Yet another puzzling disorder, with much debate.
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DISORDER
Selective Mutism is diagnosed by a Psychologist using the 2000 edition of the
Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).
Symptoms:
- "consistent failure to speak in specific social situations (in which
there is an expectation for speaking, such as at school) despite
speaking in other situations.
- not speaking interferes with school or work, or with social communication.
- lasts at least 1 month (not limited to the first month of school).
- failure to speak is not due to a lack of knowledge of, or comfort, with the spoken language required in the social situation
- not due to a communication disorder (e.g., stuttering). It does not
occur exclusively during the course of a pervasive developmental
disorder (PPD), schizophrenia, or other psychotic disorder."(Directly quoted from http://www.asha.org/public/speech/disorders/selectivemutism.htm)
Many
suggest (including ASHA) that an SLP be involved in therapy despite 90%
of children with this disorder presenting with a social anxiety
disorder. A team approach in which the child's doctor, psychologist,
parents, and SLP work together.
ASSESSMENT
As an SLP, assessing a child with this disorder would pose some challenges. The child has a phobia of speaking, so many of the standardized tests would be deemed invalid. Receptive language measures would be appropriate in some cases or a dynamic approach where other means are used to assess their abilities in a variety of situations (e.g. recording them talking at home, teacher interviews, assessing how the child currently communicates and determined what they can and cannot do).
TREATMENT
ASHA outlines a treatment structure that may be helpful as a starting point. You can find that
here.
I also found a great powerpoint
here, that outlines the ABC's of treatment
- reduce Anxiety
- Build self-esteem
- increase Confidence in communicating
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IS SELECTIVE MUTISM A SPEECH OR LANGUAGE IMPAIRMENT?
Now, in my opinion this is where the lines between the disciplines (Psych/SLP) get blurry. As professionals we are not to practice outside our expertise or discipline. To be honest, I am skeptical of the treatments conducted by an SLP, as the treatment for selective mutism appears to be more of a counseling role to treat anxiety, not treating a speech or language impairment.
Selective mutism is far more
anxiety based disorder than language based. Although research shows 10-30% (I found differing evidence) may have a speech and language impairment in addition to selective mutism. This is where we would come in with that small percentage.
In my limited experience with this, the students are diagnosed by a counselor and assessed by a psychiatrist. Then usually given counseling for anxiety or anti anxiety medication (short term until they are confident to speak). This website says students are often misplaced into speech and language therapy, and I do partially agree.
http://www.selectivemutismfoundation.org/speech.html
Many of the
treatments listed on ASHA's website could also be conducted by a
psychologist or parent. Which could be a possibility with consultation done on the part of the SLP to assist in training parents or helping teachers understand how to talk to the child. Direct 1:1 or small group therapy conducted by SLP would be helpful to gain confidence speaking without pressure of whole class (again could be conducted by a counselor). Tricky....
Now what's the big idea!? The thing I took away from my research was that students with selective mutism need intervention and they need it early! I am reconsidering my role and I should be working directly with counselors to provide appropriate education environment in which they can communicate effectively using whatever means possible.
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TO WRAP UP
Each student is different and the method of assessment and treatment will vary, but as SLPs we must do our due diligence and assess the best we can to rule out a speech or language impairment. We need to be willing to work as a multidisciplinary team and be open to treatment options.
RESOURCES
