It was over ten years ago when I first heard of Selective Mutism. I was a newly hired public school Speech-Language Pathologist. Fresh from graduate school, I took my position as a Communication Disorders Specialist very seriously. It is only with the experience of time (or is it age) that I can be humbled to now admit that I didn’t know as much as I thought I did.
It is with this frame of mind that I’d like to share with you what I have learned, but to do that, I have to also share with you my mistakes. The old adage, we learn from our mistakes could not be more true.
Donnie* was a boy on the Physical Therapist’s caseload. He was entering third grade, and at one of our weekly team meetings, we discussed what needed to be done for his three year re-evaluation. There were some concerns from his teacher that he didn’t seem to understand language as well as his peers. “How is his expressive language?” I asked. “Well, we don’t really know since Donnie doesn’t talk to us”. “Well, he does talk to me”, said Tammi, the PT. The gears in my mind were working—“you mean, he won’t talk to anyone else, except you? What is that, mutism? Or rather, elective mutism?” (I thought I had coined a new term! Little did I know that it was actually the name for the disorder! (It is now referred to as Selective Mutism)). Well, the discussion went on, and it was agreed that I would evaluate Donnie’s receptive language using tests that require only pointing as a response.
Testing showed that Donnie was on the borderline for having difficulty. I talked to Donnie and asked him if he would like to come to Speech regularly. He nodded his head for yes, he would like to see me every week. Here comes Mistake #1, which turns into Lesson #1: REASONING DOES NOT WORK. “Donnie”, I explained, “I would really like to work with you, too. But you won’t talk to me. And in order for us to do Speech Class, I need you to try and talk to me. That’s why it’s called Speech—- if you don’t talk, then I won’t know what I can help you with. Do you think you can talk to me?” Donnie shrugged his shoulders, indicating that he didn’t really know how to answer that question. “Well, why don’t you think about it, and I’ll check with you in a few days and see what your decision is”. You can probably predict that yes, I checked with Donnie, and no, he still was not able to talk with me. Which brings me to Lesson #2: IT IS NOT A SIMPLE DECISION FOR THESE KIDS. IT IS A SYMPTOM OF A DEEPER ISSUE, NAMELY ANXIETY.
When we met again as a team to go over Donnie’s test results, I was curious to know what had been tried in the past. Since Tammi had worked with Donnie since preschool, she was familiar with everything that had been tried. Witholding “snack” was one idea, but his mother didn’t want that, so it was never done. Actually, all of the team’s ideas of structuring the environment so that he would have to talk were rejected by his mother. His mother was protective of him, and rightly so, since he had a degenerative condition that meant he would have a shortened life expectancy. She wanted him to enjoy his time and not feel unhappy at school. We went round and round trying to decide how to best address this “talking” issue, and I sensed that it was going to fall into my lap. Quick thinking that I am, I brought up the fact that it really was not a Speech-Language Pathology issue since it hadn’t been covered in my coursework and it appeared to be a psychological issue, thus delegating it to the school psychologist. But, since in our district, school psychologists do not work directly with students, then it could not be on the IEP. Well but it needs to be on the IEP, so what do we do now? This brings me to Lesson #3: IT SHOULDN’T MATTER WHO DOES WHAT, JUST THAT SOMETHING NEEDS TO BE DONE.
Lesson #3 got put into effect when a few months later, I encountered my second student with Selective Mutism. Lindsay was a new student in our special education preschool. She was placed on my caseload because she reportedly had many speech sound errors. She was a demure little girl, with eyes as big as saucers. She fit the image of the “shy and bashful” type, stepping back when approached, hiding behind her mother’s skirt. Her mother let me know that “Lindsay doesn’t talk.” So I engaged her mom in a full discussion about Lindsay’s talking; where she talks and where she won’t, and why do you think she won’t talk. MISTAKE #2 on her mom’s and my own part, and that translates into LESSON #4: ANY CONVERSATION ABOUT THE MUTISM NEEDS TO TAKE PLACE AWAY FROM THE CHILD. You see, in Lindsay’s eyes, her world is her mom, and what Mommy Says must be true, right? So by engaging her mom in a candid conversation, Lindsay heard the message that she doesn’t talk, that she might be scared of talking, that she has speech impediments and so she’s hard to understand, etc. etc. I’m sure that I was not the first person to make this mistake and I’m sure that Lindsay had “heard it all before”, but it certainly did not help the process to have her present. In fact, I think it helped identify that I was the SPEECH LADY! Yes, she had it figured out that I was the lady who was going to make her talk, that I did things with the other children in the preschool and that a lot of talking was involved, and that I was someone to avoid at all costs! It didn’t take me long to figure out that she was avoiding me, so I sent in my reinforcements—my own speech assistant.
