Unspoken Words: Ask Dr. E #1 

“Ask Dr E” is where our community can ask Dr. Elisa Shipon-Blum any question they have on any topic relating to Selective Mutism. We have received some amazing questions and now, we are giving the segment more life by giving it its own series on our podcast! In our first Ask Dr E episode, Dr. E provided insight into school accommodations, avoidance behaviors, private schools and Selective Mutism, and much more!


Episode Transcription


Brandon Blum: All right, so the first question we have this month is “My son’s public school has tried to accommodate and provide interventions for selective mutism. However, their approach has been focused on getting my son to talk. My son has made very little progress, if any, in school. In fact, I think he has regressed. Having listened to your podcast, I realize my son is having a hard time interacting and communicating non. The school is very focused on getting him to speak, even offering him rewards if he does. Since he can’t speak, he is feeling defeated. How do you suggest I approach the school since they seem very committed to their approach?” 

Dr. E: This is a very loaded question. There’s a lot we can talk about here. First of all, goes back to the most basic concept that selective mutism, that term really does focus on selectively not speaking. And unfortunately, it brings about an approach of let’s do whatever we can to get this child to speak, even if they’re attempting to lower anxiety, because we know. Even just working on lowering anxiety doesn’t always bring about speech because it really is about understanding their baseline stages of social communication. To really understand where do we start and where do we go. And it sounds like with your son he is not possibly even engaging or maybe non-verbally He’s struggling. 

And so what I would wanna know, and what I would recommend is that you sit down with the school, you share resources, you explain to them that sm. Is a social communication anxiety and the approach to pushing to speak in this particular case, especially since your child is not making that progress, is probably. too brutal of an approach. And what I would recommend doing is really going over the stages of social communication. And in addition to that, I’d wanna know why is your child not speaking? It’s one thing to say, let’s get the child to speak and reward them for speaking, but maybe there’s factors into why he is not speaking. 

And so I’d wanna understand. What whys are involved in this? What whys of SM are involved in his mutism? Is he a timid child? Is there any underlying speech and language challenges? Sensory issues, learning challenges like I’d like to know. And so an evaluation to assess that would be highly recommended. So my approach with the school, since he isn’t communicating 

verbally in school and it’s affecting his, it sounds like his emotional well. He’s feeling a bit defeated there, I’m sure. And his confidence is definitely a, an issue. I would recommend an evaluation for either an I E P depending on how. while he is functioning academically, socially, and emotionally, but at least getting something underway. For example, even a 5 0 4 plan. So having a meeting with key staff members regarding the possibility of either a 5 0 4 or an i e P is your first step. And even though he may be functioning on grade level, if he is having a challenge, Communicating with peers, making his needs known, sharing his thoughts, his feelings, being able to advocate for himself. 

It is affecting him and it’s affecting his social emotional wellbeing and obviously his ability to communicate. So again, whether he qualifies for an I E P or 5 0 4, really will. About the accommodation intervention approach and whether they can go for an evaluation to assess the whys of SM. Basically in this child’s case, what I would highly recommend is that we approach the school and request That key staff members meet together. You can go to your principal, you can go to your county. I’m not saying your son is gonna qualify for special education under an I E P or even a 5 0 4, but I always say at the minimum of 5 0 4 in a public school, if a child is having difficulty communicating where it’s his wellbeing, he’s not able to make his needs known. 

He’s having a difficult time initiating his needs in one. So I’d wanna understand that. So at the minimum, he would qualify for a 5 0 4 plan because every child is deserving of accommodations and interventions. 


Brandon: Next question is, “My daughter has selective mutism. The school has not brought up needing accommodations and interventions. She’s mute with her teachers, but does whisper to two of her close friends. I’m concerned since she is in fourth grade, and although bright in school, she is having a difficult time starting and completing tasks and she’s functioning below her grade level. The teachers are having a difficult time assessing her as well. This is affecting her confidence. Do you have any advice on where we should go from?” 

