1.) What is my role in supporting a child with SM?+-
One of the most important things you can do as an educator in supporting a child in your class who is dealing with SM is to familiarize yourself with this disorder and the treatment approaches. The more information you have and the better understanding you have of SM and what your student is experiencing and working on, the better you will be able to support his or her needs in the classroom. Another important role that you have is to partner with your child’s family and treatment team. Selective mutism is not something that gets better on its own, and despite children working in an outpatient therapy setting, there will need to be direct intervention and supports put into place in the school environment in order for progress to be made there. In order to do this, it is essential that there is open, frequent, and consistent communication between school, family, and treating professionals. The following are some helpful resources for educators. However, it is important to recognize that every child is different and will have different needs in terms of how you interact with him or her in the school environment depending on the status of treatment. Therefore, it is essential that there is communication with the child’s whole team in and outside of school.
2.) What are some resources to provide psychoeducation to educators?+-
For educators with limited time, the SMA online library provides handouts with information about SM, including suggested accommodations and classroom-based intervention strategies for maximizing learning.
The following book is intended for educators:
Kearney, C. (2010). Helping children with selective mutism and their parents: A guide for school-based professionals. Oxford University Press.
The following books (in reverse-chronological order) are designed for multiple audiences and may be useful to educators:
Kotrba, A. (2014). Selective mutism: An assessment and intervention guide for therapists, educators & parents. PESI Publishing & Media.
Wintgens, A., & Johnson, M. (2012). Can I tell you about Selective Mutism?: A guide for friends, family and professionals. Jessica Kingsley Publishers.
Perednik, R. (2011). The Selective mutism treatment guide: Manuals for parents, teachers, and therapists: Still waters run deep. Oaklands.
Kervatt, G. G. (1999). The silence within: A teacher/parent guide to helping selectively mute and shy children.
This web-based learning resource, which features video demonstrations, is also intended for multiple audiences, including teachers: http://selectivemutismlearning.org/selective-mutism-101/.
3.) How should I respond if other kids in the class speak for my student with SM?+-
Based on our clinical experience, the majority of children with selective mutism speak to their peers before speaking to school personnel. Children with selective mutism may rely on a trusted peer to communicate needs, such as needing to use the bathroom or as a way to answer their teacher’s question. The child with selective mutism may whisper in that child’s ear or write something for the speaking child to communicate to the teacher and the class. This then allows for the child’s needs to be known.
This can put teachers in a difficult situation because this may be one of the only ways to assess the child’s academic knowledge or understand their needs. However, the child’s teacher may be concerned that 1) the speaking child may feel responsible for helping the child with selective mutism and not focusing on their own needs and 2) the speaking child may enable the child with selective mutism to continue to remain mute around others.
As stated, children with selective mutism may speak with peers before school-personnel. This is a positive sign that the child is beginning to feel comfortable speaking at school. Teachers who notice that the child with selective mutism is speaking to a peer are encouraged to provide positive attention to the child for speaking in the school setting. Ideally, once the child with selective mutism is encouraged to speak at school, the need to speak through other peers will diminish. The speaking peer can also encourage the child with selective mutism to answer the teacher or other peers. Teachers may also respond to the speaking peer that “Child is working on speaking and can answer for themselves.” The mute child may answer non-verbally (i.e. writing, showing with their hands the answer) or verbally (by whispering or using one-word answers). To promote speech, teachers are also encouraged to provide opportunities for the child with selective mutism to answer school-professionals and peers in 1:1 settings, with a reward system in place.
4.) What are some helpful books I could read to learn more about SM in general and how to manage SM in the classroom?+-
The following is an excellent book is written for parents of children of SM:
Helping Your Child with Selective Mutism: Practical Steps to Overcome a Fear or Speaking by Angela McHolm, Charles Cunningham, and Melanie Vanier
The following book is a well-written for educators working with children with SM:
Helping Children with Selective Mutism and their Parents: A Guide for School-Based Professionals by Christopher Kearney.
The following books are designed for treating professions and describe effective therapy techniques:
Treatments for Children with Selective Mutism: An Integrative Behavioral Approach by Lindsey Bergman.
