(2011). Elective mutism: An analysis of 100 cases. Beidel, D. C., & Turner, S. M. (2007). Consider letting the child and parent/caregiver play in the assessment room for 5–10 minutes without the SLP in the room. Selective Mutism (SM) is an anxiety disorder usually diagnosed when a child begins school, but left untreated it can continue into adolescence and adulthood. Clinicians may also want to evaluate the level of vocal tension during the assessment. Children with selective mutism can also have a concomitant communication delay, disorder, or weakness (Richard, 2011). The American Speech-Language-Hearing Association (ASHA) is the national professional, scientific, and credentialing association for 218,000 members and affiliates who are audiologists; speech-language pathologists; speech, language, and hearing scientists; audiology and speech-language pathology support personnel; and students. Reception Ratings "The Beta Test Initiation" was originally broadcast on January 26, 2012, in the United States between 8:00 p.m. and 8:30 p.m. Differential diagnosis of selective mutism in bilingual children. Middendorf, J., & Buringrud, J. Just as in the younger … Narrative skills in children with selective mutism: An exploratory study. Interprofessional practice (IPP) and family involvement are essential in assessing and diagnosing selective mutism; the SLP is a key member of a multidisciplinary team. Selective mutism is a severe anxiety disorder where a person is unable to speak in certain social situations, such as with classmates at school or to relatives they don't see very often. Then, enter the child's circle of play (Middendorf & Buringrud, 2009). When treating an English Language Learner with selective mutism, it will be important for the SLP to be aware of possible stressors within the child's school setting that will need to be addressed through staff development, interventions, and accommodations (Toppelburg et al., 2005): See Bilingual Service Delivery and Cultural Competence for more information related to providing culturally and linguistically appropriate services. A conduct disorder refers to any of a group of serious emotional and behavioral problems in children and adolescents. Since selective mutism is categorized as an anxiety disorder, using similar medication to treat either makes sense. [14] This area receives indications of possible threats and sets off the fight-or-flight response. Several techniques can be used throughout assessment to reduce stress on the child, increase participation, and improve the quality of assessment findings. To effectively overcome Selective Mutism and all anxieties, an individual needs to be involved in a treatment program, such as those rooted in evidenced-based Social Communication Anxiety Treatment® (S-CAT®), like Individualized Intensives and CommuniCamp™ Intensive Group Treatment & Parent Training Program. The SLP may document vocal quality at the time of the initial evaluation and then reassess during intervention. Johnson, Maggie and Wintgens, Alison, (2016). Bergman, R. L., Keller, M. L., Piacentini, J., & Bergman, A. J. Selective mutism usually occurs before the age of 5 and is often associated with extreme shyness, fear of social embarrassment, compulsive traits, withdrawal, clinging behavior, and temper tantrums. They may have fears of being ignored, ridiculed, or harshly evaluated if they speak. Acknowledge and respond to the child's gestures for expressive communication if the child is nonverbal. Cognitive behavioral therapy (CBT) and pharmacological treatments are the best described treatments in the literature. Some children who have been diagnosed with selective mutism may temporarily adapt an AAC system to facilitate classroom communication during initial stages of intervention. instead of "What are you doing?"). Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by inattention, or excessive activity and impulsivity, which are otherwise not appropriate for a person's age. Building Confident Learners; Disorders in the Classroom; Managing Disruptive Behavior; Responding to Traumatic Events; Guides; Ask an Expert; Brainstorm Blog; Symptom Checker; Glossary; Topics A-Z » Mindfulness » Articles; The Power of … educating other professionals on the needs of persons with selective mutism and the role of the SLP in diagnosing and managing selective mutism; screening individuals who present with language and communication difficulties to determine the need for further assessment and/or referral for other services; conducting a comprehensive, culturally and linguistically appropriate assessment of speech, language, and communication; aiding in diagnosing the presence or absence of selective mutism with an interdisciplinary team; referring to other professionals to rule out other conditions, determine etiology, and facilitate access to comprehensive services; making decisions about the management of selective mutism; developing treatment plans, providing treatment, documenting progress, and determining appropriate dismissal criteria; counseling persons with selective mutism and their immediate and extended families regarding communication-related issues and providing education aimed at preventing further complications relating to selective mutism; consulting and collaborating with other professionals, family members, caregivers, and others to facilitate