If you were to visit a class in our learning center, you would observe a student mouthing words from her reading lesson to her teacher, instead of saying them aloud. This student has a disorder known as selective mutism, in which the child fails to speak in social settings but exhibits verbal language in other settings, especially the home. It is thought that the underlying symptom of selective mutism is anxiety.
Understanding the Student with Selective Mutism
Selective mutism is usually not the result of a traumatic event in a child's life, as many people tend to think. Instead, it stems from a pattern of chronic anxiety. The student wants to speak, but fear of social situations keeps her from speaking. In most cases, it is very difficult to pinpoint the cause of anxiety.
According to psychologist and psychotherapist Robert L. Schum, "It is important to emphasize the underlying anxiety disorder that is the likely origin of selective mutism. Often, one or both parents of a child with selective mutism have a history of anxiety symptoms, including childhood shyness, social anxiety, or panic attacks. This suggests that the child's anxiety represents a familial trend. For some unknown reason, the child converts the anxiety into the mute symptom."
Selective mutism usually appears in the elementary years when a child is required to interact with peers, read aloud, and generally perform for all types of audiences. As anxiety is increased, the mutism parallels and increases. Eventually, the child is only speaking within the confines of home and only with the parents and very close relatives.
What Can Teachers Do to Help the Student with Selective Mutism?
The approach to teaching a child with selective mutism is a multi-disciplinary one. When selective mutism first began to be acknowledged in school settings, speech-language pathologists were the last people involved. Since the child did not speak, he or she did not qualify for speech and/or language services. However, with the realization and understanding that speech is affected by anxiety, SLPs have now become an integral part of working with a student with selective mutism.
Selective mutism responds to "shaping" techniques. Shaping involves reinforcing approximate steps toward a desired behavior. Positive reinforcement is given for small steps; as each step is achieved, the student moves closer to the overall goal. Reinforcement is only given for the step the student is working on. In the case of the child at our learning center, reinforcement was first given for pointing at the words as other students were reading. Next, reinforcement was given for approximating the sound of the word through mouth formation. She is now at the step where she is mouthing multi-syllabic words to the teacher. The next step will be for her to whisper the words. Ultimately, the goal is for our student to be able to read aloud in a class setting.
Keeping in mind that anxiety is usually the underlying cause of selective mutism, techniques that involve routine and structure are very important when teaching these students. Predictability reduces anxiety. Allowing a child to observe before attempting to join in any social activity is imperative. If adult guidance is needed, fade the presence of the adult as the child becomes more comfortable in the activity. Keep academic pressure very limited. Set boundaries by all means (there are many times when our student has to stay in from recess because she has not finished an assignment), but too much pressure can cause regression. Trying to find a balance when working with a student with selective mutism can be tricky.
Use terms such as "shy" and "nervous" when working with a child to describe their feelings and their reluctance to speak. Using the words "brave" and "courageous" are very reinforcing when the child meets successful approximations of the speaking goal. Be empathetic, not sympathetic. Give the child a chance to work with peers one-on-one. Although the student may not speak to the peer, a bond is forming, and this can be very helpful in the future when the child begins to speak. We have found that our students are very accepting of our child with selective mutism and treat her with respect, often talking to her as though they are expecting an answer.
Assessing a child with selective mutism, especially in reading, can be difficult. Allow her to point to words, to mouth words (if she is at that stage), and to write answers if possible. An SLP may be able to offer suggestions and to help with assessment. Some students allow their parents to tape them at home reading. This tape can then be shown to the teacher as a form of assessment.
Teaching a child with selective mutism is a challenging experience. Teachers should understand that anxiety is usually the underlying cause of this disorder, and treatment should involve a multi-disciplinary approach to reduce anxiety. Teachers must definitely think outside the box to find ways to help these students produce in the classroom. Using shaping techniques is the preferred and most researched method that insures that the student has ample opportunity and instruction to meet the goal of eventually speaking.
References:
Burke, J.C. (1992). Decreasing classroom behavior problems: Practical guidelines for teachers. San Diego: Singular Publishing Group, Inc., 1992.
Schum, R. L. "Selective Mutism: An Integrated Treatment Approach." The ASHA Leader, 2002, September 24.
Tina Halbert - Tina M. Halbert, M.Ed., NBCT
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