By Marie Tsilimos

What is Selective Mutism?

Selective Mutism (SM) is a relatively rare anxiety disorder that causes children to experience difficulties when communicating in certain social situations such as at school, with relatives or friends. Children with Selective Mutism typically speak in situations where they are comfortable, such as at home with family members and siblings or with select people. Selective Mutism is usually diagnosed between the ages of 3 and 6 years, however children can often be misdiagnosed or go through school undiagnosed.

Common Characteristics

  • Consistent refusal or fear to speak in certain social situations.
  • Physical symptoms of Anxiety.
  • Excessive shyness or self-isolation from social situations.
  • Oppositional Behaviour.
  • Difficulties with the development of speech and language skills.
  • Non-verbal communication such as gesture is used in situations where they have difficulty speaking.

The Do’s and Don’ts for Parents, Teachers, and Professionals

Do Don’t
  • Refer as early as possible or if you are unsure.
  • Refer to a Speech Pathologist and have the child’s speech and language skills assessed.
  • Refer to a psychologist for further assessment and treatment.
  • Give the child time to respond rather than talking for the child.
  • Provide the child with opportunities to communicate verbally or nonverbally without placing pressure on them.
  • Model appropriate language and responses for the child.
  • Stay neutral if the child verbally responds, rather than immediately praising them.
  • Work as a multidisciplinary team with speech pathologist’s, psychologists, parents/carers and teachers.
  • Include siblings or peers the child feels comfortable with in therapy, if possible.
  • Do not assume that this is a choice, and the child is just being stubborn.
  • Do not pressure your child to speak in social situations. E.g. “Say ‘hello’ to your grandmother.”
  • Do not bribe the child to talk. E.g. “If you tell me I will buy you a toy.”
  • Do not wait to see if the child will outgrow their silence.
  • Do not criticise the child for not talking.
  • Do not compare the child to siblings or peers that are always talking.
  • Do not ask the child multiple questions and expect immediate answers.
  • Do not choose activities that place expectations on the child to talk.
  • Do not catch the child off guard and ask them to read aloud or answer a question in front of the class.

Functional Impacts of Selective Mutism

  • Difficulties attempting or completing classroom tasks such as answering questions, reading aloud, or participating in group work.
  • Inability to express needs and wants to their teacher e.g. asking to go to the bathroom, letting the teacher know when they feel sick or have hurt themselves.
  • Difficulty initiating and maintaining conversation or play with their peers.
  • Difficulty forming and maintaining peer relationships.
  • Difficulties with learning and developing literacy skills required for reading and writing.

What can Speech Pathologists do?

  • Speech Pathologists can conduct an in-depth assessment of the child’s communication skills including receptive language (understanding of words and language), expressive language (use of words and language), pronunciation, play and social communication, attention and listening skills.
  • Speech Pathologists can work with families to help them obtain a language sample through storytelling or ask the parents to send through videos of the child in order to assess the child if they do not speak to the clinician.
  • Speech Pathologists can provide the child, families, and teachers with non-verbal forms of communication such as pictures or gestures to encourage communication as the child works toward verbally communicating.
  • Speech Pathologists can facilitate structured activities either with the family or at school where the child is provided with opportunities to communicate in small groups where they may feel more comfortable.
  • Speech Pathologists can help to create a behavioural intervention program for the child as well as assist with targeting any underlying speech and language difficulties.
  • Speech Pathologists can liaise with school staff and families to provide strategies such as offering choices, tips to develop the child’s confidence and other ideas to encourage engagement and communication in all environments, to ensure the success of intervention.

References

Catchpole, R., Young, A., Baer, S., & Salih, T. (2019). Examining a novel, parent child interaction therapy-informed, behavioral treatment of selective mutism. Journal of anxiety disorders, 66, 102112. doi: https://doi.org/10.1016/j.janxdis.2019.102112

Cleator, H., & Hand, L. (2001). Selective mutism: How a successful speech and language assessment really is possible. International journal of language & communication disorders, 36(S1), 126-131. doi: https://doi.org/10.3109/13682820109177871

Jemmett, M., Lanes, D., Jones, K., Bramble, D., Firth, C., Sage, R., … & Katz-Bernstein, N. (2014). Tackling selective mutism: A guide for professionals and parents. Jessica Kingsley Publishers.

Kovac, L. M., & Furr, J. M. (2019). What teachers should know about selective mutism in early childhood. Early Childhood Education Journal, 47(1), 107-114. doi: https://doi.org/10.1007/s10643-018-0905-y

Rozenek, E. B., Orlof, W., Nowicka, Z. M., Wilczyńska, K., & Waszkiewicz, N. (2020). Selective mutism-an overview of the condition and etiology: is the absence of speech just the tip of the iceberg?. Psychiatria Polska, 54(2), 333-349.