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Title: Selective Mutism and the Anxious Child: Strategies for a successful transition into school for the S


1
Selective Mutism and the Anxious Child
Strategies for a successful transition into
school for the Selectively Mute child
  • Ann Sander
  • Ann Sander Associates
  • This document may not be reproduced,
    redistributed, or used commercially without the
    express written consent from
  • Ann Sander at annsconsulting_at_yahoo.com

2
What is Selective Mutism (SM)? The inability to
speak in certain situations while having no
problem speaking in other situations. The higher
the expectation is to speak, the LESS likely a
SM child will be able to do so. SELECTIVE
MUTISM IS NOT WILLFUL DEFIANCE, STUBBORNNESS, A
STRUGGLE FOR CONTROL, OR SOMETHING A CHILD CAN
CONTROL
3
  • Selectively Mute (SM) children
  • CAN NOT CONTROL
  • WHEN THEY ARE UNABLE TO SPEAK
  • any more than
  • a person can control when they get an itch
  • a person can choose whether or not to have a
    headache
  • a person can be persuaded to not feel pain
    despite an injury
  • a person can decide to stop a heart attack in
    progress
  • Or
  • any one of us could swim across the Atlantic
    Ocean
  • no matter how much people threatened us,
    punished us,
  • or bribed us with incentives or treasures

4
Current statistics show just 7 out of every 1000
children in the general population are
Selectively Mute. However, it is believed that
the actual number may be much higher as this
disorder is relatively newly recognized and
therefore many children who have this disorder
may not yet be identified and/or reported.
Statistic as reported by The Journal of the
American Academy of Child and Adolescent
Psychiatry, 2006
5
When you hear that a child has Selective Mutism
you may envision a child with these
characteristics Shy Quiet Nervous Withdrawn Worr
ies a lot Wont make eye contact Wont play with
others THIS MAY BE TRUE SOME OF THE
TIME! HOWEVER, AT OTHER TIMES, THESE SAME
CHILDREN ARE OFTEN ALSO DESCRIBED THIS
WAY Silly Talkative Bossy Wont ever STOP
talking! A Selectively Mute child WILL NOT BE
ABLE TO SPEAK some of the time, but will have NO
PROBLEM speaking at other times.
6
Isnt this just shyness? What is the
difference? How can I tell the difference between
a shy child and a child with Selective Mutism?
A shy child Starts out quiet in most new
situations, but will eventually become
comfortable and join in. The shy child tends to
remain quieter than his peers even when he is
participating.
A Selectively Mute child Will not speak AT ALL
sometimes, but will have NO PROBLEM speaking at
other times. The child may be speaking just fine
one minute and suddenly appear to shut down or
freeze. She may speak to some people, but not
others often her ability to talk seeming to
make no sense such as NOT speaking to a close
relative, but easily speaking to a complete
stranger. This is directly related to the
expectation for the child to speak. The higher
the expectation is to speak, the less likely she
will be able to do so.
7
Typical feelings/reactions WE experience when a
Selectively Mute child will not speak to
us Frustration Hurt feelings/Taking it
personally Anger Belief that the child is being
willfully defiant Thinking child is engaging in
a power struggle Blaming the childs behavior on
poor parenting (Parents are not firm enough or
child is spoiled) Disbelief that this disorder
is, in fact, real
8
  • Settings to consider
  • Home
  • Relatives homes
  • School
  • Friends houses
  • Extra-curricular activities
  • Out in public

