Screening & Informal Evaluation: Selective Mutism

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Are you planning for a screening or informal assessment for selective mutism?

What is selective mutism?

According to Asha, selective mutism is a childhood anxiety disorder. It is also known as “situational speaking.” A primary characteristic is a child’s inability to speak and communicate effectively in select social settings, like school. A child’s symptoms of reluctance to speak can vary greatly. Some never talk outside the home, some whisper, and others speak with a select few people. The “individual has not elected to withhold the ability to talk in all situations; rather, the individual selects the situations and people with whom they verbally communicate” (Richard, 2011, p. 8).

What is the SLP’s role in assessment of selective mutism?

Speech and language therapists have a role in the assessment, identification and management of selective mutism, working in collaboration with school staff and other professionals. A screening for selective mutism is indicated whenever selective mutism is suspected or as part of a comprehensive speech and language evaluation . If a child is communicating successfully at home but not in one or more settings, consider the evaluation for selective mutism.

Gathering the case history, conducting observations and conducting a parent/caregiver interview are vital parts of the evaluation process. According to ASHA, the screening or informal portion of the evaluation typically includes:

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1. Interviews with parents and caregivers.

An interview with parents/caregivers is conducted without the child present. Gather this information:

Any suspected problems or existing diagnoses,
Environmental factors (e.g., amount of language stimulation, other languages spoken in the home),
How much and where the child uses verbal expression:
Who does the child talk to?
In what situations and settings is the child most likely to talk?
How does the child communicate?
The child’s symptom history (e.g., onset and behavior)
Family history (e.g., mental health, personality, and/or physical problems) and exposures to truama,
Speech and language development,
How the child manages stress, and
Educational history- academic reports, parent/caregiver and teacher comments, previous testing (e.g., psychological), and standardized testing.

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2. Interviews with teachers.

Teachers are busy! I like to forward them my teacher rating scale and give them plenty of time to complete it. Then, I find times where they can talk. With the scale in hand, we discuss the ratings and any other observations and concerns of the teacher. I also collect the following information:

How much and where the child uses verbal expression in the classrroom.
What children does the child talk to? Are there any adults in the classroom that the child gravitates towards during their day?
In what situations and settings is the child most likely to talk? 1:1, small group, in lines, at recess etc.
How does the child communicate? Verbally? Gestures? Written communication? Whisper voice? Pictures?
The child’s symptom history (e.g., onset and behavior in the classroom and/or in past classrooms, and
How the child manages stress in the classroom.

3. Observations

I perform observations of the child in multiple settings. I observe the child in a setting where they are comfortable speaking, (often the home) and a setting where they do not speak. If an in-person observation is not doable, the child can be videotaped in these settings. Try to observe how the child interacts with a new person. Determine what types of verbal and nonverbal communication the child is exhibits in different settings and situations. This information can be helpful for treatment planning and writing IEP goals and objectives.

I’ve put together a screening/informal evaluation tool together to give some structure to the parent/teacher interviews and observations that provide helpful information in the diagnostic process and for intervention planning.