I have successfully treated my daughter who had Selective Mutism. We were lucky that her condition was detected at an early age.
The objective of treating Selective Mutism is by making the child feel comfortable and increase his speech to everyone and in all settings. The best way to address this is by changing their behaviour which is based on desensitization.
This involves taking very small steps towards facing their fears. To start with we should remove all prompts and demands on speaking. They are anxious because the prompts and demands are so great that it exceeds their ability to respond. Here are a series of developmental steps which could help the child recover from the Selective Mutism
- First, we work to build a rapport with them. This more appropriate when would like your child to start talking to a stranger or a key person in their life e.g. therapist, teacher caregiver etc. This is done by doing a “special time” and using the PRIDE skills. How best to get a Selective Mutism child to start communicating with a you?
- Once the child starts communicated with the new person, you can increase the verbalization for the child by giving the child more opportunities to talk by using multiple choice or forced choice questions. How best to increase verbalization of Selective Mutism child with a teacher/caregiver/therapist?
- You would want the child to start talking in different environments and to different people by doing a scripted role play and then executing it in different environments like e.g. restaurants, coffee shops etc. How do I get my child to talk in different situations?
- Reinforcement in the form of privileges or rewards for all the brave talking the child does. How do I reinforce brave talking in different environments? How do I build an effective reward system for encouraging brave talking?
- The child should also be able to ask questions and initiate conversations. You need to work with the child to develop their spontaneous speech. How do I teach my child to initiate conversations?
Treatment Plan
Once the assessment is done, we need to treat the anxiety. Parents play the most important role in the whole treatment. It is important to note that it will take time for the child to overcome this anxiety, so you need to set your expectations accordingly.
- This requires a big energy and financial commitment. Every day and every hour is important for the children to practise talking. Hence you will need to consider who all are the people to work with and get their buy-ins. The biggest support you would need is from the child’s teachers and school.
Some of the people you would want to consider engaging apart from the treating psychologist –- Teachers
- School administrators
- Caregivers
- School counsellors
- Friends at school and outside
- Siblings
- Grandparents
- Extended family
- We need to break their cycle of avoidance and give them the opportunity to practice brave talking. The goal of the treatment is to decrease avoidance and enable talking.
- Teaching parents how to support the child. Parent training to learn the skills to support the child’s brave talking is extremely important. Parents play a very important role in the treatment. Every time you see the child in a situation of Selective Mutism you should implement the skills so that the child is used to brave talking and we break cycle of silence.
- Advocating the teachers. A teacher training is very important to get everyone on board on what Selective Mutism is about and the skills required.
- You may want to identify the people whom the child is currently talking to and whom you would like the child to start talking to. You may want to create a table with a list of people whom you think it would be helpful to talk to and in what environments.
- The idea is to make the child feel comfortable and reduce the anxiety rather than to force them to talk.
- Set achievement goals which are achievable for the child and slowly increase the difficulty. Its like climbing the ladder slowly and gradually.
- The treatment sessions should move from the therapist office to school and other social settings.
How Best To Get A Selective Mutism Child To Start Communicating To A Teacher/Caregiver/Therapist?
The best know therapy for Selective mutism is PCIT (Parent Child Interaction Therapy) adapted for Selective Mutism. This helps to break the cycle of speech avoidance and enforces more brave talking consistently. Brave talking is concept which is used in Selective Mutism for children. The goal of the treatment is to –
- Verbalize in different environments (e.g. school, restaurants, coffee shops etc.) and to more people across settings.
- Increasing distress tolerance level for kids and adults. Goals should be set by the psychologist which may make them feel uncomfortable at first but eventually as they build confidence, they feel comfortable with it.
This technique can be more appropriate for getting the child to start talking to caregivers, teachers or treating professional however parents could also follow the same strategy to support the child’s social and emotional growth. Spend some “Special Time” with your child. I generally put a 10-minute timer and let the child know this is our “Special Time”. This means there will be no other distractions and my whole and soul focus will be on the child. Do make it a part of the child’s routine.
Do’s for PCIT or “Special Time” –
- Make the environment conducive for “special time”. Make sure there are no distractions during this time from your partner or siblings otherwise you can’t give your child the undivided attention.
- Get down to the child’s level and focus on what they are playing with. I generally, like to do my “special time” with more creative toys like – Lego, magnetic tiles, puzzles, card games, drawing, painting, Montessori toys etc.
- Allow nonverbal communication. However you could say something like to prompt speech- “ I can see you are nodding but I didn’t hear you”.
- Use of PRIDE skills. In you “special time” aim for 10 Labelled praises, 10 Reflections and 10 Descriptions.
PRIDE skills
Do’s For PRIDE Skills
Don’t For Pride Skill –
How Best To Increase Verbalization of Selective Mutism Child With A Teacher/Caregiver/Therapist?
Once the child starts to verbalize with a new person and build a rapport, we can use some forced questions or multiple-choice questions to give them opportunities to talk.
At start, the child is asked some forced choice questions and we slowly move to open ended questions. Always give the child at least 5 seconds to respond.
You should try and avoid giving the child a yes/no question. As this gives them the opportunity to provide a non-verbal response by shrugging their shoulders of nodding their heads.
Some examples of a Yes/No question and how to change them to forced questions and open-ended questions –
If the child is presented with an open-ended question at the beginning it might be overwhelming for them, and they may struggle to frame an appropriate response.
How to Build Conversation with a Selectively Mute child ?
Once the child is comfortable answering forced choice questions you can move on to open-ended questions. If it doesn’t work, we come back to forced choice question.
Eg. If you asked a child- “would you like to go the playground or not ?” If the child nods then you can say “Great, nodding your head Charlie. Would you like to go the playground or not? “
What are the Do’s and Don’ts for Selective Mutism?
Do’s of Selective Mutism
Don’ts of Selective Mutism–
