Speech-language Pathologists play an important role in interventions for students with selective mutism. Children with selective mutism often talk normally in settings where they are comfortable, like home. In other places, such as school or the community, they can’t speak due to anxiety. A first step in treating these children is to remove all direct pressures to speak in the “uncomfortable” settings. The school-based speech-language pathologist not only provides services but also gives recommendations on accommodating the communication needs of children with selective mutism in the classroom.
Since selective mutism is essentially a social anxiety disorder, your goal to find low-stress ways for the child to communicate. These students are often diagnosed as they enter their first school experiences and the speech-language pathologist can play a pivotal role in helping students thrive in the school setting and in assisting classroom teachers in developing an intervention plan for these students in the classroom. This list of possible accommodations includes things that adults can do when they communicate with the child and ways of making the child more comfortable communicating in the classroom environment. Most children with selective mutism can participate in regular education environments with appropriate accommodations, supports, and modifications.
The Adult’s Communication
1. Offer forced choices in your questions. For example, instead of asking open-ended questions that require more extensive verbal responses, give response choices within your question. For example, ask “do you want James or Ellen to be your partner?” instead of asking “who do you want for a partner?”
2. Watch your nonverbal communication. Communicating with a child with selective mutism can be inherently frustrating for some adults but it is important that we don’t communicate this frustration with our body language or tone of voice. When the child is communicating with you in whatever way they are comfortable, make sure your nonverbal communication is welcoming and supportive by smiling, nodding and maintaining eye contact.
3. Make your verbal messages supportive and productive. Well-meaning adults may want to say, “speak up, no-one can hear you” or “stop being so shy” but these are not productive messages and can make the child feel more anxious.
4. Repeat what the child communicates to you in a loud voice so that other students can hear you and will know what the child has said.
5. If the child is communicating verbally, allow 5-8 seconds of response time while the child gets their thoughts together. We want them to see that we do expect an answer and are prepared to wait while being supportive. If you wait 5-8 seconds and still don’t get a response, you can repeat the question or state it a different way (e.g., instead of open-ended try forced-choice.) Try not to guess what the child wants. We really want the child to learn that they need to tell people their needs and desires.
The Child’s Communication
- Accept whatever communication the student is willing to give to you. If they will gesture or point, have them point to items they need or give you a thumbs up/down to indicate their likes and dislikes. Some students with selective mutism use a whisper voice. Requesting that they use a loud voice may actually make them more anxious. If they are willing to use a whisper voice, accept it as an entry point!
- Assess the preferred communication settings of the child. Assess what environments (large group, small group, individual etc.) the child is most comfortable in and do as much learning as possible in these settings. However, don’t avoid large group learning if the child can participate in it with accommodations.
- Assess the preferred peers of the child. Give the child opportunities to have input into who they’d like to sit near or play near in the classroom. If possible, encourage relationships among these peers in your speech sessions, friendship groups or for play dates.
- Establish a mode of communication that the child is willing to do that is least restrictive. Possible modes of communication include using a whisper voice, choice boards or other low tech picture boards, pointing, gesturing and nonverbal communication. If the child is able to write, perhaps they will communicate by writing their responses or questions in a notebook or on a laptop. Be sure to have a way for the child to communicate essential needs such as going to the bathroom by giving them a bathroom card they can hold up when they need to use the restroom.
Interventions and School Management
- Remember that selective mutism is a performance deficit not a knowledge deficit so plan your interventions accordingly. Reading social stories about using a loud voice is not typically a productive intervention. The child knows they need to use a louder voice. The issue is not one of not knowing, it is one of not feeling comfortable in using a louder voice.
- The SLP and general education teachers can brainstorm accommodations for classroom times that typically require speaking (show and tell, sharing times, answering questions in class) and involve the student in this process. There are many options to consider. Have the child pre-record his presentation via audio or videotape? If it’s a group presentation, can the child have a role that is not communicative (showing how to do something versus telling, making the posters or other visuals for the presentation)? Can you use speech-generating AAC devices- pre-record with the response? Be creative and involve the child!
- Be alert to new or special situations that might be uncomfortable for the student. Have the teacher leave special notes for any substitute teachers to avoid difficult situations for the child. Encourage the child to let school staff know of situations they are worried about-field trips, birthday celebrations, changes in schedule: these are possible things that the child with an anxiety disorder may have concerns about.
- Build confidence by recognizing the child’s special skills or areas of expertise. I have a student who is talented at puzzles. When his peers are having difficulties with a puzzle and ask me or an adult for help, I often refer them to my student with selective mutism: “ask Lucas if he will help you, he is a puzzle master!”
- Plan, plan! Plan for a good classroom teacher match and plan for transitions to new schools! Work with your school psychologist to plan for re-evaluations! Are you anticipating an IEP or 504 plan? Does your state require a medical diagnosis for a student to have a 504 plan? Give the parent ample time to get this diagnosis.
By providing supports and accommodations, we can make school a more comfortable place for our student with selective mutism!
Please check out the Selective mutism association’s position on treatment, for further treatment ideas and of course, ASHA.