Dr. E: Absolutely. There’s so much to say here. First of all, we can already see that she is communicating with a few. although she is mute with her teachers. So what I would recommend we do is we set up a time where you approach this school key staff members. I you can, if you’re not sure where to go, you can go to your principal to see where this starts. 

The county often has special education services to get the ball rolling here, but since your child. Is struggling to start and complete tasks and functioning below grade level. Again, it has nothing to do with her intelligence. She could be in the gifted range of intelligence, but within the school setting, she is struggling. So to me, we need to approach the school to definitely get accommodations and interventions in place so that they can assess her, but that they can also accommodate her because obviously there’s something going on that’s affecting this, that she’s not able to perform on grade level, not able to start in complete task on time. 

To me, that is one of the biggest questions I always wanna know. And when families fill the SM school evaluation form, which we have for every family that comes to the smart center. I have the schools fill that out because that will let me know functioning in terms of academics, but it’ll also help me know how this child is communicating. 

So if we put communication aside, we definitely can think about ways to utilize friends as intermed. To be able to have a starting point in progression of communication in school. But to back up, we need accommodations and interventions in place, not only just to help her progress communicatively, but to have an effective plan in place because the academics are affected. 

I believe the I E P is probably the best way, the individual educational plan evaluation to assess. And in that assessment, they’re going to be picking up on some of the why’s of SM that they need to think about. Timidity, speech and language, sensory processing learning challenges, whatever the reasons may be, we need to be able to figure out so that we can accommodate her and be able to begin to really, truly assess her, but also help her function academically, especially You’re telling me she’s bright, so this must be incredibly frustrating for this child. 

Brandon: So, but it starts with the evaluation- 

Dr. E: Yes. I mean, there’s two types of. Absolutely. There’s two types of accommodations and intervention plans. One is the 5 0 4 plan, which I always call of a more informal plan. It’s a plan in place to be able to accommodate a child and provide interventions. But when academics are at stake, when the child is struggling academically, that to me already bumps them up into an evaluation for an I E P. 

I wanna think about functioning here, Brandon. I wanna think about how is this child functioning academically. She’s definitely not reaching her potential for sure. two. How is she socially Well, she might be doing okay. She has a few friends she’s communicating with, so doesn’t sound like she’s socially struggling, although maybe it’s just those two friends. I’d have to dive into this a little bit more. 

Brandon: Mm-hmm, but it starts with an evaluation. 

Dr. E: Absolutely. But how is she functioning emotionally? This is something that is affecting her confidence. So social, emotional and academic wellbeing is what we. To begin the process of an i E P evaluation to help her with accommodations and interventions and develop an effective plan with goals and so forth to really help her make that progress communicatively, but also to help her from a academic standpoint. 

Brandon: Got it. Okay. The next question is about private schools. “How do you get a private school to be more receptive to the SM diagnosis?” 

Dr. E: Another really great question here. I would not say that private schools are not receptive to the diagnosis. I think that private schools are incredibly appreciative of a diagnosis. The question becomes, are they able to accommodate and provide the interventions that most students need that have selected mutism? Because private schools, by law do not have to follow an i e. To the level that a public school does. It doesn’t mean they’re not gonna honor it, but it, each p private school is different in terms of what they’re willing to provide in terms of accommodations intervention. So it’s very important that parents sit down with the private school. Staff members, again, beginning with the principal, and they often have a guidance counselor, sch school psychologist on staff to really talk about the child’s selected mutism. And what, again, I’d wanna know is this child’s level of functioning academically, socially, and emotionally, and then together with the school, make that determination.  

Are they able make the accommodations interventions? I’ve worked with so many private schools that are willing to do the buddy process, are willing to do the small group in school, in the classroom, doing lunch bunches, friendships, groups. And the child has made really great progress. But I’ve also worked with private schools where they’ll tell parents, listen, we are not set up. 