9
Ineffective strategies that are often attempted
with SM children Punishment You are being
rude. Say hello to our guest or you are going
to Time Out! Insistence/Pressuring We are not
leaving until you say thank you! Just tell
her your name! Its not that hard!
(Sigh) Ultimatums Grandma says, If you just
say Hi Grandma to me, Ill give you ten
dollars! Motivational rewards If you want the
toy, all you have to do is ask the store clerk to
hand it to you.
Selectively Mute children often experience
responses such as those listed above. However,
these attempts to try to make the SM child speak
almost always fail. In fact, these approaches
generally increase the childs anxiety, making it
even less likely that he will be able to
speak. Remember that no amount of punishing,
rewarding, coaxing, or bribing can get YOU to do
something that you are INCAPABLE of doing!
10
If a child with Selective Mutism is left
untreated, he or she may be at an increased risk
of suffering Depression Panic attacks Social
Anxiety Disorder Agoraphobia Drug or alcohol
abuse Suicide
11
Daily situations at school What questions do you
ask children? What is your answer? How was
your weekend? Will you go tell Johnny to come
here? Things you are askedor things you hear
from kidsevery day Where do I put my
name? Could you repeat the directions? Can
I go to the bathroom? I am sick or hurt. I
need to go to the restroom. I dont understand
something. Hes bothering me. I forgot my
lunch.
12
Consider all the times children typically talk
to their peers at school? Group
activities Asking for help Free time in
class Lunch Recess On the bus
13
Things a teacher can do in the classroom
Assure the child that whenever possible you will
only call on her to speak if she volunteers and
that when it cant be avoided, you will do your
best to make it as easy as possible and to give
her advance warning. Explain that she WILL be
responsible for doing all work you assign,
however you will do your best to find ways to
help her do the same work as her peers without
her having to speak or with as little stress as
possible. Share some examples If I am calling
on people to answer questions during a lesson, I
will only call on you if you raise your
hand. If I need you to read aloud, I will
always let you know in advance what you will be
reading so you can check it out before you have
to read it. If I notice that you are having
trouble speaking during school, such as during a
group activity, I will try to find an alternative
way for you to do the assignment, such as writing
your answers. I will not make a big deal out of
your talking or not talking if your classmates
ask. I will explain that it just takes you a
while to warm up and well move on. I will be
sure substitute teachers know our agreement.
14
Strategically place where the child sits in the
classroom.
Ask the childs parents to discuss with him (and
later share with you) where he would prefer to
sit in the classroom and why. This will give you
clues about what triggers stress for this
particular child. (Possibilities might
include near the door so he wont have to walk
in front of others if he needs to go to the
restroom, near the teachers desk, or in the back
so he does not have anyone behind him) Also, do
not make the mistake of assuming the SM child is
just fine sitting next to the class clown or
behavior problem! The SM child may not show signs
of or express distress, but he is likely
experiencing extreme anxiety in this situation.
15
Please DONT!...
Publically make a big deal if the child does
talk. This can be extremely embarrassing to the
child. Silently rejoice that this is an
indication that you have successfully made the
child feel comfortable enough to speak! Try to
trick the child into speaking. If you have
earned the childs trust, this could cause you to
lose it. Say or allow others to say the SM
childdoesnt talk or cant talk. This may
lead a child to adopt this as his or her
permanent make-up or M.O.. Instead, acknowledge
the differencebut state it in a manner that
assumes the child IS capable of speaking. (For
example, Melissa DOES speak. It just takes her a
little longer to get comfortable using her
voice.)
Please DO!... Privately praise the child
(e.g. discreetly whispering or perhaps sending a
note home with the child saying, Im so happy
you felt comfortable enough to talk in class
today!)
16
Ask the childs parents to make a list of things
the child is afraid he/she might want to ask or
tell the teacher, but wont be able to, such
as Can I go to the bathroom? I need another
piece of paper. My pencil broke. Can I sharpen
it? I forgot my lunch. I didnt understand
the directions. I am feeling anxious and I
dont know why. I dont want to participate in
this. Someone is upsetting me and Im afraid to
tell on them. Then privately meet with the
student and parent to formulate a plan, such as
the teacher and child each keeping a copy of the
list to assist with communication.
17
When possible, ask child questions that require
specific responses rather than questions that ask
for opinions, preferences, or one of many
possible answers.
Stressful
Less stressful
18
When possible, instruct child to perform specific
tasks in front of others, rather than asking for
child to display spontaneous behavior.
Stressful
Less stressful
19
  • If something an SM child will or wont do
  • does not seem to make sense,
  • or simply ANNOYS you to no end,
  • it may very well be caused by their anxiety.
  • Common examples
  • Wont use the bathroom or has potty accidents
    when you know the child
  • is completely potty trained
  • Complains about aches, injuries, fatigue, feeling
    sick or other ailments
  • when they are clearly okay
  • Expresses worry or fear about things you know
    they can do, such as
  • climbing stairs or going to another room alone
  • Speaks using a silly voice or while pretending to
    be an animal or character

