Selective Mutism Treatment | Speech Therapy Plan and Activities

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Carrie Clark 0:00

Hey everybody, this is Carrie Clark, and you are listening to episode number 40 of the Speech and Language Kids Podcast. This is the podcast with resources and activities for speech therapists and parents of children with speech and language delays. Today we are talking about selective mutism. But before we get to that, I do want to mention that I have a new page up on the website that is a um it's an opt-in page for my up. Upcoming book. I am writing a book right now, and my book is going to be about childhood apraxia of speech. And I am just now getting to the point where I'm starting writing that and getting ready to release some sneak peeks of the book to the members that are on the mailing list.

Carrie Clark 0:40

This mailing list will also be how you will find out when the apraxia book goes live. So if you would like to opt into that list, you can find out more information about my upcoming book on childhood apraxia of speech. You can find that at speech and language kids dot com slash apraxia dash optin. That's O-P-T-I-N. So you can find um head on over to that and you can opt into the website and it will give you um I will g I will send you all kinds of good information about the the book and give you some sneak peeks and also I will be selecting a number of people from that list to get a free copy of the book in advance. um in order to get some reviews on Amazon for that. So if you want to also get a chance to get a free copy of the book, you can head over to Apraxia Dash opt-in.

Carrie Clark 1:27

Um, well, speech language kids slash apraxia dash opt-in, and that will let you sign up for that list. All right, without further further ado, further ado, further ado, let's jump into our topic today, which is selective mutism. Okay, so selective mutism is a diagnosis that describes a child who does not speak in certain situations where speech is expected, such as at school or out in public. Around people she doesn't know. But the child is able to speak normally in at least one other setting, which is usually the home. So usually the child speaks in the setting where they feel most comfortable, but they are refusing to speak or unable to speak when they are in certain other environments or situations, or maybe even when certain people are around.

Carrie Clark 2:13

I've had kiddos with mute selective mutism who are are able to speak at home, but if uh mom's friends come over or somebody that is not usually in the house. then they stopped speaking in that situation too. So They are able to speak in at least one situation with at least one communication partner. but are not speaking in other settings. Now, according to the Diagnostic and Statistical Manual, which is the DSM, we are on the DSM five right now. This impairment must be, in order to qualify for this diagnosis diagnosis, the impairment must be interfering with the child's child's education or occupational achievement, so their job or their schooling. Um or be impacting his or her social communication. for that child to qualify.

Carrie Clark 2:57

Uh the child must also be have been experiencing the selective mutism for at least one month and this does not count like the first month of school. So if it's been, you know, a month and the child is not speaking in school yet but they've never been in school before, you gotta give it a little bit more time just to make sure that it's really selective mutism and not just shyness due to the new situation. Also, it cannot be due to a lack of knowledge or comfort with the language. So it can't be because the child doesn't understand English. And it cannot be better explained by some other communication disorder like stuttering. So keeping all of that in mind, you're going to be looking for this diagnosis for kiddos who are it's not just a kiddo who's shy or who is less um vocal in

Carrie Clark 3:43

the school setting than they are at home, but really a child who has a a severe disorder with this where they are just unable, completely unable to speak in certain settings or certain situations. Okay, so then what is the treatment for selective mutism? Well, unfortunately, the research base for treatments of selective mutism is extremely limited.

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1 What is selective mutism and how is it diagnosed? 0:00–24:49

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Carrie Clark 23 min

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iTunes 1 Speech and Language Kids podcast 1 Carrie Clark 1 B.F. Skinner 1 Childhood apraxia of speech 1 Selective mutism 5 DSM V 1 stimulus fading 1 shaping 1