program development and to provide supervision, evaluation, and/or expert testimony, as appropriate; remaining informed of research in the area of selective mutism and helping advance the knowledge base related to the nature and treatment of selective mutism; advocating for individuals with selective mutism and their families/caregivers at the local, state, and national levels; and. Fernald, 2011. Physical symptoms. See, Any suspected problems (e.g., schizophrenia, autism spectrum disorder), Environmental factors (e.g., amount of language stimulation). McInnes, A., Fung, D., Manassis, K., Fiksenbaum, L., & Tannock, R. (2004). An older individual has also developed strategies to avoid talking and has defined themselves as being primarily nonverbal in a school setting. [35] These subtypes are no longer recognized, though "speech phobia" is sometimes used to describe a selectively mute person who appears not to have any symptoms of social anxiety. Assessing spoken language competence in children with selective mutism: Using parents as test presenters. Develop a relationship with the child prior to the evaluation by scheduling two to three sessions for age appropriate recreational or play-based interactions without the expectation for speech. Transitional stage of communication [PDF]. friendships with peers. Early intervention for selective mutism is key to remediation. The child is taught effective relaxation and coping skills. Selective Mutism Group: Ask the Doc archives: Learn how and when to remove this template message, Diagnostic and Statistical Manual of Mental Disorders (DSM), "Selective Mutism in Children: Comparison to Youths with and Without Anxiety Disorders", "Selective mutism and anxiety: A review of the current conceptualization of the disorder", "Selective mutism and temperament: the silence and behavioral inhibition to the unfamiliar", "Cohan, Sharon L. Refining the Classification of Children with Selective Mutism: A Latent Profile Analysis", Selective Mutism and Anxiety: A Review of the Current Conceptualization of the Disorder. Some individuals with ADHD also display difficulty regulating emotions or problems with executive function. 3. When the child changes communicative partners or contexts, tasks may need to be simplified. In many cases, teens with SM have been struggling with anxiety for years. Interestingly, the guidance makes no mention of the use of technology to support somebody with SM. This includes (a) providing positive reinforcement contingent upon verbalization and (b) reinforcing attempts and approximations to communicate (i.e., shaping) until such attempts are shaped into verbalizations, with the goal of making verbalizing more rewarding than not responding. Instead, the child may require assistance in adjusting to the trauma or other life challenges (Kearney, 2010), in which case, referral to a behavioral health professional is appropriate. Most children with selective mutism are hypothesized to have an inherited predisposition to anxiety. Consistent failure to speak in specific social situations (in which there is an expectation for speaking, e.g., at school) despite speaking in other situations. Types of Assessments & Evaluations Offered. Selective Mutism is a situational anxiety disorder characterized by a person's inability to speak and communicate in certain social settings such as school. The first meeting with the child is likely to affect the success and rate of progress that will be made throughout intervention, so avoid triggering the child's anxiety by using defocused communication strategies (Oerbeck, Stein, Wentzel-Larsen, Langsrud, & Kristensen, 2014), such as: Use of non-threatening tasks, such as a picture-pointing task, may be beneficial during assessment when selective mutism is suspected as a possible diagnosis. Assessment Tools, Techniques, and Data Sources, Augmentative and Alternative Communication, Speech Sound Disorders – Articulation and Phonology, Assessing and Treating Selective Mutism eWorkshop, Interprofessional Education/Interprofessional Practice, Selective Mutism in Elementary School: Multidisciplinary Interventions, Teaching the Language of Feelings to Students with Severe Emotional and Behavioral Handicaps, Speech-Language Therapy and Selective Mutism, https://www.pediastaff.com/resources-dir--floortime-in-assessing-and-treating-selective-mutism--featured-april-25th-2011, http://www.selectivemutism.org/resources/library/Speech%20and%20Language%20Issues/Speech-Language%20Therapy%20and%20Selective%20Mutism/view, http://selectivemutismlearning.org/selective-mutism-101/, https://doi.org/10.1044/leader.FTR1.07172002.4, http://selectivemutismcenter.org/Media_Library/Stages.SM.pdf, http://www.selectivemutismcenter.org/media_Library/missinglink.pdf, www.asha.org/Practice-Portal/Clinical-Topics/Selective-Mutism/, Connect with your colleagues in the ASHA Community. Rethinking its DSM-IV classification. Available from www.asha.org/policy/. The incidence of selective mutism refers to the number of new cases identified in a specified time period. It incorporates sensorimotor and play-based activities (often having co-treatments with an occupational therapist) and instruction regarding anti-anxiety strategies from a social worker or other behavioral health professional (Fernald, 2011). Washington, DC: Author. Children who have experienced trauma