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 DefinedSelective 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 ContinuedIndividuals 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.

CharacteristicsConsistent failure to speak in specific social situationsNot speaking interferes with school, work, or social

communicationNot 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.

CausesSelective 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.

IdentificationSpeech Language Pathologist (SLP)PediatricianPsychologist/PsychiatristTeachers (generally early childhood teachers, but not

always)FamilyReview educational historyHearing Screening by health care professionalOral-motor exam by health care professional or SLPParent/Guardian InterviewMental health evaluation by psychExpressive language ability by SLPVerbal and non-verbal communication by SLP

Educational ConsiderationsNever punish a child for not speaking or

force a child to speakUse multiple intelligences in the classroomIncorporate a reward systemAllow 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 InterventionUnderstand symptoms are not intentionalConsistent behavioral strategies Behavioral management programs focusing

on phobia’sDesensitizing by providing short term goalsPositive reinforcement and praise Early Intervention is Key

Interventions for Inclusion If student has “safe” person allow “safe” person to answer for

them as 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 groupsCommunicate 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 ProgressAssess 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 assessmentsAllow student to take tests in another

location where they feel comfortable.Consult with other specialists and families

about progress they see.

TransitionsMost 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 settingsShould have a way to communicate non-verbally:

notebook, texting, etc.May need advocates until they can self advocate.

References1. http://www.asha.org/public/speech/

disorders/selectivemutism.htm2. www.nipissingu.ca/education/thomasr/.../

SelectiveMutism.ppt3. www.selectivemutismfoundation.org

Questions, Comments, ConcernsThank You!