Pam was a talented woman with a warm and friendly smile, and Lindsay warmed up to her in time. By the fourth quarter, Pam came to me with wonderful news, “Lindsay talked to me today!” “She did?” “Yes, she actually answered me out loud. She said “no”. It was very soft, but I heard it!” Great news! Okay! Well, why don’t you start pulling her into the speech group with the other girls from the preschool. That way, she’ll get the benefit of working on the various phonological processes (Lindsay’s mom had confirmed that Lindsay had difficulty articulating) and she’ll eventually try practicing some of the words.
LESSON #5: YOU CAN’T RUSH THE PROCESS. This was, in hindsight, too much too fast for Lindsay. After all, she was the poster girl for shyness, remember. Her entire personality was not one to jump in with both feet. As you can predict, she did not readily participate in the group.
Because the year was coming to a close and I was a dedicated therapist wanting to meet those IEP objectives, I decided to up the ante. We have to think of something that she’ll really really want, and then she’ll talk for it! I knew from talking with her teacher that the beloved tricycle (a favorite for Lindsay) had been used somewhat successfully in getting her to talk. We had structured it so that ALL the preschoolers had to tell the teacher what they wanted to play with before entering the playground. As Lindsay stood in line, you could sense the anticipation building up.
Many weeks had gone by where she did not say “tricycle”, but eventually, she whispered it to the teacher. Whispering counts! And Lindsay got to enjoy the tricycle. This brings me to LESSON #6: WHILE IT IS SOMETIMES SUCCESSFUL, STRUCTURING DOESN’T NECESSARILY GUARANTEE GENERALIZATION. That is, Lindsay never did generalize her requests. She didn’t spontaneously start requesting things left and right in the preschool. It always had to be structured, and even then, there was still no guarantee, as I came to learn.
Oh, we came up with a great idea! We would plan a tea party and talk it up with the girls weeks in advance, so that Lindsay would know it was coming up. We told the girls that they would be able to ask for their drinks and cookies, that way, Lindsay would know and be prepared to ask out loud. When the big day came, I brought in my real china teacups and saucers and exited the room so that Pam could work her magic (remember, I was already pegged as someone who wanted her to talk, so I knew the chances for success were slim if I stayed in the room). I did my therapy on the other preschoolers in the classroom, and I eagerly awaited Pam’s report as she walked the girls back into the room. Lindsay looked forlorn as she joined the circle. I dashed into my room and said, “well?”. “She didn’t talk. I couldn’t believe it, but she wouldn’t talk. She wanted to, but she just wouldn’t. I even bent over for her to whisper, and she wouldn’t.” So now picture this, here’s a lovely tea party and little Lindsay sat there without anything in her cup or any snacks on her plate. Her anxiety was probably building for each minute of the tea party. At that point, I know Lindsay’s heart hung heavy that day, but mine was a close second. Ten years ago, I didn’t know how strong the anxiety was for these children. Which brings me to LESSON #6: “BAITING” A CHILD TO TALK, AND THE ANTICIPATION THAT BUILDS UP, IS SURE TO BACKFIRE.
Preschool ended the last week of May, and so that was our last opportunity to get Lindsay to talk. A week later I got a phone call. It was Sherri, our preschool coordinator. “Mary, I’ve got a darling little girl for you to meet. She’s going to go into kindergarten in the Fall, and she won’t talk outside of her home environment”. Another Selective Mutism case! It was my third case in a year.
Little Jennie had ringlet curls and a bright smile that lit up her whole face. She came to tour the school with her mom, and while she didn’t hide behind her mother’s skirt, she did cling tightly to mom’s leg when introductions began. But that was only for a moment, and then she joyously began to explore my room. She had non-verbal communication down pat, using her facial expressions and yes/no head movements to interact with us. This was much different from Lindsay and Donnie, who were hesitant to even make eye contact, and shyly nodded their heads only in the most pressing situations. Jennie seemed to be very comfortable in our presence just like other children, only she was silent.
Summer came and went, and I returned to the school in September. Prior to the start of the school year, Jennie’s kindergarten teacher, Mrs. Wandell, had arranged to meet with Jennie and her mom at Jennie’s house. Jennie had no problem talking with her teacher, so we had hoped that it might mean that she would at least talk to Mrs. Wandell in the classroom.
The first few weeks went by without a word from Jennie, and then she began to speak quietly to Mrs. Wandell when other children were not around. At about the same time, our new school psychologist, Fran, was eager to meet Jennie, as she had never encountered a child with Selective Mutism before. Fran asked Jennie to come down to her room, and began to ask Jennie some questions. Jennie said to Fran “I don’t talk”. Fran said, “sure you do, you just talked to me didn’t you”. Jennie nodded her head in agreement.
