that may appear to be very small
is, in actuality, a huge leap for the child as they may feel the words are
stuck in their head even though they want to speak. Even the smallest of successes from a child
with SM, such as looking at the teacher or sitting with the group, should be
calmly and fully praised. Do not praise
the child for these efforts in front of others, but do so quietly and
privately.
7.
Provide related services such as speech and
language therapy, occupational therapy, and the services of an applied behavior
analyst.
8.
Do not single the
child out and make them the center of attention.
9.
Provide a
structured setting within the classroom routine. These children do better with predictability.
10. Provide a safe place in the classroom such as a desk
with a partition so the child can reduce all the stimulation from the classroom.
11. Do not expect the child to talk.
12. Do not comment to the child if you do hear them talk.
13. Provide a
“buddy” for the child that sits next to them and helps the child manage
classroom communication and expectations. Rotate the buddy weekly so the child
has interaction with several children in the classroom.
14. Ask the child questions requiring only yes and no
responses.
15. Do not pressure the child for eye contact and allow it
to occur naturally.
16. Give the family advance notice of any changes in
routine such as planned substitute teachers, guest speakers, and field trips. Allow a parent to be present during these
situations.
17. Weekly communication between the teacher and the
parents is very helpful.
18. Do not draw attention to the child but either talk
with her privately or positively comment on good behaviors in general. Stickers for success also work quite well.
19. Be aware that these children are sensitive to loud
noise or being overwhelmed by a lot of activity or chaos.
20. Explain to these children how you feel so they do not
have to guess, which tends to make them more anxious and uncomfortable.
21. Be concrete as children with SM often have difficulty understanding
abstract language.
22. Quarterly meetings with all related service providers
and the teacher are very helpful to both the teacher and the parents.
23. Minimize direct questioning in front of others.
24. Provide these
children with word prediction software to encourage them to communicate with
written responses that can be heard by the teacher.
25. Provide one-on-one time with the teacher to play a
simple and familiar board game or computer game. These familiar activities that are not
performance based may allow children with SM to become more comfortable and
transfer that comfortability to verbally engaging with the teacher. This may
have to occur several times to reach a higher level of comfort with the
interaction between teacher and child.
Please
keep in mind that progress may seem very minimal to the adults involved with
the child with SM. However, each minor
success builds a foundation for the next success and progress is progress. Plateaus are also not uncommon, and you can
use that time to reinforce what has already been accomplished. Although not yet mentioned, some children
respond better to treatment when they work with a psychiatrist and take
medication. Parents worry about
medication, but it is helpful and usually temporary. The medication often allows the child to
progress more quickly through the therapy process. Whatever you decide, be patient and advocate
for your child. Some schools are very
cooperative and unfortunately, some schools are not.