A Counseling Approach for Children With Selective Mutism

Speech-language pathologists are uniquely prepared to counsel individuals who are anxious about talking and communicating. While we are known for our expertise in language facilitation, our understanding of communication extends beyond surface level linguistics into the rich inner world of beliefs and emotions and the complex outer world of speaking demands. We appreciate how perceptions, desires, and feelings shape each communication act within a social context and are adept at describing these factors when we examine how an individual talks (or doesn't).

If a child does not respond in class, we take an open stance, and look at the complex variables involved. We observe the child in important classroom and playground speaking contexts and with different partners. We describe the full complement of speaking opportunities and speaking demands that encase the child's verbal and nonverbal abilities. We listen and clarify when interviewing the child's parents and teachers. We manipulate aspects of the contexts so we can find out how a child might respond to a specific intervention strategy. As we carefully analyze and interpret our data, we draw a conclusion about why we think the child is not talking, and then design an intervention plan that involves changes in beliefs, perceptions, and emotions, as well as observable behaviors. We are masters at using counseling skills to solve communication issues and, as you will discover as you read on, this kind of experience is essential to the development of a credible intervention plan for individuals diagnosed with selective mutism.

What Is Selective Mutism?

The first article on selective mutism appeared in 1999 in an American pediatric journal (Joseph, 1999). Thanks largely to prompting by the selective mutism community of families and professionals, such as the Selective Mutism Group~Childhood Anxiety Network (SMG~CAN), selective mutism is becoming a serious area of research in the United States, although it remains an understudied area. (A quick search on www.PubMed.org brought up 857 articles related to selective mutism, compared to 2,682 for stuttering, 8,838 for autism, and 9,274 for aphasia.) Most mental health professionals now agree that selective mutism is an anxiety disorder characterized in childhood by an inability to speak and communicate effectively in select social situations (Anstendig, 1999; Manassis, Fung, Tannock, Sloman, Fiksenbaum & McInnes, 2003; SMG~CAN, n.d.). From this perspective, the core of selective mutism is debilitating fear, a fear that goes well beyond what a timid or shy speaker might experience and reaches to the anticipation of speaking in a social situation. These children simply find themselves unable to talk in some situations. Professionals who specialize in selective mutism believe the mutism is an attempt to avoid anxious feelings brought on by the expectancy to talk. Adults with selective mutism tell us just how painful this loss of speech is for the child.

What makes this disorder puzzling is that the child with selective mutism is often able to speak and communicate effectively when feeling secure and relaxed. This observation may lead to the conclusion that the child is behaving willfully and that mutism is the child's attempt to gain control over the environment. Uninformed but generally well-intentioned proponents of this point of view may negatively reinforce or punish the child to alter the speaking behavior (SMG~CAN, n.d.). While there is some disagreement among researchers about the degree to which social anxiety plays a role in the genesis of selective mutism, the majority of experts warn against trying to force a child to speak (Gordon, 2001; Yeganeh, Beidel, Turner, Pina, & Silverman, 2003). Such a course of action is likely to increase the child's anxiety and the adult's frustration. If the adult persists, the child may develop oppositional behavior as a reaction to the constant pressure to speak. The preferred intervention approach is a carefully constructed behavioral plan that works on reducing anxiety while building the child's ability to handle it (Rye & Ullman, 1999; SMG~CAN, n.d.). Pharmacotherapy is generally not the first choice of intervention but may be included later (Kumpulainen, 2002).

Children with selective mutism show fear in different ways. Some children are completely mute in all social situations while others may whisper or speak in select settings. Fear may rob some children of expression and action, leaving them emotionless and frozen in place, while other children, though not talking, look completely natural and comfortable in the social context. Most children experience some degree of social isolation, although a small percentage of children seem easy with social engagement.