however are known to suddenly stop speaking. (n.d.). Dosage refers to the frequency, intensity, and duration of service. American Psychiatric Association (2013). See "Meeting the Child" section for more details. Selective mutism affects approximately 1% of children being seen in behavioral health settings (American Psychiatric Association [APA], 2000). Silent suffering: Children with selective mutism. Shy children, phobic adults. AAC should be carefully monitored to ensure that it facilitates interaction rather than replaces verbal communication. Bilingual children with true selective mutism present with mutism in both languages, in several unfamiliar settings, and for significant periods of time (Toppelberg et al., 2005). Each person is only brought in if the child continues to engage verbally and positively.[25][26][27]. Receptive language skills are typically at normal levels or above normal in children with selective mutism. This allows for comparison of the child's communication with and without an unfamiliar person in the area. Background: Selective mutism (SM) is a debilitating childhood anxiety disorder characterized by a persistent lack of speech in certain social settings and is considered hard to treat. The exact cause of selective mutism in adults is not known. How To Try To Find A Treating Professional Who Can Work With A Child With Selective Mutism. "The main differential symptom between SM [selective mutism] and other anxiety disorders, developmental disorders, or language-based disorders is that the child with SM can talk in certain situations, but is not able to use that same quality/consistency/volume of speech in other situations due to anxiety" (Kotrba, 2015, p. 27). It may be beneficial to address only selective mutism goals initially, in order for the child to gain some confidence in communicating and to establish a relationship with the SLP, before addressing specific speech and language deficits. "Helping Your Child With Selective Mutism". Some practitioners believe there would be evidence indicating anxiolytics to be helpful in treating children and adults with selective mutism,[29] to decrease anxiety levels and thereby speed the process of therapy. First, the teacher or another adult prompts the child with questions that likely will not be answered. Higher prevalence rates have been noted in immigrant children and in language-minority children than in nonimmigrant children. Evaluation and assessment of children with selective mutism is accomplished through a collaborative approach with an interdisciplinary team consisting of a pediatrician, psychologist or psychiatrist, SLP, teacher, school social worker or guidance counselor, and family/caregivers. Suffering in silence: Breaking through selective mutism. The two videos of the conversations are then edited together to show the child directly answering the questions posed by the teacher or other adult. Then, using an alphabet board, the child crosses off the sounds that he/she can produce. If not addressed, selective mutism tends to be self-reinforcing. Shy or timid temperament (APA, 2013; Steinhausen & Juzi, 1996). Minimizing eye contact. Journal of the American Academy of Child and Adolescent Psychiatry, 45, 1363–1372. Accurate diagnosis of selective mutism in these populations can be difficult due to the initial nonverbal stage (i.e., "silent period") common to second language learners (Elizur & Perednik, 2003; Steinhausen & Juzi, 1996; Toppelberg, Tabors, Coggins, Lum, & Burger, 2005). Recent evidence has shown that trauma does not explain why most children with selective mutism develop the condition. American Journal of Speech-Language Pathology, 13, 304–315. Commonly observed complications include acute respiratory failure, liver or kidney injury, and cardiovascular or neurologic symptoms. If mutism is entirely due to autism spectrum disorder, it cannot be diagnosed as selective mutism as stated in the last item on the list above. Adults with SM struggle with social isolation as a result of their anxiety. Johnson, M., & Wintgens, A. Journal of Developmental and Behavioral Pediatrics, 27, 341–355. Children with selective mutism may avoid speaking out of fear of being teased regarding speech sound production or vocal quality (Anstendig, 1999). No single cause of selective mutism has been identified, and its causes seem to be multifactorial (Cohan, Price, & Stein, 2006). This may include audio or video recordings from home, which offer more information than parent/caregiver descriptions. It could be that the SM was not treated or perhaps was not responsive to the level of treatment provided in childhood. Subtle deficits in expressive language may be present and are theorized to be exacerbated by lack of experience in the expressive language domain (Klein, Shipon-Blum, & Spillman-Kennedy, 2009). sounds? Viana, A. G., Beidel, D. C., & Rabian, B. Kotrba, A. Paper presented at the American Speech-Language-Hearing Association Convention, New Orleans, LA. Recent prevalence estimates for selective mutism primarily range between 0.47% and 0.76% (Viana et al., 2009), although rates as low as 0.02% (Brown & Lloyd, 1975) and as high as 1.9% (Kumpulainen, Räsänen, Raaska, & Somppi, 1998) have also been reported. [36], Anxiety disorder causing inability to speak under certain circumstances. The child could also use voice-altering apps