We don’t have the staff to do this. So I don’t wanna think that they’re not receptive. It’s whether or not they’re able to. What is needed. Now, I will mention, and I have to mention this, that if this parent doesn’t know their child’s level of functioning, what they’re able to do, like their level of social communication functioning, I would recommend, at least at our center, we do something called the selective mutism evaluation or a selective mutism interview. 

If they are in a state that we are not licensed in, we do the interview. I would highly recommend an evaluation like that because at least at our center, we will assess their social communication in terms of their ability to communicate across the board in terms of the bridge with peers, with teachers in small groups, in large groups, are they functioning academically, starting completing work on time? Are they functioning at grade level? I’d wanna know this. I’d wanna know what their whys of smr. It’s very possible this private school can accommodate this child and they just need an education, Brandon. That’s what they need. They need guidance. And again, I’ve worked with so many private schools that are willing to do that, so I wouldn’t rule it out here. I’d wanna have a conversation and a true understanding of that student. 

Brandon: So what, what do private schools generally like look to when they, when they have a student at the school who isn’t talking or is mute at school, what do they usually think or what do they, what’s their, what’s their usual approach? 

Dr. E: Well, usually it’s about, again, having information from professionals that have an understanding of that child. Parents can go to their public school and request an evaluation at the public school in terms of an I e P, they can do that. They’re paying taxes. They can do it. They can. 

Brandon: not at private schools though. 

Dr. E: No, no. They can go to their public school and ask for an evaluation, get a full report whether or not that public.  

Brandon: Even if their kid goes to private school in, they can go their district. 

Dr. E: Absolutely because they’re paying taxes. The parents are choosing to go to a private school within their district, but they can go to their public school for an evaluation for an I E P, for example, independent educational plan. Bring that evaluation again. A lot of public schools have difficulty assessing children with sm. They can go to a private treatment professional for an evaluation to be able to have a written report to give to their private school so that the parents are going with the information to their private school. I would not expect that any school in general is going to hear the word selective mutism and know what to do because you need to understand that child, that student, you need to understand their level of functioning, their academics, their social, their emotional wellbeing. They need to know that to be able to give an answer of whether they can accommodate this student, because they may not be able to, they may not have the staff. The true understanding of what a school can do is going to be based on that child’s individual needs, and so therefore, they need to go as parents to the school with that information. 

Brandon: Got it. The more information, the better. All right, so the next question we have is on avoidance behaviors. The question is, “I am a social worker working with a third grade female student. She’s not speaking at school, and is exhibiting avoidance behaviors such as requesting to use the restroom numerous times per day. Can you please share any recommendations you have for these kinds of avoidance behaviors?” 

Dr. E: Yeah. Avoidance behaviors to me, you know, my concept of “Look, Listen, and Learn” from a child, a teen or adult. Like look at them, listen, learn from them. What are they telling you? In this particular case, this third grade student is basically saying, I am not comfortable. I don’t wanna be here. I feel, I feel awkward. 

I feel this isn’t working for me. So I am going to avoid this uncomfortable feeling and having frequent restroom breaks is an example of that. I need to go to the bathroom. That is an excusable excuse. A teacher is not gonna say, no, you can’t go to the bathroom. So this student has figured out, if I ask to go to the bathroom, I am removing myself from this uncomfortable feeling. And even if they’re going or not going, they’re getting that reprieve. So what I would wanna. Why are they avoidant? What is being missed with this student? So again, I go back to, yes, I understand this child has selected mutism. Yes, I understand she’s not speaking. Why is she not speaking? What are her stages of communication? What are we doing to help understand her, but what are we doing to accommodate this child’s anxiety, which is clearly their avoidance and what interventions are in place to help her? So from what I’m seeing here, this child needs an evaluation to really understand her unique needs that may be causing her to run out of the room to avoid. Is there peer pressure going on? Is this child not functioning academically to the level that this child feels comfortable? Do they see, does this child see her peers starting tasks, completing tasks, doing schoolwork? And she is not doing that. She is feeling anxious, she’s not able to perform. Are there learning issues involved? Like what’s going on? Like, I know nothing about this student, and that is why to me, we treat a person and not a diagnosis. 

