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Selective Mutism


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Essential characteristics of Selective Mutism

Selective Mutism is an anxiety disorder which leads to children and young people (CYP) persistently failing to speak in specific social situations (e.g. at school, with peers and/or the teacher), despite being able to speak in other, more familiar situations. Selective Mutism is a phobia; CYP want to speak but have an irrational fear in certain situations, similar to other phobias such as the fear of spiders or clowns. When CYP with Selective Mutism don’t speak, they are either physically unable to do so because they are overwhelmed with anxiety about prospect of speaking or they are avoiding doing so to spare themselves the high levels of distress caused by speaking. Selective Mutism is not the same as shyness; shy CYP may feel worried about speaking, those with Selective Mutism are terrified and find themselves unable to speak.

There is no single cause of Selective Mutism; three contributing factors lead to the process of fear conditioning:

  • A sensitive personality which makes them vulnerable to developing anxiety disorders, including a family history of mental health disorder, SLCN and autism.
  • Stressful events such as separation from parents, new or busy environments, or difficulty speaking/being understood, where the CYP associates the expectation to speak with feelings of distress
  • Maintaining factors where the negative association is strengthened by the pressure to speak, disapproval, parental anxiety or increased attention and comfort when anxious about talking.

Selective mutism is not an emotional reaction to or consequence of trauma, neglect or abuse. It can be triggered at any age but is more common in younger children. Studies suggest that about 1 in 140 children under the age of 8 years old are affected and about 1 in 550 in older children and young people. According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the essential characteristics of Selective Mutism include:

  1. A consistent pattern of speaking in some situations where speech is expected but not others.
  2. The failure to speak is persistent, lasting more than one month but not including the first month in a new environment such as school.
  3. The failure to speak has a significant impact on educational or occupational achievement or social communication.

Speech and Language Therapists, Educational Psychologists, Mental Health Professionals, Teachers and Specialist Teachers all have a role to play in identifying and supporting CYP with Selective Mutism. Early intervention remains crucial in order to avoid issues such as low self-esteem, poor social communication skills, social anxiety, depression, school refusal and underachievement. A Speech and Language Therapist can support identification, assessment and diagnosis as well as planning intervention.

Education settings should additionally consider the following recommendations to ensure an anxiety-free environment:

  • Recognise that Selective Mutism is an anxiety disorder and that any pressure to speak may make things worse. The pupil with Selective Mutism must be allowed to take small steps forward, in a controlled way, at their own pace.
  • Include the pupil by talking to them in a chatty, friendly way without expecting an answer. Make comments, rather than asking direct questions; for example, ‘I’d love to know where this came from, it’s gorgeous’, rather than ‘Where did you get that?’
  • Provide the opportunity to speak rather than making demands, e.g. ‘Hmm, I wonder where this one goes?’ (pause); ‘Oh dear, I can’t find any round ones’ (pause).
  • Reassure the pupil in private that you won’t single them out in class to answer a question, read aloud or demonstrate an activity unless they let you know that they want to be chosen.
  • Avoid bribing, persuading or challenging the pupil to speak. Don’t make the pupil say ‘Hello’, ‘Please’, ‘Thank you, etc. Remember, they are not being rude.
  • Include the pupil in activities by offering alternative forms of communication, e.g. pointing, holding up a picture, writing answers on a mini whiteboard etc. Tell the class that you welcome all forms of contribution – listening, speaking or making notes.
  • Make hands-up, thumbs-up or eye contact and a nod acceptable at registration.
  • With younger children, use puppets, masks, voice-activated toys, recorded messages and talking tins, which may be easier for the child than direct talking.
  • Warmly respond to any attempts to communicate through gesture or whispering by talking back in a natural way as if they had spoken and not ‘over-fussing’.
  • Ensure that the pupil can access the toilet, meals, drinks, help and first aid without speaking, using visual symbol cards for example.
  • Encourage the pupil to sit or work with friends they talk to in other settings and ask questions through their friends. Move away to make it easier for them to answer ensuring that peers don’t pressurise the pupil to speak and understand that they will speak in their own time.
  • Ensure the pupil doesn’t become isolated. Actively foster friendships with peers, both in and outside of school, through shared projects, interests and activities.