Selective Mutism for SLPs

Understanding Selective Mutism

  • Definition: Anxiety disorder where children cannot speak in specific situations (e.g., speaking at school but not at home).

  • Prevalence: Affects roughly 1% of children, often underdiagnosed.

  • Onset: Typically identified when children start preschool around ages 3-4.

  • Comorbidities: 30-40% of affected children may have speech or language delays.

Key Characteristics

  • Common in bilingual/multilingual children and often appears alongside parental anxiety history.

  • Often displays increased sensory sensitivities, social avoidance, and behavior issues (e.g., tantrums).

  • Can be academically advanced despite speaking difficulties.

Diagnostic Criteria (DSM-5)

  • Consistent failure to speak in social situations lasting over a month.

  • Speaking difficulties must not be attributed to language knowledge or other disorders (e.g., autism, stuttering).

  • High incidence of extreme shyness, non-verbal communication, and social avoidance.

Causes of Selective Mutism

  • Involves genetic, environmental, and developmental components.

  • Children may have an inhibited temperament and experience environmental pressures (e.g., immigration, academic expectations).

  • Family dynamics might enable avoidance behaviors (e.g., parents answering for them).

Myths and Misunderstandings

  • SM is not caused by trauma; differs from mutism due to traumatic events.

  • It's important to differentiate between being shy and having selective mutism; SM is driven by anxiety, not defiance.

Therapeutic Approaches and Practical Strategies

  • Objective: Creating comfort rather than forcing speech.

  • Use techniques under Cognitive Behavioral Therapy (CBT), including PRIDE approach:

    • Praise: Offer specific praise for brave talking.

    • Repeat: Parrot back what the child says to acknowledge it.

    • Imitate: Engage in parallel activities without demanding speech.

    • Describe: Act as a sportscaster, narrating actions to encourage participation.

    • Excitement: Keep interactions fun to decrease pressure.

Interaction Techniques

  • Child Directed Interaction (CDI): Focus on fun play for warming up; no questions asked.

  • Verbal Directed Interaction (VDI): Increase verbal demands gradually using forced-choice questions.

  • Use a mix of verbal, non-verbal, and interactive prompts while allowing enough response time.

Assessment Strategies

  • Receptive language usually intact; expressive language scores may be depressed due to anxiety.

  • Utilize selective mutism questionnaires assessing speech behaviors in various settings.

Recommendations for Intervention

  • Suggest community or school-based therapies; follow up with parents and provide resources.

  • Emphasize the importance of ruling out other anxieties and consider psychiatric consultation if necessary.