Brandon: So, what are other examples of avoidance behaviors besides going to the bathroom numerous times per day. 

Dr. E: Other examples are actually disruptive avoidant behaviors. What I see sometimes in students is a disruptive behavior, especially in younger boys. I see this a lot where they are avoiding a situation because of either their inability to communicate effectively. or again, something else going on academically, they have found that by being a bit disruptive, being silly, being goofy, they get attention from their peers. So avoidance behaviors can be disruptive. Behaviors, they’re avoiding what else is going on. They’re avoiding academics, they’re avoiding social interaction. 

They’re avoiding numerous. academic situations going on, avoiding tasks by acting silly or goofy, maybe they’re shutting down. Another form of avoidance is complete shutdown. Some students, especially as they get older, may put their hoodie over their head. I’ve had teens where. the the teachers will say she’s sitting there with a hoodie. We can’t even see her face. Her face is down. She’s not doing her work. Those are avoidant behaviors. So they may not be leaving the room, Brandon, but they may be in the room and completely avoidant by shutting down and being non-communicative. 

Brandon: Got it. Okay. That’s, that’s helpful. Sounds like those avoidance behaviors aren’t, aren’t typical of children with SM though, cuz that’s drawing attention to them versus trying to kind of hide and, and not be noticed, right? 

Dr. E: That’s a great question as well, because you would think. Right that a lot of kids with SM don’t like to bring attention to themselves. I have plenty of kids I’ve worked with that have no problem bringing attention to themselves, but the typical child with selective mutism, especially with a social anxiety tendency. You’re right. They don’t wanna bring attention. They almost wanna kind of blend in. But here’s the thing that I’ve learned, which is interesting because it doesn’t seem to make any sense. They’re disruptive behaviors, if that’s what it is, or their complete avoidance and shutdown behaviors is their way of coping. 

A maladaptive coping. It doesn’t seem to always make sense, but that’s how they cope. Either shut down cause it’s maladaptive, right? They’re coping with an anxious feeling by shutting down. They’re coping. Being silly or goofy, they’re externalizing. So even though they’re avoided, they’re externalizing their behaviors or they’re getting up and going to the bathroom, or they’re getting up and they’re sharpening their pencil. 

If they have pencils, they’re getting up and they’re walking around, they seem disinterested. They’re. Whispering or talking to a friend if they can do that. In other words, they’re avoiding. And so what are they avoiding? Are they avoiding social interaction because they’re uncomfortable? They don’t have friends, they don’t feel connected. 

Are they avoiding academics, Brandon? Are they having difficulty understanding the schoolwork? Are they having difficulty starting completing tasks? What is going on? Are there subtle learning issues so often? Focus on, and parents too, the not speaking without diving deep to truly understand that student, that child. So please if, for all of our listeners, stop looking at a symptom of SM and really focusing on understanding that student deep down, that whole person, why are they avoiding. 

Brandon: Right. And what are they avoiding? 

Dr. E: Exactly. What are they avoiding? They’re not just avoiding, they’re avoiding, they’re not. It’s not just avoidance. Let’s fix the avoidance. I’m gonna give you a token for staying in the room. You are creating more anxiety, more avoidance, more frustration by rewarding them to stay in a room without realizing why they’re leaving the. So we have to understand that, and that’s where understanding the person is so important, that evaluation, that true understanding of that child comes into play. 


Brandon: So the next question we have is on 5 0 4 plans. “I’m coming up on my son’s annual 5 0 4 meeting and I’m on the fence about keeping it since the school went back to in-person learning. My son has been really good, thriving. Actually, he’s in fourth grade and I know from your research you say third grade, is pivotal in SM symptoms. He goes to a small school, so all the students have been the same. Have been the same since kindergarten. I’m asking if you recommend keeping the 5 0 4 plan, even though right now it seems like he doesn’t really need it.” 

