Children with Selective Mutism present in a variety of different ways. Some children can be shut down and noncommunicative (Stage 0 on the Social Communication Bridge®) while others can become comfortable but use nonverbal means of communicating, such as pointing, gesturing or nodding, etc. (Stage 1 on the Social Communication Bridge®). Some children can whisper or speak quietly to select others while remaining mute with these same individuals in a different social setting (Stage 3 on the Social Communication Bridge®)!
Therefore, no two children with SM are the same in terms of their social communication skills. For the typical child with SM, not implementing strategies and interventions while the child feels an expectation to speak only reinforces the child’s anxiety. The child will remain ‘stuck’ in nonverbal communication.
Question: If a child is comfortable, shouldn’t he/she simply start to speak?
Answer: The reality is that comfort alone is often not enough to prompt speech. In fact, unless the proper strategies and interventions are in place, the child often remains nonverbal or progress can be quite limited, especially if the child feels people want him/her to speak.
Question: For the nonverbal child, is lowering anxiety enough to stimulate speech?
Answer: For the majority, the answer is NO, especially as a child ages. For the child who can respond via nodding, gesturing, pointing, writing, etc. he/she may appear comfortable, relaxed and engaged, yet mutism persists.
Question: If anxiety is low, and the child appears comfortable, why does he/she just talk?
Answer: Mute behavior becomes learned, ingrained, and conditioned to the point of impossibility. And with emphasis on trying to get the child to speak, such as asking him/her when and why he/she does not speak, reinforced mute behavior persists.
The child with SM is often stuck in the nonverbal stage (Stage 1 of the Social Communication Bridge®) and cannot just begin speaking. For older children/teens who have been mute for years, they are that much more stuck, even if they appear comfortable and relaxed.
So often we hear, “He is right there! I just know it! He will start to speak any day!” Sadly, this rarely happens within an environment where the child has been mute for a long time. There are rare cases in which children, specifically those with speech phobia, who are verbal in all or most settings remain mute in one or a select few locations. For example, the child who is mute in the classroom but outside of school he/she can speak to a teacher and/or peer(s), or a child who is mute in school but verbal in most other social settings. The speech phobia in this case is specific to school.
The saying, “So close, but so far” is more appropriate for most older children and teens, especially those who have been mute for many years in one specific location (such as school) and with specific people (such as select relatives/friends).
Question: How then, do you get a child to speak if lowering anxiety is not enough?
Answer: By helping the child unlearn their conditioned mute behavior and using transitional strategies* to bridge from nonverbal to verbal communication.
*It is this stage of communication that is the missing link in most treatment plans.
Treatment that focuses solely on lowering anxiety without regard for structured ways for parents and children to unlearn conditioned behaviors will not be successful. For the mute child, if focus is on in-office therapy without implementation of strategies outside the office, treatment resistance will often occur.
There are thousands of specific transitional strategies to implement in treatment. They can be categorized into three categories:
- Verbal Intermediary®
- Sounds-to-Words (RSA®)
- Augmented Devices
For specific examples of these strategies, visit www.SelectiveMutismCenter.org/resources and download our helpful handout, The Transitional Stage of Communication: The Missing Link in Treatment.