Selective

Mutism
By Lauren Farrell
 What is Selective
Mutism?
 Selective Mustism (SM) is an Anxiety Disorder usually
effecting young children that is characterized by an
inability to speak or communicate in certain social
settings when they are normally capable of speech.

 SM is different than Social Anxiety or phobia Disorder

which is characterized by the fear or intense anxiety of
being judged, rejected or negatively viewed in a social
situation.

 There is often but not always a co-occurrence between

SM and Social anxiety
 How Do we know
when Anxiety
becomes a disorder?
 Frequency- The child experiences several symptoms consistently

 Duration-Symptoms have been present for a certain amount of

time. With SM the duration for diagnosis is one month, not
including the first month of school.

 Impairment-The symptoms are interfering with a child`s

development

 Discrepancy - how the child speaks/ does not speak in different

situations/environments
 recognize Selective
Mutism in our
especially when in astudents?
 Many children with SM may have frozen blank facial expressions,
situation that may expect them to speak

 Many have stiff and awkward body language with avoidance of eye
contact and seem very uncomfortable in certain environments

 May have difficulty staying on task, following directions,

completing tasks while in the classroom

 Many children with SM once comfortable with certain

people/places will play, interact and participate completely
normally for their developmental stage
 Misconceptions
about
Selective Mutism
Selective Mustism is not:

 A social Phobia

 Outgrown

 Just Shy

 Autism

 Oppositional or defiant

 A Learning disability

 A Language disorder

 Elective

 Related to abuse, neglect or trauma

 Facts about SM
 Often appears from infancy on as signs of severe anxiety such as separation
anxiety, frequent tantrums, moodiness, inflexibility, sleep problems and extreme
shyness.

 Approximately 1 in 140 children have SM and of these children 2:1 are female.

 Age of onset is typically around 3 or when the child enters school/ daycare for
the first time.

 Mean age of diagnosis is 6 years old.

 The majority of SM children are developmentally socially appropriate when in

comfortable environments, with parents often commenting on how talkative,
social, funny and even bossy their child is at home
 Why diagnosis and
treatment is crucial
SM left untreated can have an array of negative effects over the
course of a childs life:
 Increasing anxiety

 Depression and the manifestation of other anxiety disorders

 Social isolation and withdrawal

 Low self-esteem and confidence

 Underachievement in school and in the work force

 Self- medication

 Suicidal ideation
 Treating Selective
Mutism
 Cognitive Behavioral Therapy with adaptations for parent-child
interaction is the best way to treat children with SM.
 Most therapies focus on speaking and then working toward
generalization of speaking using positive reinforcement
 The goals of treatment include:

- Increasing the number of people, places, and activities that the

child is verbal with/in/during

-Build stress tolerance (both child and parent)

-Increase settings where the child speaks responsively and

spontaneously
 Selective Mutism at
school: What can we
 Remove all pressure for themdo?
to speak- avoid using the words “talk”,
“tell me”, “use your words”.
 Reassure the student that they won`t have to talk if they don`t want to

 Avoid asking any direct questions, if asking a question try to phrase it

in a way that can be answered with a single word response
 Don`t draw any unnecessary attention to the student

 Encourage non-verbal responses

 Don`t Comment if the child does talk (ie. Don`t say “good talking”)

 Don`t pressure the child for eye contact

 Help child initiate peer interaction

 The Stages of Confident Speaking

Stage Child’s Presentation Examples of behaviour

1 Does not communicate or
participate
2 Co-operates but limited
communication
3 Communicates through visual,
non-verbal means
4 Uses non-verbal sounds
Child may:
Observe activity from a distance or sit passively as
part of group
Accept help but make no attempt to seek assistance
or interaction
Child is able to:
Participate in non-verbal activities (e.g. puzzles,
board games) and may show enjoyment
Make limited choices (e.g. favourite food)
Comply with requests that are felt to be non-
threatening (e.g. pass an object, draw a picture)
Child responds and may even initiate contact through:
Pointing
Nodding/shaking head
Mime/gesture
Drawing/writing
Otherwise is silent, even when in pain
Child is more vocal and may use audible sound to:
Express emotion

Progression through the

Accompany play (e.g. transport, animal noises)
May seem close to speaking but not actually do so
5 Speaks within earshot of person Child may:
but not directly to them Talk to mother in same room as another person,
quietly or at normal volume
Talk to other children in classroom but not to a
teacher
stages
of confident speaking
Talk to family using telephone in public area
6 Uses single words with selected Child may:
people Respond to questions/prompts giving minimum of
information
Whisper when standing close
Read aloud or in a whisper, but use minimal
conversational speech
7 Uses connected speech with Child may be:
selected people Comfortable with certain adults and able to
communicate with them provided no one else is
perceived to be listening
8 Begins to generalise to a range of Child may:
people Continue speaking to a selected adult when others
enter the room
Talk normally at home in front of visitors
Talk to several children/adults in ‘safe’ settings
9 Begins to generalise to a range of Child may:
settings Speak to a selected adult outside ‘safe’ settings
within earshot of others
Talk more easily with family in community settings
10 Communicates freely Child:
Responds to, or approaches strangers in familiar and
unfamiliar settings
Contributes to class discussion
Volunteers information

Taken from ‘The Selective Mutism Resource Manual’ by Maggie Johnson&

Alison Wintgens
 SM in Older students
 Older students who have had SM for longer will be
accustomed to not speaking in certain places or to certain
people. Therefore SM is a long standing habit for the
student.
 Older students would benefit from Intensive Cognitive-
behavioral therapy.

 Students with a longer history of SM are more likely to be

prescribed medication to help them participate in therapy
 Older students with SM are also more likely to have other
disorders- social phobia, other anxiety disorders, depression
 Resources for
Selective Mutism
 https://childmind.org/guide/teachers-guide-to-selective-mutism/ A great resource
for all kinds of disorders, on the SM page it also covers SM in older students
 https://www.youtube.com/watch?v=6LJJ4xvYRJk A really great Video that gives in
depth information about the basics of selective mutism.
 https://www.amazon.com/Arohas-Way-childrens-through-emotions-ebook/dp/
B07SPWZXK5Ted Talk Selective Mutism: Tips for Teachers R. Lindsey Bergman,
PhD UCLA Cares Center
 https://www.amazon.com/Arohas-Way-childrens-through-emotions-ebook/dp/
B07SPWZXK5 Awesome children's story book about emotions, including how to
identify anxiety and simple effective ways to manage those feelings.
 file:///Users/Ren/Downloads/Selective_Mutism_-
_effective_approaches_to_assessment_and_management.pdf working with
Selective Mutism, great information with lots of practical information for the
classroom.