As speech-language pathologists we wear many hats. By the time we finish grad school, we have training in articulation, language, fluency, AAC, pragmatics, voice, aphasia, apraxia, swallowing and more. But sometimes the terrain becomes more psychological in nature, as I discovered on day one of my clinical fellowship, when I met a student with selective mutism (SM), in which children speak in some situations, but not others.
Here’s what I learned from treating my first student with SM. First and foremost, creating a treatment plan must begin with a thorough, team-based assessment. Then, I found the following steps produced the best results.
- Build trust and rapport
You first must gain a child’s trust before trying to desensitize him into using verbal communication. Build rapport by engaging in fun activities and positively praising your student, as well as imitating what he or she does. By developing a communication ladder together, you help your student with SM face his or her fears at a reasonable pace. As students progress, they need to trust the person standing by their side.
- Reinforce verbal communication
When asking your student a question requiring a verbal reply, the anxiety-filled silence feels uncomfortable. As a result, well-intentioned bystanders often swoop in and speak on the child’s behalf or change the question to require only a yes/no response. What should you do about this issue? According to Aimee Kotrba, a psychologist and expert in this area, don’t lower your communication expectations: Ask forced-choice rather than yes/no questions to encourage verbal responses. Always wait at least five seconds to give the child an opportunity to respond. Don’t enable SM by speaking on the child’s behalf. Encourage verbal communication by setting up motivational situations—such as playing a game your student enjoys—and positively reinforce any verbal communication with praise or tangible prizes.
- Fade stimuli
Stimulus fading involves a gradual increase in exposure to a fear-inducing stimulus and desensitization to the stimulus over time. In the case of SM, your goal with this approach involves gradually increasing the number of communication partners and settings in which the child verbally communicates. For example, perhaps a child communicates verbally only with you in your office. To slowly expand this achievement, first work on communicating with your office door open. Next, move around the room and eventually ease into the hallway. Over time, move into another room by letting your student select a new setting from a list of choices you provide.
- Use shaping
This approach is typically used with children who do not speak at school. Shaping initially involves reinforcing all communication attempts from the child and gradually taking small steps toward encouraging them to use verbal communication—in the form of blowing, whispering, sound production, etc.—with the use of a significant amount of positive reinforcement.
- Record on video
Videotaping students speaking effectively (with family members, for example) at home can increase their self-confidence and help to generalize the desired behavior to other settings.
I turn to these websites for useful information and free resources to help students, teachers and families navigate the complexities of SM:
- ASHA: Selective Mutism
- Free On-line Library from the Selective Mutism Group
- The Selective Mutism Foundation
- An Intensive Summer Camp for Children with SM
Claudia Doan, MS, CCC-SLP is a pediatric speech-language pathologist with experience in school and clinic settings. She created and blogs at Creative Speech Lab, which provides resources that incorporate experiential learning into speech-language treatment. You can follow her on Facebook, Twitter, Instagram, Pinterest and Bloglovin’. firstname.lastname@example.org