Question:

We have a second grade student who fits the criteria for Selective Mutism. She has not spoken in school for her entire educational career. We need help in developing classroom modifications and in establishing alternative modes of classroom-based assessment (i.e., “How do we modify grades for reading fluency?)

Thank you, in advance, for your help.

Gwen Weiland, School Psychologist
Maki Itoh, MFTI

Answer:

Gwen, thanks for your question. I have enlisted the help of Virginia Sanchez-Salazar, an extraordinary Speech/ Language Pathologist at the Diagnostic Center (www.dcn-cde.ca.gov). She wrote:

Selective Mutism (SM) is a childhood manifestation of social anxiety disorder. Children with SM are anxious to the point that they actually exhibit a physical reaction and literally cannot talk in one or more social settings, including school, despite speaking in other social situations, such as at home. These children may also lack typical facial expressions because they are overwhelmed with fear and unable to participate in any way. Other children with this diagnosis may be able to participate in activities while remaining silent. Some anxious children may speak only when required but do not volunteer to speak and do not initiate interaction.

In many cases, these children have fully developed to age expectations in all respects; they tend to be intelligent, sensitive, introspective, and perceptive. However, some children with Selective Mutism may also have receptive or expressive language disorders, articulation disorders, or learning disabilities; they may be bilingual or come from bilingual homes.

For the majority of Selectively Mute children, inclusion in the regular classroom is important and necessary. Proper socialization and meeting the demands of the academics should be instilled from the beginning. A teacher who is patient and understands that the SM child is suffering from anxiety can help greatly by making special accommodations within the classroom setting. Such accommodations should allow the child the opportunity to develop a comfort level within the classroom in order to benefit from an optimal educational experience. Consider the following accommodations that have been shown to be helpful with SM children: Small group activities (in contrast to large group).

• Pair the SM child with a partner for classroom discussions.
• Allow the child to respond with nonverbal signals (such as pointing, head nods and shakes, thumbs up or down, eye contact, facial expressions, etc.).
• Allow the SM child to write answers to questions, instead of having to verbalize.
• Allow the child to TAPE RECORD lessons at home and/or alone in the classroom for the teacher to listen to later.
• Allow the child to take home grade appropriate work if she is unable to perform successfully in the classroom.
• When an oral presentation is required from the students, the SM child could meet this requirement by videotaping the lesson at home and then playing it for the class, or writing the presentation for the teacher or a classmate to read to the class.
• Provide some fun and motivating project periods, such as arts and crafts, which allow for comfortable, nonverbal peer interaction.
• Encourage the child to play on a computer with a buddy using interactive software that requires at least nonverbal interaction between the students.
• Provide the SM child with word prediction software on laptop computer to encourage her writing responses to questions in class that can be “heard” by all.
• Allow the parents to help in the classroom as much as possible for the SM child to feel more comfortable. Experience proves that the SM child will whisper to the parents rather rapidly, and over some time, with guidance, this can carry over to verbalization.
• Provide one-to-one time with the teacher (or speech/language pathologist, or psychologist) to play a simple, familiar board game or computer game. The relaxed atmosphere will allow the SM child to “open up.” Then, when the child is comfortable enough to speak in this situation, add one close friend in the room with the SM child and adult. Next, increase the peers to two in the same room with the SM child and adult, etc.

Alternative modes of classroom-based assessment will need to be established. For example, taping reading fluency lessons at home via video or audiotape is appropriate, assuming a gradual weaning to “verbalization” is taking place. Consider this sequence of steps:

• Allow the child to tape her lessons at home.
• Next, encourage her to tape in a classroom with her parent present.
• Encourage her to tape part of a lesson on tape, then whisper the lesson to the parent (or teacher) within the class setting.
• Next, have her whisper the entire school lesson in the classroom with only the teacher present.
• Increase to another student (a preferred friend), plus the teacher.
• Increase all to verbalization.

Each individual step is often a huge leap because the child feels that “the words just won’t come out” even through she desperately wants to speak to her peers. Even the slightest successes from the child—including looking at the teacher, or coming to the speech room—should be calmly but fully praised the adult.

A professional (usually a physician or psychologist) who is experienced in treating Selective Mutism should design an individualized treatment plan for the SM child. The treatment should not focus on getting the child to speak, but rather, to lower her overall anxiety, build self-esteem and increase her confidence in social settings. According to current research reports, the best treatment for Selective Mutism seems to be a combination of behavioral therapy and medication (such as a Selective Serotonin Reuptake Inhibitor). Over a period of 9 -12 months, the medication may help lower anxiety levels enough to allow the SM child to benefit from the behavioral treatment necessary to build long lasting coping skills and to overcome Selective Mutism.

A collaborative effort among the SM child’s treating clinician, school psychologist, teacher, speech/language pathologist and parents is essential in order to best help the child progress. Frequent “tweaking” of the treatment plan is necessary in order to find the best tactics.

Additional help in understanding Selective Mutism is available through the Selective Mutism Group-Childhood Anxiety Network (SMG-CAN) at www.selectivemutism.org. At this site, very useful and reader-friendly booklets (written by Dr. Elisa Chipon-Blum) for school personnel and parents are available including:

• “The Ideal Classroom Setting for the Selectively Mute Child.”
• “Easing School Jitters for the Selectively Mute Child.”
• “What is Selective Mutism? When the Words Just Won’t Come out: A Guidebook to Understanding Selective Mutism.”
• “Understanding Katie.”