The Selective Mutism Resource Manual by Maggie Johnson and Alison Wintgens
Selective Mutism: Implications for Research and Treatment by Thomas Kratochwill
The following books are designed for multiple audiences and can be useful for parents, educators, and/or treating professionals:
The Selective Mutism Treatment Guide: Manuals for Parents, Teachers and Therapists: Still Waters Run Deep by Ruth Perednik
Selective Mutism: An Assessment and Intervention Guide for Therapists, Educators and Parents by Aimee Kotrba
The Silence Within: A Teacher/Parent Guide to Helping Shy and Selectively Mute Children by Gail Kervatt
Can I Tell You About Selective Mutism? A Guide for Friends, Family and Professionals by Maggie Johnson and Alison Wintgens
5.) Will children with SM improve or "grow out" of it once they become more comfortable?+-
There are no long-term research studies on the outcome of children with Selective Mutism as they grow into adulthood, and therefore much of what we believe occurs in adulthood for this population is conjecture by experts with experience in the field. Treatment for selective mutism is often very successful in reducing anxiety and improving social interactions. Children with selective mutism who receive treatment often begin to speak in social situations, but some of these children can have remaining struggles. Specifically, adults diagnosed as children may continue to experience remaining effects such as poorer speaking behaviors, residual social phobia, and other anxiety disorders (APA, 2013; Caspi, Harrington, Milne, Arnell, & Moffit, 2003; Steinhausen & Juzi, 1996). These individuals may struggle to communicate in social situations, and may have difficulties in their place of employment.
The outcomes for children who do not receive intervention for selective mutism are complicated with more significant mental health issues in adulthood. While some children may, over time, demonstrate an increase in speech (possibly due to self-motivation to face fears), untreated individuals are at a much greater likelihood for depression, generalized anxiety, social anxiety, work and relational issues, school refusal, and self-medication in adulthood. Given this risk for an increase in anxiety and comorbid mental health issues, psychologists strongly recommend not waiting for symptoms to improve and to instead obtain early behavioral intervention for Selective Mutism.
6.) How do I help make sure the child's needs are met when they can’t let me know they need help? (using the bathroom, not understanding their work)+-
Some suggestions to help children get their needs met without verbalization include giving the child information without asking a question. For example, “the bathroom is here and you can use it any time you want.” In addition, using a hand signal can be useful. However, it should be noted that some children have a hard time even using a hand signal but can go if prompted. In that case, you could prompt the child to go at a specific time.
7.) How do I work with school psychologists/counselors to support the emotional needs of this child?+-
First of all, it is very important to have a shared understanding that SM is an anxiety disorder and that intervention includes communication amongst parents, outside treatment providers and the school team. When there is a 504 or IEP in place, the specific methods and interventions to support the child’s emotional needs may be more clear. Being open to behavioral interventions that the providers are using is really important, as is being open to learning strategies to implement in the classroom. A few ways professionals can support the child include using warmth, giving the child time to acclimate and verbalize, and being creative about interventions. For example, many children may love coming to the counselor’s office to play and talk. Kids who have SM may appear hesitant or inhibited and may need a lot more time to warm up.
8.) How do I give a child opportunities to communicate without putting them on the spot?+-
Though the ultimate goal is for the child to speak in class, a first step for the child may be to invite them to participate nonverbally. For example, invite a child to have a classroom job (e.g. door holder), come up and point at morning meeting and show his/her work without speaking. These are all ways that a child can participate without words. It is important for educators to work closely with the child’s treatment provider so you know when it’s appropriate to ask a question or place appropriate demands. When a child is prompted to speak, it is important to wait for a response before asking another question (at least 5 seconds).
Using a forced choice format (e.g. “do you want chocolate, vanilla or something else?”) can also help, as this type of question may be more likely to get a reply. In the classroom setting, allowing a child to practice answering questions (at home) can help–they can practice raising their hand and answering at home and then move to being called on and actually answering that same question in class that was previously practiced. In the best case scenario, opportunities for speaking should be planned and intentional, and treatment providers who have experience in treating SM can help set appropriate goals.
9.) How can parents be involved in helping their child speak at school?+-
Parents can be an integral part of treatment, especially when the parent possesses the skills to help transfer speech from themselves to another conversational partner. Allowing the parent to come into the classroom before class starts or when school is over is a wonderful time to practice, because there are less people and likely less anxiety for the child. The parent could play a game with the child and help them engage and then speak, with the goal of “fading in” a new adult.
10.) I think my student may also have speech/language difficulties in addition to SM. How can this best be assessed?+-
This is a great question and it can be very hard to assess if the child is not yet verbal. Some children are able to participate in a speech and language evaluation if they are able to speak to that evaluator. If not, this assessment may need to wait until the child is further along in treatment or consider alternative measures. Parents can be trained to administer some measures so this can be considered as well.