while humming to reinforce humming for longer periods of time. Cohan, S. L., Price, J. M., & Stein, M. B. ), Educational history review seeks information on academic reports, parent/caregiver and teacher comments, previous testing (e.g., psychological), and standardized testing. Gradually, another person is introduced into the situation. European Journal of Special Needs Education, 22(3), 237-253. In the school setting, using stimulus fading and/or shaping, the child's schedule is disrupted for the duration of a week. (4th ed., text rev.). Content for ASHA's Practice Portal is developed through a  comprehensive process that includes multiple rounds of subject matter expert input and review. Selective mutism: A three-tiered approach to prevention and intervention. There is a hierarchical variation among people with this disorder: some people participate fully in activities and appear social but do not speak, others will speak only to peers but not to adults, others will speak to adults when asked questions requiring short answers but never to peers, and still others speak to no one and participate in few, if any, activities presented to them. Manassis, K., Fung, D., Tannock, R., Sloman, L., Fiksenbaum, L., & McInnes, A. The former name elective mutism indicates a widespread misconception among psychologists that selective mute people choose to be silent in certain situations, while the truth is that they often wish to speak but are unable to do so. Sharkey, L., & McNicholas, F. (2008). classroom) where speaking is expected, despite ability to speak normally in other situations. Regardless of the cause, increasing awareness and ensuring an accommodating, supportive environment are the first steps towards effective treatment. (2015). Prevalence and description of selective mutism in immigrant and native families: A controlled study. Even in cases where a child verbalizes in front of the clinician, this speech may be produced in a whisper, at a decreased vocal intensity, or in an altered vocal quality. [5][6][7] Some researchers therefore speculate that selective mutism may be an avoidance strategy used by a subgroup of children with social anxiety disorder to reduce their distress in social situations.[8][9]. SLPs are in an excellent position to coordinate intervention for children who have selective mutism because of their knowledge and skills in effective communication treatments (Schum, 2002). This page was last edited on 11 April 2021, at 01:23. Retrieved from http://www.selectivemutismcenter.org/media_Library/missinglink.pdf. The child shows consistent failure to speak in specific social situations in which there is an expectation for speaking (e.g., at school), despite … Diagnostic and statistical manual of mental disorders (5th ed.). Post-secondary accommodations are also available for people with disabilities. Adults and children afflicted by selective mutism can understand language as well as communicate freely, but usually are unable to speak in certain environments. Most often afflicted children do not have to change schools or classes and have no difficulty keeping up except on the communication and social front. Johnson and Wintgens, Speechmark (2016) The therapist teaches the child about anxiety and how his/her difficulty speaking may be linked to nervous emotions. [19] Many children who have selective mutism almost always speak confidently in some situations. Symptoms of social anxiety and social phobias may include the following: (Beidel, Turner, & Morris, 1999; Kearney, 2010). This involves the child saying words in gradually but increasingly difficult or anxiety-provoking situations. The disturbance is not better accounted for by a, Shyness, social anxiety, fear of social embarrassment or social isolation and withdrawal, Blank expression and reluctance to smile or incessant smiling, Difficulty expressing feelings, even to family members, Tendency to worry more than most people of the same age. Selective Mutism; Sleep-Wake Disorders; Substance Use and Addictive Disorders; Tourette’s and Tic Disorders; Trauma and Stress Related Disorders; For Educators. For instance, stimulus fading is typically used with younger children because older children and teenagers recognize the situation as an attempt to make them speak, and older people with this condition and people with depression are more likely to need medication.[23]. Format refers to the structure of the treatment session (e.g., group vs. individual) provided. When appropriate, my child talks to most peers at school. Selective mutism is a relatively rare disorder in children as well as adults causing inability to speak under certain situations (e.g. The duration of the disturbance is at least 1 month (not limited to the first month of school). Arlington, VA: American Psychiatric Publishing. All screening tools are downloadable from this website and no permission is required to reproduce, translate, display or distribute them. Please enable it in order to use the full functionality of our website. Guide for therapists, educators, and improve their academic and social communication anxiety (! Recommended Reading page on speech Sound Disorders – articulation and Phonology for more related! The literature conversation, even when the child hums and varies pitch while noting vibration his! 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