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Recorded13 Apr 2015

Publisherspeechandlanguagekids.com ↗

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Selective Mutism Treatment | Speech Therapy Plan and ActivitiesA child with selective mutism will speak in some situations (like home) but not in others (like at school). What is the best selective mutism treatment? How can we help them feel more comfortable communicating with others? This page will outline the step-by-step selective mutism treatment plan and how it can be used to support children and teens with selective mutism. Selective Mutism CurriculumA Structured Program for Treating Selective Mutism in Children and TeensView the Selective Mutism Treatment CurriculumWhat is Selective Mutism and How is it Treated?Selective mutism is a complex anxiety disorder that is characterized by a child’s 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 (e.g., at home). As this is primarily an anxiety disorder, treatment for selective mutism should be conducted by a full team that includes a mental health provider along with the speech-language pathologist, the child’s caregivers, and the child’s teachers. This program should be completed with that full team. Sample Goal for Selective Mutism Treatment: By the end of the IEP cycle, Client will increase spoken communication in the classroom by achieving at least a 4 out of 5 on the following rubric scale as reported by her classroom teacher: Rubric Scale: Over the past two weeks in the classroom, the student… 1 = Did not speak or communicate in other ways (pointing, gesturing, making sounds) 2 = Did not speak but did communicate in other ways (pointing, gesturing, making sounds) 3 = Spoke every once in a while and also communicated in other ways 4 = Sometimes spoke to participate in school/social activities, but not often 5 = Spoke frequently in the classroom, enough to participate in many school and social activities Overview of Selective Mutism Treatment Environmental Modifications: A variety of environmental modifications will be made to increase the client’s sense of control and self-sufficiency in order to reduce anxiety about speaking situations. These strategies include: increasing predictability of their routine, increasing their sense of control about what happens to them, and increasing their sense of self-sufficiency and independence. Identifying Motivation: Client will work with trusted adults to identify three reasons for them to speak to others and three relaxation techniques that can be used to self-calm during anxious moments. *Note: Client will not be required to speak to participate in these activities. The client will be allowed to identify these strategies with pointing, gesturing, and nodding/shaking head (for yes/no questions) if needed. Gradual Changes: Client will gradually increase their ability to communicate in more challenging situations through strategies such as exposure-based practice, desensitization, and shaping. Step 1: Providing Environmental Modifications for Children with Selective MutismSince selective mutism is primarily an anxiety-based communication disorder, we can support children with selective mutism by modifying their environment to make them feel more comfortable. Increasing Predictability: Children with anxiety and selective mutism often do better when they know what is going to happen. We can help by increasing the predictability of their day. Increasing Sense of Control: Children with selective mutism may be choosing not to speak because they feel that they don’t have control over many other aspects of their life. Feeling like your anxiety and emotions are out of your control is a scary feeling! We can help by showing the child ways that they can feel more control in their day. Increasing Independence: The more a child is able to do things independently, the more confident they will feel. We can help children with selective mutism feel more confident throughout their day by increasing their ability to do things independently. In turn, this will increase the likelihood that they will be willing to try hard things, like speaking to others. Step 2: Identifying Motivation for Children with Selective MutismTalking is a great way to connect with the people around us. We can tell other people our ideas and they can tell us theirs. We can let others know what we need and participate in activities that we enjoy. But sometimes, talking to other people can be uncomfortable. We can work on gradually becoming more comfortable with talking to others. In this phase of therapy, we will work with the child to identify their own reasons for why they may want to speak to others. We can also help them learn calming strategies that they can use if they start to feel overwhelmed. Step 3: Gradually Expanding Speech for Children with Selective MutismHere’s the part of this plan where it’s going to change depending on each child’s needs. The goal here is to gradually increase their ability to speak in progressively more challenging situations. Since each child is different, you will start in different places and progress at different rates. The key is to push the child a tiny bit out of their comfort zone at each new step, but not so far that you cause high levels of anxiety. Think of it like a bullseye. If we push too hard, we hit the outer ring where we may cause meltdowns or shut downs. We want to push them slightly out of their comfort zone but not too far. How to Help Children with Selective Mutism take Baby Steps Toward Speaking: Identify what the child can do right now – What type of communication is the child successful with right now? Is there one adult that the child will talk to at school? Or is the child able to gesture or use some other non-speech communication with others? Take that and make it one tiny step farther – Take a look at the example progressions below. How can you take the child’s successful interaction and move up one step? Only change one aspect of the interaction at a time. For example, if the child can nod yes/no in the speech room, you could either have them move up toward making sounds OR you could have them nod yes/no with another adult in the room. But you wouldn’t try to change both at once. Keep in mind that you may have to try several different things before you find one the child can do. Also, keep in mind that a child may not follow these progressions in this order. They may find a different order easier. Go with what the child needs. A Structured Curriculum for Selective Mutism Treatment:Would you like a pre-made curriculum that covers all of these steps? Our Selective Mutism Curriculum by Speech and Language Kids is a structured program that will walk you through these steps with a child with selective mutism. Whether you’re a speech-language professional, parent, or other therapist, this Curriculum has everything you need to support gradual, confident communication for children with selective mutism. Selective Mutism CurriculumA Structured Program for Treating Selective Mutism in Children and TeensView the Selective Mutism Treatment CurriculumAbout the Author: Carrie Clark, MA CCC-SLPHi, I’m Carrie! I’m a speech-language pathologist from Columbia, Missouri, USA. I’ve worked with children and teenagers of all ages in schools, preschools, and even my own private practice. I love digging through the research on speech and language topics and breaking it down into step-by-step plans for my followers. Connect with Me: The post Selective Mutism Treatment | Speech Therapy Plan and Activities appeared first on Speech And Language Kids.

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