I don’t believe that Jennie talked to Fran by accident, rather I think Jennie sensed something about Fran or the situation, and realized it was not a threat. And that perhaps, it was time to talk to somebody about “talking”. Fran knew as little as I did about mutism. At the time, the internet was not as rich with information, and much of it was outdated. But Fran came up with a plan that included her as one of the key players, even though the psych’s “don’t work” with the children. Remember Lesson #3; it doesn’t matter who does what, just that something needs to be done… well, Fran recognized this. Since she was someone who Jennie would talk to, then she needed to be a part of the plan. Fran decided that she would invite Jennie down to her room and get her to the point where she was comfortable talking with her, and then begin to include other girls from class. Eventually, the Learning Specialist became another person that Jennie would speak to, and did the same thing.
Meanwhile, it didn’t take the perceptive classmates long to voice their observations. One day while Jennie was involved in a table activity, led by Mrs. Wandell, a little boy piped up “Mrs. Wandell, Jennie doesn’t talk”. All the kids looked at Jennie, then looked at Mrs. Wandell. She replied, “Jennie does talk, and she can talk quite well. She talked to me before when I visited her at home. She’s just not ready to talk here in our classroom, but when she does, you’ll still all be friends.” Other kids chimed in, “yeah, we like Jennie”, and Jennie held her head high and smiled at Mrs. Wandell. Which brings me to LESSON #7: ANY CONVERSATION THAT TAKES PLACE IN FRONT OF THE CHILD NEEDS TO BE STRUCTURED AND CAREFULLY WORDED SO AS TO FACILITATE THE PROCESS OF LEARNING TO SPEAK WITH OTHERS. Imagine what could have happened if Mrs. Wandell had said “…but when she does [talk], we’ll all be ready to listen”. I mean, imagine that you are at a table of adults, perhaps at a job interview, and the leader says “and when you give your answer, we’ll all be ready to listen”. Can you feel that burst of adrenaline flowing through your body? Can you feel your heartbeat rise up into your throat? It’s anxiety-provoking. And for these kids, the idea of talking is anxiety-provoking. Their world is safe and predictable, and we are trying to get them to do something that is unpredictable (“if I talk, will they laugh at me? Will they still like me?”). So Mrs. Wandell had played it right. She acknowledged the concern of the classmates, and at the same time, helped the process by giving confidence to Jennie.
It wasn’t long before the plan was working. By the end of the school year, Jennie was talking in the classroom. She wasn’t a chatterbox, but she was by the end of the next grade level. She never did need to work with me; her articulation errors cleared up on their own. She would say “hi” to me in the hallway, and would engage in a conversation with me from time to time. By the time I transferred to a different school, Jennie showed no differences academically, or socially.
You may be wondering what happened to the other children. Well, Donnie is in the latter part of high school. He never did become totally verbal, but he did form a few friendships in which he talked openly. And his mom was fine with this. Little Lindsay’s family had to move to the East Coast that summer after preschool. Just recently, I learned through the “parent grapevine” that she was still having problems with mutism, and had developed other anxiety related problems and her parents were looking into some medication that might help her. Clearly, Donnie and Lindsay had other emotional factors that needed to be a part of their plan. Jennie’s level of anxiety was probably not as severe.
If I had to do it all over again, I would take the lessons I learned and combine it with a few more that I have learned from becoming a parent. And that is, JUMP INTO THE HEART AND SOUL OF THE CHILD. SEE THE WORLD FROM THEIR POINT OF VIEW. PUT YOURSELF IN THEIR SHOES, AND TREAT THEM WITH THE DIGNITY AND RESPECT THAT THEY DESERVE. BELIEVE IN THEM, AND TELL THEM THAT YOU BELIEVE THEY CAN DO IT. Selective Mutism is more than just “wanting” a child to talk to others, it is believing that they can do it. It may take time, and there may be many stops and starts and tears and smiles. You may have to plan and plan-again and find the right support to help the child along the way, but it can be done. The internet is full of information on Selective Mutism, and resources like KidPower are helping others find out more about this disorder, so that kids don’t have to live silently. Speak out about Selective Mutism.
Mary Shields Wetherby, M.A., CCC-SLP
*Names, ages, and other details may have been altered to protect the confidentiality of those involved.
LINKS TO MORE INFORMATION
Family Village Selective Mutism
Selective Mutism
Selective Mutism Group
Selective Mutism Foundation
Selective Mutism from Child Anxiety.com
Selective Mutism in Children
Selective Mutism Help
The Silence Within