Selective Mutism (SM)
Definition: “Selective Mutism (SM) is best understood as a childhood anxiety disorder characterized by a child or adolescent’s inability to speak in one or more social settings (e.g., at school, in public places, with adults) despite being able to speak comfortably in other settings (e.g., at home with family). Affected individuals understand language use and, although they have the physical and cognitive ability to speak, they demonstrate a persistent inability to speak in particular settings over a particular period of time due to anxiety.”
Treatment: Effective treatment of selective mutism requires a highly refined and consistent response among all significant adults around the child. Often a team approach, which involves the child, his/her parents & teachers, the speech-language pathologist, and a counselor or psychologist, works best. The parent is crucial & often serves as the bridge between the child with SM and the rest of the team. An effective program involves a slow, systematic program that rewards successive approximations of social interaction and communication. Children with SM cannot be tricked, cajoled, or commanded to speak. Any attempt at improved communication and interaction needs to be noted and reinforced, even if it is nonverbal, such as making eye contact, following directions, and nonverbal participation in group activities. The successive steps in this approach often need to be quite small. The lack of speech is only the most obvious and dramatic sign of the underlying anxiety. Improvement of the mutism is predicated on a generalized reduction of anxiety. Therefore, reduction of other anxiety symptoms is important and relevant to the treatment of SM. The speech-language pathologist can help the child with SM by creating an environment that is structured, predictable, and comfortable and presenting the child with opportunities to interact in other public arenas. Some children with SM may also have expressive language difficulties which can further hinder their ability to communicate. Thus, techniques such as giving choices, use of communication devices/systems, & teaching of compensatory strategies, can aid the child with SM.
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