Transcript Selective Mutism - Vanessa Roets` bPortfolio

Vanessa Roets
Which Disability Category?
 Selective mutism is a communication disorder that is
generally categorized under Other Health Impairment
(OHI), Emotional Behavioral Disorder (EBD) or
Speech and Language Impairment, however; students
with selective mutism may be categorized under any of
the 14 disability categories.
Selective Mutism Defined
 Selective mutism (previously known as elective
mutism) is a disorder where the child does not speak
in at least one social situation, often times this is
school. The child is able to speak in other settings.
This communication disorder is usually first noticed
when they begin school. Tracey, that means you! 
Historical Origins
 Selective mutism was recognized as early as 1877 in
Germany. Dr. Kussmaul named this disorder “asphasia
voluntaria” or voluntary mute. In 1934 an English
physician, Dr. Tramer described several other cases
and renamed the term elective mutism.
Historical Origins Continued
 Individuals with selective mutism fought to get the
name changed from elective because it “suggestive of a
preference; therefore the term implies a deliberate
decision not to speak” The term selective mutism was
first seen in the DSM IV in 1994. Selective mustims
“impl[ies] a less oppositional or willful component”
Prevalence: Worth our Attention?
 According to the DSM-IV selective mutism is rare, it is
seen in less than 1% of patients in mental health
settings.
 Others believe selective mutism is under diagnosed
and has a prevalence rate higher than autism. It
should also be noted the prevalence rate is slightly
higher in girls than in boys.
Characteristics
 Consistent failure to speak in specific social situations
 Not speaking interferes with school, work, or social communication
 Not due to another type of communication disorder (e.g., stuttering)
 Children with selective mutism may also show characteristics of
anxiety disorders, excessive shyness, fear of social embarrassment,
social isolation or withdrawal.
 Additionally, they may have physical symptoms such as a headache,
stomach ache, diarrhea, nausea, and vomiting.
 They may avoid eye contact and play with hair or other items to distract
themselves from the situation.
 Some will use non-verbal communication and body language to
communicate with others.
Causes
 Selective mutism was originally thought to be the
result of a traumatic event or abuse.
Parents/guardians have been accused of abusing
children, but this is a misconception. Current
research shows that no cause has been established,
however; there is a possibility of a genetic influence or
susceptibility. Many people with selective mutism
have family members who also had selective mutism,
extreme shyness, social anxiety, or other anxiety
disorders.
Identification
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Speech Language Pathologist (SLP)
Pediatrician
Psychologist/Psychiatrist
Teachers (generally early childhood teachers, but not always)
Family
Review educational history
Hearing Screening by health care professional
Oral-motor exam by health care professional or SLP
Parent/Guardian Interview
Mental health evaluation by psych
Expressive language ability by SLP
Verbal and non-verbal communication by SLP
Educational Considerations
 Never punish a child for not speaking or force a child
to speak
 Use multiple intelligences in the classroom
 Incorporate a reward system
 Allow student to observe before giving them the
opportunity to participate, do not force them to
participate
 Provide routine and structure to help ease anxiety
Early Intervention
 Understand symptoms are not intentional
 Consistent behavioral strategies
 Behavioral management programs focusing on
phobia’s
 Desensitizing by providing short term goals
 Positive reinforcement and praise
 Early Intervention is Key
Interventions for Inclusion
 If student has “safe” person allow “safe” person to answer for them as
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they work on becoming comfortable enough to answer for themselves.
Transfer “safe” person to other friends they feel comfortable around.
Reinforce all efforts to communicate.
Self modeling: have student view or listen to themselves communicate
in a place they feel comfortable to build confidence.
Forming small, cooperative groups
Communicate with peers using non-verbal methods and gradually
increase verbal communication.
Working with family and other specialists to generalize communication
to other situations.
Assessing Student Progress
 Assess multiple ways, not just orally.
 Ask trusted students or another adult to help assess.
 Tape recorders or video can be used to assess oral
proficiency.
 Written language assessments
 Allow student to take tests in another location where
they feel comfortable.
 Consult with other specialists and families about
progress they see.
Transitions
 Most students will not have selective mutism their entire life.
 Some adults who have overcome it still report anxiety,
depression, and panic attacks.
 Transitions should be gradual, starting in a quiet place that the
student feels comfortable with.
 As student gains confidence they can be transitioned to more
verbally demanding settings
 Should have a way to communicate non-verbally: notebook,
texting, etc.
 May need advocates until they can self advocate.
References
http://www.asha.org/public/speech/disorders/selectiv
emutism.htm
2. www.nipissingu.ca/education/thomasr/.../SelectiveM
utism.ppt
3. www.selectivemutismfoundation.org
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Questions, Comments, Concerns
 Thank You!