20
PREPARE TO DESENSITIZE! Consider sensory
issues Noise levels(the room, the building,
the teachers voice, bells, alarms,
announcements) Movement (lining up, when
everyone is entering/exiting, when groups join
others such as at lunch or at recess in
school) Lighting (fluorescent lights, if
lighting changes from one room to another,
whether or not there are windows, what it would
look like if the teacher blinked the lights) How
crowded it is (sitting at desks, sitting as a
group, standing in line, sitting in the
lunchroom, riding on the bus, free time in the
classroom) How many people will be
involved(note that this may change such as
having 20 students in the classroom and then
joining other classes/students for P.E., recess,
lunch, dismissal, fire drills, walking in the
hallway, using the restroom)
21
Try to ANTICIPATE! What changes in environment
will occur regularly? (lunch, P.E. music, art,
computer, library, the bus, restroom
breaks) Who might the child need to interact
with occasionally and what will it be like? (the
nurse, the cafeteria workers or monitors, the
office personnel) Some surprises that are
likely to occur without warning (fire drills,
substitute teachers, parents helping in the
classroom)
22
Practice! Practice! Practice! Have a trial run
at participating in classes (regular classroom as
well as extra classes such as music, art, P.E.)
with assurance that no speaking will be
involved. Walk to the restroom from various
locations and actually use it! Walk to the nurse
and practice saying, Could you call my mom/dad?
or handing the nurse a note with this
request. As an observer, follow along with a
class (preferably the one the child will be
enrolled in, if that is known) as they come in in
the morning or are dismissed in the
afternoon. Walk through the lunch line and
practice ordering and eating while WITH a parent
or other person with whom the child feels
secure. Get permission to ride the bus with a
sibling, friend, or parent. If possible,
establish and practice pre-agreed upon signals or
modes of communication (such as a hand signal to
indicate needing to go to the restroom).
23
But wont that just encourage the behavior to
continue?
Absolutely NOT! A Selectively Mute child NEEDS
to have his or her environment adapted so that he
or she can function. The childs behavior is not
something he or she can control. There is no
encouraging or discouraging this disorder any
more than one could encourage or discourage
Diabetes. However, just as with a medical
condition such as Diabetes, the severity of
symptoms MAY be controlled with appropriate
adaptations. If one student was cold and
shivering in a classroom, despite all of the
other students feeling fine in that temperature,
the one student might put on a jacket. Without a
jacket, the student will continue to be
cold. With the jacket, the student can feel
comfortable according to his or her individual
needs and can more easily participate in
class. Allowing the child to continue to wear a
jacket every day is not encouraging the child
to be cold. It is addressing and accommodating
the childs individual predisposition to feeling
cold.
24
What is NORMAL anxiety? How do I know when it is
a problem?
  • Healthy levels of anxiety
  • Our bodies natural alarm system
  • Encourage people to carefully analyze
    circumstances
  • and factors in order to make wise decisions.
  • Unhealthy levels of anxiety
  • Repeatedly interfere with a persons ability to
    make decisions
  • Cause a person to avoid things they would like to
    do
  • Interfere with relationships in at least one
    setting
  • Interfere with day-to-day living

25
So what do I do if I suspect that a child has
Selective Mutism? It is important that any
diagnosis of this condition be made by a
qualified professional. Since this
condition has not been widely recognized,
understood,
and/or treated appropriately in many
cases it is essential to locate a professional
who is familiar with the
disorder and who has experience successfully
treating other SM children. You might
start your search for a qualified provider by
looking for a pediatrician or psychiatrist who is
experienced in treating childhood anxiety
disorders. Some other helpful resources
include http//www.selectivemutism.org

(a non
profit organization offering resources, support,
and general information about SM) http//www.selec
tivemutismfoundation.org

(offers information about SM, research,
resources, and a list of healthcare providers)
For information about scheduling presentations
or workshops, contact Ann Sander and Associates


email AnnsConsulting_at_yahoo.com

or call 281-723-6572
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