Heated Debate-Selective Mutism

Sunday, December 16, 2012

Yet another puzzling disorder, with much debate. 

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Selective Mutism is diagnosed by a Psychologist using the 2000 edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).

  • "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.

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).


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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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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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.


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