Selective Mutism and the role of a speech and Language therapist

“Why is a speech and language therapist involved with children with Selective Mutism? Are you going to make them talk?”

This is a question that I get asked a lot and I know that it can be confusing as to why we are involved with SM. As experts in stammering, which is anxiety based, it was suggested that we have all the tool with working with “communication” as well as assess (if needed) the child’s language, as a small percentage also have additional speech and language difficulties.

Therefore our role is:

  • Collaborative working with school, professionals like NHS SLT, Educational Psychologist in a GIRFEC meeting in order to look at the child’s need and parents/carers thoughts/reflections, coupled with professional expertise in this field.
  • Enable everybody’s learning about the child’s anxiety and communication style
  • Involve parents, staff and the child to establish a step by step communication programme
  • Have a clear picture of the child’s communication level
  • Have a talking map
  • Elimination of any maintaining factors
  • Introduce a behavioural programme of desensitisation and graded exposure based on her level of communication

I believe that SM is a social communication anxiety that is more than just not speaking.

With my approach families are provided with structured, individualized, step-by-step treatment. This will involve looking at all the various stages of social communication and mapping the speaking habits for a child with SM.

I offer a complete evaluation consisting of:

  • Parent and teacher assessment forms
  • Parent and child interviews
  • Evaluation and understanding of which stage the child is in during particular social encounters.

Treatment needs to address key points:

  1. Development of SM
  2. Factors such as influencing, precipitating and maintaining
  3. School and parents awareness and strategies
  4. What can be done at home, in school, and in the real world to help the child build the coping skills needed to overcome his/her social communication challenges?

Treatment is then developed via the whole child approach.  This means under the direction of the treatment professional, the child, parents, and school personnel work together.

Although anxiety lowering is key, it is often not enough, especially as children age. Over time, many children with Selective Mutism no longer feel anxious, but their mutism and lack of proper social engagement continue to exist in select settings.

Children with SM need strategies and interventions to progress from nonverbal to spoken communication.

Strategies and interventions are developed based on where the child is confidence speaking scale in a particular setting and are meant to be a desensitizing method as well as a vehicle to unlearn conditioned behaviour.

Relatives and friends of children diagnosed with selective mutism can have a major impact on the success of treatment for this disorder. A child needs love, support and patience as well as verbal and emotional encouragement.

Every child is different and therefore an individualized treatment plan needs to be developed to incorporate home (parent education, environmental changes), the child’s unique needs, and school modifications (teacher education, accommodations and interventions).


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