Dr. E: So it depends on the time of year that we’re dealing with this, right? So if it’s the end of the school year and they’re thinking, let’s drop the 5 0 4 because he’s doing so well, I’d wanna understand what so well means. Is he functioning academically? He’s functioning socially well, he’s functioning emotionally well, he’s thriving as this parent said. Here’s what I re. I recommend reassessing that child in terms of the social communication, making sure he’s initiating his needs. He’s able to answer questions. He’s able to function in a group. He is socializing. He is doing well emotionally. Obviously he’s doing well academically. Typically for the 5 0 4 plan, they are functioning academically. 

Cuz he doesn’t have an i e p I usually recommend setting up the new school year with that 5 0 4 in place, making sure teachers are educated to his needs, understanding how to bridge down if needed, because again, the beginning of a school year, any time of transition may be a little rough and a child may take a back step. 

Also, the teachers that this child has now know how. engage this child. Know, may know intuitively how to bridge up and down, know what is working for this child. The beginning of a school year may be a little rougher. Maybe this teacher doesn’t understand, SM doesn’t understand this child’s needs. I’d want something in place for the beginning of this school year, get that child functioning where they are, and then slowly just drop down. And then as long as this child is functioning for at least a year, Socially, emotionally and communicatively, I then consider pulling that 5 0 4 plan. But I’d wanna know that that child can start a new school year functioning well. 

Brandon: So it is about just staying on top of it? 

Dr. E: I’ll never forget a few years ago when I had a early elementary age child, the child did fabulous through the school year. By the end of the school the child was doing just, just great, honestly. And I recommended to the family to please keep your 5 0 4 plan in place till at least the fall after your child starts. 

The school year we did a back to school. I recommended a back to school. Session prior to school to talk to the child about the beginning of the school year, deal with any anxieties or fears or worries. I did recommend an education to the school in terms of the basics of SM and also this child’s needs and how to bridge up and how to bridge down. This parent was so thrilled with the child’s progress. They didn’t do it, and the school’s like, oh, we’re good. We’re good. 

Don’t you know, two weeks into the school year, we get an emergency call from theparent and the parent was really upset because their child stopped speaking in school, didn’t, wasn’t speaking. And I’m like, well, whoa, wait, wait. Did you do an, like, did you educate the school? Because I know we hadn’t. Right? So I assumed the parents met with the school and the parents’ like, no, we didn’t do that, because he was doing so well at the end of the school year. And of course I wanted to say, but I told you to make sure that your school had an education in that. Had these accommodations and interventions in place, and the teacher and the parents said, well, the teachers felt like they didn’t really need anything. I said, okay, let’s, let’s not worry. Let’s just get everything in place. Let’s get the school accommodations back up. Let’s have a meeting with the school. 

It wasn’t even a long meeting. I think I met with the school for 30 minutes. Just talk to the teachers about ways to accommodate the child. I met with the child, I talked. How the child was feeling, I was reassessing the child’s social communication and literally within two and a half weeks. The child was doing fabulous because it really wasn’t that difficult for this child, but the teacher didn’t know, don’t ask open-ended thought-provoking questions in the middle of a group. At the start of the school year when he didn’t even have any buddies in his class. They didn’t even buddy 

Anything in place. They didn’t educate the special teachers and there was a new music teacher that wanted him to get up and perform, and that wasn’t the place for him at that moment, at the beginning of the school year, he needed a more general approach to be able to work himself back up and to make sure the teachers knew how to pair and group him, knew how to question him. You know, I always make this comment that it’s not about small groups. It’s not about just the buddy process. Yes, of course, every child needs a buddy. Small groups in the room, small groups out the room. Of course, those are basic accommodations. It’s what you do in the small groups, how you do it, when you do it, who you include, how you question, why, when you question, why you question, and et cetera, et cetera. 

So it’s really about, again, having it set up so that it isn’t going to cause a regression in a child.