HELPING A CHILD
WITH SELECTIVE MUTISM 11/04

 Sandra Coiffman-Yohros, Psy.D, LMHC
North Miami Beach, Florida Advisory Board Member, Selective Mutism Foundation, Inc.

Treating children with Selective Mutism can be an arduous and difficult task for teachers, parents and professionals alike. It is difficult to understand the reasons why a child does not talk in the school or social settings, and frustration and desperation often follow treatment approaches.  If we can fully understand what Selective Mutism is, the etiology and most importantly the child, treatment progress should follow in a slow but steady pace.  As parents, teachers and professionals setting realistic goals and applying understanding, we can help children overcome this condition.

Based on my research and clinical experience, many children show a pattern of anxiety, social phobia as well as predisposing factors such as excessive shyness and slow to warm up temperaments.  These children, for the most part, are smart, inquisitive and highly observant of their environment and the interactions around them.

The treatment of Selective Mutism requires a “WHOLE APPROACH” incorporating social, educational, psychological and at times psychiatric interventions. The purpose of this paper is to give parents and professionals a framework as well as tools for working with Selective Mutism. It is important to be creative, have patience, understanding and be flexible in all your interventions. What might work for one child may not work for another. Therefore, an open mind and holistic approach are of utmost importance.

 THERAPEUTIC INTERVENTIONS:

• For young children a play therapy approach is recommended.The therapist should have enough materials such as games, pretend situations, and coloring materials to allow the child to feel comfortable without initial communication.

• Allow the child to take the lead.Do not force interaction or participation, and do not focus exclusively on verbal responses until the child feels secure and comfortable.

• Music and art are wonderful tools for promoting interaction and communication.
• As treatment progresses, work towards successive approximations such as a sign system, verbal cues, one word responses leading to full sentences as more language develops.
• Ask the parents what are the child’s favorite pastimes and activities and try to provide them in the office setting.
• Keep the focus on the child and the present moment.
• When the child talks in the office with ease, bring family members in to generalize verbal interactions.
• Remember, be creative. Use telephones, microphones, screens, puppets to allow the child a means of communication through projective approaches.
• Keep in mind that anxiety is a big underlying factor and promote safety, empowerment and security for the child.
• Incorporate enhancing self-esteem activities in the therapeutic setting.
• Teach the child relaxation, breathing and positive imagery techniques to help with anxiety.
• For some children a behavioral program set with tangible rewards works. Make sure there are a lot of small steps and frequent praise. Involve people, usually parents and siblings, with whom the child does speak.
• Keep open communication with parents and teachers to follow up treatment progress.

SCHOOL INTERVENTIONS: it is important that the school considers the child’s needs across the school day.

• Make sure all adults who are involved with the child are aware of the difficulty and most importantly, provide them with accurate, up to date information about Selective Mutism.  There are many professional that do not understand what Selective Mutism is or how to deal with it.
• Decreasing the anxiety

  -Do not force the child to speak
  -Keep the child in regular mainstream classes.
  -Give opportunities for activities that do not require spoken language (such as silent reading, writing, board games etc)
  -Allow the child to have a buddy system and participate in small group activities.

   

• Allow the child to communicate in another way

  -For example by symbols, gestures, cards, e mail.
  -For verbal reports, the child may tape themselves at home and then bring the tape to the school.
  -Use a peer that the child talks to in the class as a bridge for initial communication and for need situations, such as restroom use or medical needs.
  -As much as possible, make sure the child is always included in teams and group activities, regardless of verbal communication.-Keep schedule as consistent as possible, and advise the child in advance of any changes in routine or classroom activities.
  -Keep the child in the same small groups for classroom work. Switching partners frequently is not recommended.
  -Be consistent and provide a “firm-loving” hand.
  -Provide plenty of praise for any sound or attempt at communication the child makes.
  

HOME INTERVENTIONS: the home is a wonderful place to learn about social interactions and rules of behavior.

• Provide a safe and loving environment for the child.
• Accept the child for who they are.
• Do not use threats or punishments to get the child to talk.
• Be understanding and provide a secure environment for the child.
• Instill hope in the child, reassuring them that there is help and they can overcome their situation.
• Foster self-esteem and empowerment.
• Provide the child with plenty of opportunities to explore extra-curricular activities, such as swimming, gymnastics, art, theater or dance. This will allow them to find pleasure in activities, practice their strengths and foster self-esteem.
• Provide opportunities for after-school play-dates. Invite a peer that the child likes to the home, allow them free time to play and interact. Once the child talks to this peer freely, take them to the park or outdoors to promote communication outside the home.
• Keep bringing different peers into the home (one or two at a time) and follow steps above to generalize communication to other places and people. Once a peer group has been established, consider having the play-dates at the other child’s home.
• When taking the child to social activities, such as birthdays, school plays etc., arrive early, allow the child time to “check out the environment”, feel comfortable, and slowly warm up. Do not force them to interact or play.
• The biggest challenge as a parent is knowing when to “push the child” and “when to let go”. You want to provide opportunities for socialization and not reward isolation and withdrawal. This is done in a slow and caring manner.
• Teach the child relaxation techniques, positive imagery and incorporate physical activity into their daily routine. This will help reduce the anxiety.
• Role-play situations that are anxiety provoking at home. This will help you understand their difficulty as well as giving them social skills.
• Provide plenty of praise and social rewards for communication.
• Seek advice and help form professionals in your area.
• If family conflict, trauma or dysfunction is present, consult a professional and attend family therapy.
• Establish a support network for you as a parent. Children perceive their parents anxiety and frustration. Take care of yourself so you can care for your child.

PSYCHIATRIC INTERVENTIONS: if the Selective Mutism is causing significant impairment and no progress is seen in treatment, consult a child psychiatrist for medication management. Medication is not the cure, but is one more tool. Always as part of an integrative “Whole Approach”.

The Do’s and Don’ts for Selective Mutism
10/04
Adina Newman
B.A. Psychology
Exemplary Advisory Board Member |
Selective Mutism Foundation, Inc.

DO’S

• Encourage children to speak in social settings.  You can do this by saying “you can talk to me because you will feel better after you do”.

•  Always give children the opportunity to participate in class even if they say one word.

• Try a reward system, e.g. children who say a word in class at least twice a week will be given an ice-cream party (class mates want to have an ice-cream party so that will encourage a child to speak in class).

• If children use gestures such as nodding their head or pointing, tell them that they are doing a good job.  Also, encourages them to speak.

DON’TS

• Never bribe children just so that they will speak.  If a reward system is used, be careful of what you do to help children. 

• Do not yell at children for not speaking.  This just makes them feel more anxious and insecure about themselves. 

• Do not lie to children.  If they need more improvement with speaking up, tell them.  They need to know how you're feeling and, they are also aware of the fact that they are not speaking very much.

• Do not have other people talk for the child experiencing Selective Mutism.  This does not help the child at all. 

• Do not ask a child to bring in a cassette tape that will play his/her voice on a tape recorder unless the child says that it is ok.

• Do not be critical of these children.  This will only intimidate them more.

• Do not assume that a child does not understand you because they do.