How to Treat Selective Mutism: Information for parents
Our treatment program is based on several principles. The first is an ecosystems theory which tries to build bridges between the diverse settings in which your child lives, enabling him to move more seamlessly between contexts. In other words, to understand what allows him to speak at home, and to try to incorporate those elements at school, so that he will feel more comfortable there. At the same time, some factors at school may be conducive to assertiveness and independence, which the parents may wish to incorporate at some level, at home. This outlook is reflected in the location of the therapy – at home and at school.
In addition, the treatment plan incorporates what is widely accepted today about treating selective mutism: that behavioral methods with cognitive components are thought to be most effective for SM, that it is frequently anxiety based, and that the family and school should be intimately involved in any course of treatment. This program has been developed out of clinical experience of treating over one hundred children with SM.
While all children and every family is unique and responds to SM in their own way, certain feelings and reactions are common. One thing is always the case with a child who is not speaking (usually) in kindergarten or school: A child with SM suffers! He cannot be himself, the more spontaneous, communicative child he is in other contexts. He must expend effort to ensure that his radar informing him of who is in his proximity is always on, and control himself so that when his private space in encroached, or when he is in a setting in which he does not speak, he stays quiet. High and constant energy expenditure is required to maintain this awareness and control. This in itself is anxiety producing, however effortless the SM child appears to make it.
The lack of verbal communication causes the child to miss out on social and learning experiences which would further his development. A child who cannot say what he wants, will frequently be included in activities he wishes to avoid, and conversely, will be excluded from experiences he desperately wants to have. This is a recipe for frustration. This frustration is often taken out on family when he returns home, and can finally express himself. Sometimes the frustration expresses itself in school, as the child makes his presence felt with his hands, not his voice.
When a child with SM is unfortunate enough to be in a context in which he is misunderstood, and considered to be unintelligent, unable to communicate, or oppositional, he may be inappropriately labeled and consequently placed in an unsuitable learning environment. This frequently exacerbates the child's difficulties.
Parents confronted with a child who fails to speak in school, frequently go through a period of heightened anxiety themselves. The parents' concern for their child, and their grappling with schools and possible interventions, as well as long term projections and postulations regarding future implications for their beloved child, can be overwhelming. To make matters worse, the parents' posturing to get appropriate intervention for their child can be misconstrued as over protectiveness and indentified by the school as the cause, not the effect, of the child's SM.
For all these (and many more) reasons early intervention is vital. What's more, it usually works! Response to intervention using behavioral therapies for children with SM has been found to be highly effective. In addition, our treatment plan is generally experienced by the child as an enjoyable, satisfying experience, and once children break the barriers and speak, they usually experience a surge in self confidence.
Selective mutism is usually anxiety based and that must be borne in mind when talking to your child: One of the aims in discussing speech difficulties with your child, is to lower her anxiety levels. However you choose to express it semantically, the message should be " we love you exactly as you are, right now you can't speak in some situations or to some people, but we know that soon you will overcome it and be able to speak" In other words, you are telling your child three things:
2. You accept her as she is,
3. You have total confidence that she will overcome her SM soon.
Other family members, siblings, grandparents etc, should adopt a similar stance. This fosters confidence in the child that she has the strength and courage to speak, and your apparent lack of worry will do wonders for lowering her anxiety level. Paradoxically, the more she is pressured to speak, and feels your concern, the harder it will be for her to speak, as her anxiety levels will rise. Lowering her anxiety level regarding speech is usually prerequisite for enabling speech.
It follows from this that constant checking as to whether she spoke in kindergarten or school, and to whom, transmits to her your anxiety, and increases her anxiety. Similarly, prizes offered for speech, or punishments for non speech, are contra indicated – they too will increase your child's anxiety levels.
You do not need to try to increase your child's motivation to speak – as explained in the previous section, SM causes suffering and frustration in children, and every SM child I have encountered desperately wants to speak.
Another productive message to your child is to normalize the SM. She can be told that many children find it hard to speak in school, are wonderful children, and overcome their SM in time. This is often a relief for a child who may see herself as different, or problematic. During therapy, it can be said to her that many children have been helped by sessions such as she is having in school. This should not be said at the beginning of therapy, rather, when it has got underway, and it is clear to the child that its aim is social communication.
After these two messages have been conveyed to your child, do not engage her in ongoing discussion about SM unless she initiates it. Your frequent discussion of SM may cause her to feel more pressure to speak, and paradoxically make it harder for her to progress.