Question:

I am dealing with a 3rd-grade student with "selective mutism" (i.e., he talks at home, but not at school) He is above grade level in all areas. He is animated at school (raising his hand to "answer" questions by pointing, acting out, etc) and completes all his work. He has some friends and communicates with them through pantomime. Can you please talk about behavioral strategies for dealing with this? There is much controversy among the people who work with him about how we should respond to this at school. I think that there is a lot of enabling going on from home (his mother even brings his lunch and takes him out for a walk every day because he refuses to eat at school), but I don't want to make things worse by getting into a power struggle about the talking. Any ideas would be appreciated.

Answer:

(The Not So Lonely Anymore (but still needs new friends) Behavior Specialist enlisted the help of her friend and colleague, Lynn Roberts, M.A. CCC, who is an authority on selective mutism, to answer the question this month.)

Selective Mutism is an anxiety disorder and should be treated as such, rather than as a communicative disorder. A student who has Selective Mutism needs a special education team to work with him or her in a coordinated fashion. The team should be made up of a mental health professional, Speech-Language Pathologist (SLP), general education teacher (in the case of this student who is doing well academically) and parents. The mental health professional should consider medications and counseling for the anxiety disorder. The SLP should observe the student's communication and develop a program of expanding his current communicative behaviors, working with the other team members.

Everyone will need to collaborate to prioritize goals, encourage the student and reinforce progress. Systematic desensitization has been helpful with some students who have this disorder; coercion and bribing are consistently counterproductive.

Without seeing the student, it is impossible to say exactly what will be effective. However, one way to begin could be to work toward his eating lunch at school. At no time should speaking aloud be a goal in this procedure; it might be a goal at a later time, with the agreement of all IEP team members. The goal is to help him be more comfortable in the social situation of eating with non-family members. Here's an example of a sensitization plan:

Talk with his mother about this goal

Begin with her having him eat closer and closer to school, eventually making it in to the playground

When he has been able to eat on campus (not necessarily in the lunch room), encourage the student to invite a friend to eat with him

Continue this process until he is able to eat regularly with his classmates.

This process could take several months.

The following references may be helpful:
Selective Mutism and Communication Anxiety in Children, Shari A. Gross, M.A., CCC-SLP, e-mail at SLPShari@aol.com

ADVANCE, for Speech-Language Pathologists &Audiologists, 2-11-02; Selective Mutism in Children, Tony Cline and Sylvia Baldwin, Singular Publishing, San Diego, 1-800-521-85