Selective Mutism

DO:

  • Openly acknowledge the child’s speech difficulty in an accepting and relaxed way, while stressing that the situation is only temporary;

  • Reassure the child they will find talking easier if they just take things slowly and try to join in one small step at a time;

  • If appropriate, visit the child at home to build a rapport in a non-threatening environment;

  • Encourage communication in a relaxed atmosphere, with no pressure on the child to actually speak, e.g. by warmly responding to attempts to communicate through gesture;

  • Allow the child to sit and work with friends they talk to within their own home;

  • Introduce alternative forms of communication (e.g. pointing, holding up a picture, using a dry-wipe board) as a temporary stepping stone while the child is finding speech difficult;

  • Include whole class or small group activities which do not require speech, making this clear before the activity;

  • Invite parents to take part in classroom activities to ease young children into talking at school;

  • Encourage parents to invite classmates home after school and during holidays;

  • Prepare the child for changes and transitions well in advance, with photos, visits and pictorial timetables;

  • Provide the opportunity rather than expectation to join in, e.g. ‘I love this colour - I wonder what your favourite colour is?’, ‘Look at this! I bet you haven’t seen one of those before’;

  • Try to find time to be with the child alone in a corner of the classroom or in a quiet room;

  • Set tasks which provide opportunities for speech in situations which the child may find less threatening, e.g. ‘Can you take [new child] to the pegs and show her where to put her PE bag?’; ‘Take Mummy to the hall and show her the models we’ve been making for assembly’, ‘Please help [less able child] tidy up - he’s not sure what he’s got to do’;

  • Actively support friendships with other children, making sure peers do not push the child to speak and understand he or she will speak in their own time;

  • Use puppets, masks, voice-activated toys and recorded messages to help reduce the fear of speaking;

  • At registration allow hands-up, involve whole class in a social activity or ask ‘Is [each child’s name] here?’ so that class can answer in unison;

  • Ensure relatives, supply teachers, playground and canteen staff understand the child’s needs and adopt a consistent approach.

DO NOT:

  • Be hurt or offended when children remain silent;

  • Beg, bribe or challenge the child to speak, nor let on how important it is to you to hear them talk;

  • Ask direct questions which put the child on the spot, especially when others are watching and waiting for an answer;

  • Look directly at the child after providing the opportunity to speak;

  • Anticipate the child’s ever need;

  • Give special attention for being silent, but reward effort to communicate, help or participate in whatever form that may take.

Eliciting Speech: Specific Techniques

All techniques are based on the behavioural principle of starting at minimal anxiety level and changing only one variable at a time, with the child’s full knowledge of what is about to happen. In this way, individuals can gradually tolerate conditions which collectively would cause great anxiety. After gradual exposure they are able to face situations they previously avoided without fear.

Sliding-in (stimulus fading)

The child talks to a trusted conversational partner (usually a parent) in a minimal anxiety situation and then on factor is changed - an anxiety trigger is introduced. If the child is relaxed to start with and the change is only slight, they can tolerate the anxiety trigger and keep talking. For example they can tolerate another person gradually coming closer and joining in the activity.

When this is carefully planned and broken into very small steps we call it ‘the sliding-in-technique’. At first the child talks freely to a member of their family with the keyworker outside the room; this is repeated with the door slightly ajar, then with the door open and finally with the keyworker inside the room. If the child is able to maintain some voice at this stage, the keyworker can move forward and join in the activity. Direct eye-contact is generally avoided until the child is talking more confidently. For children who understand the principles involved, the process is further facilitated by setting specific targets and starting with very short, undemanding turn-taking activities (such as counting to 10) which are gradually extended to longer sentences. After each target is achieved the child marks their progress with a sticker or tick.

The technique is complete when the parent reverses the procedure and ‘slides-out’, leaving the child talking alone with the key-worker.

Shaping

With this technique the speech target changes, rather than the proximity of their audience. The child starts by using pointing/gestures with a keyworker and then takes tiny steps towards verbal communication by gradually increasing articulatory effort through blowing, non-speech sounds, voicing, speech sounds, syllables, words and phrases, volume and eye-contact. Shaping is useful for initial rapport-building games with young children and for when parents cannot be involved, but is generally a much more stressful way of eliciting speech.

Lone Talking

The student records their voice when alone and plays the recording to the keyworker until they are comfortable with reading or reciting rote sequences and answering questions via voice-recordings. The keyworker then applies the sliding-in technique as above, but the student reads or counts aloud without the support of a conversation partner. Helpful for older students.

Generalisation

After any of these techniques, the sliding-in technique is used to introduce new talking partners, one person at a time, and activities are repeated in different settings with no extra audience.

Talking Circle

Once the child is confident that the Sliding-in technique works, more than one person can be introduced at a time. Two or three extra chairs are placed in a circle and the child and keyworker start counting alternately. After an agreed signal a new person enters the room, slowly takes their place in the circle and joins in the counting. This is repeated until all those waiting outside have joined the circle. Activities then move from single words to sentences, moving round the circle in different directions. Finally, the keyworker can gradually ‘slide-out’ leaving the child talking alone with the new people.

Walkabout

Once the child is able to talk in small groups they can try ‘Walkabout’. Here they start talking to the keyworker in a ‘safe’ area where no-one else can hear - choose a simple activity to begin with rather than spontaneous conversation. The challenge is to continue talking as they walk to another safe area or back to the original spot. E.g. walk down a public corridor from one room to another, or circle the playground at lunchtime.