An advice sheet for parents of children with selective mutism
Easing in Friends and Relatives
An Informal Approach to Building Rapport and Facilitating Speech:
Do you have a family friend or relative that your child sees on a fairly regular basis but is unable to speak to? Try these six steps at home over several sessions or over the course of a few hours.
C = Child P = Parent F = Familiar adult
Whenever C speaks, P and F must not draw attention to this fact, but calmly respond to what C says as if they’ve always spoken.
Make sure F understands the nature of selective mutism and accepts that it is a phobia which needs sympathetic support to overcome. You need to agree:
- C is not being rude, difficult or silly. Their silence is caused by anxiety like stage-fright, so no-one must take it personally.
- No-one will put pressure on C to talk – no bribery, persuasion, negative comments or expectation to say ‘hello’, ‘please’, ‘thank you’ etc.
- It will help C talk in F’s presence if F initially avoids watching C while C is speaking or trying to speak.
Before F arrives, tell C that F does not expect C to talk to them unless they want to. They just want to have a nice time chatting to P and possibly joining in whatever C is doing or wants to show them. Set C up with a practical activity they enjoy. Tell C they can chat to you as normal and F will not butt in or make any comments about them talking. Remind them that if they want to be brave and have a go at talking to F that’s fine, but it’s up to them and F won’t be upset if they don’t.
3. BEING COMFORTABLE IN THE SAME SPACE
The first target is for C to feel comfortable around F so stick with this stage until C appears fairly relaxed and is moving and smiling easily:
- F greets C but does not ask any questions. F can make positive comments about C (e.g. admiring a picture they’ve drawn) but initially their focus should be on light-hearted chat with P.
- P should also give F more attention than C initially, to let C physically relax in the same room at their own pace. At this point young children will very often dip in and out of the room, as if they are testing the water.
- P includes C by making casual comments that don’t require an answer,
e.g. “We had a great time at the zoo, didn’t we?”, and distracts C with physical activity such as handing out biscuits, drawing a picture, finding their model collection, decorating cupcakes etc.
- P can ease C in gently by asking C ‘Yes/No’ questions which C can answer non-verbally by nodding or shaking their head. However…
If C uses gesture to try to tell P something (e.g. points at the biscuit tin) P must not interpret this or try to guess what C means. Such behaviour delays progress by showing C that gesture is a successful and acceptable form of communication. P can say, “Sorry, I’m not sure what you mean” or ask C an ‘X or Y?’ question, e.g. “Are you asking for a biscuit or do you want to offer F a biscuit?” WAIT for an answer (at least 5 seconds) and if no response, P smiles and says, “it’s OK, you can tell me in a little while”, and carries on talking to F.
4a. TALKING TO PARENT
Once relaxed, the next target is for C to talk to P face to face in F’s presence (whispering in P’s ear is not an option!):
- P starts to ask C questions that cannot be answered Yes or No, so C can no longer just nod or shake their head. Questions starting ‘What?’ ‘Who?’ ‘Where?’ ‘When?’ are best. WAIT for an answer (at least 5 seconds) while F looks away and stirs their tea, studies the newspaper, looks in their bag for a tissue, etc.
- If C wants to whisper in P’s ear, or appears to be on the verge of speaking, P maintains eye contact with C and says “It’s OK to talk in front of F”.
- Smile and WAIT for an answer (at least 5 seconds).
- If no answer, P prompts C by offering an alternative, ‘X or Y?’, e.g. “Are you having coke or juice?” WAIT for an answer.
- If no answer, repeat the options, e.g. “Coke or juice?” Pause. Add “Or something else?” WAIT for an answer.
- If no answer, P says “Tell me in a little while” and carries on talking to F.
- If this doesn’t seem to be working, P says “You can tell me while F _____” (e.g. checks their phone messages/makes a drink/gets on with the crossword). This enables F to feign disinterest while P repeats the sequence.
- If C tries to pull P out of the room P says, “Don’t pull me, I’m having a nice time with F”. Then distract C, e.g. “Why don’t you go and get your ____?”; “Shall we look in the oven and see if the cakes are ready?”; “Could you go and pick me some mint please?”
- Stay calm and stick with it, after 10 minutes in the room with F, C’s anxiety will have dropped considerably!
- C may speak in a very quiet voice which is fine; do not ask C to repeat as their voice will get louder as they relax.
- C may feel more comfortable talking at the doorway at first, rather than in the room; this is again fine. They’ll come closer of their own accord.
4b. INTERACTING WITH FAMILIAR ADULT
A simultaneous target is for C to interact non-verbally with F, using eye contact, relaxed facial expressions and gesture:
- F shows interest in what C is doing or shares an activity. F chats away without expecting an answer in the style of a running commentary, leaving pauses so that C can comment if they feel ready: “You’re cutting out some really good shapes!”, “I wonder if that’s a flower… or maybe it’s a star…”.
- F can also direct questions via P, e.g. “I’d love to know what C’s favourite film is?” This provides the opportunity for C to respond, or for P to ask C the question following the above procedure ‘TALKING TO PARENT’. e.g. “C, what’s your favourite film?” C may then answer F via P.
5. TALKING TO FAMILIAR ADULT
When C can talk to P in front of F (4a), and engage with F non-verbally (4b), the next target is for C to answer F and eventually take the lead in conversation by making comments or asking questions:
- When C is happy, relaxed and occupied, F occasionally asks C questions by providing an alternative, X or Y: e.g. “C, I’ve forgotten your cat’s name, is it Lucky or Licky?” (it helps to be a bit silly!); “What Level shall we do now C, 2 or 3?” It helps to include C’s name so that C does not wait for P to answer, and to remind P not to inadvertently answer for C.
- WAIT. Allow plenty of time for C to answer (at least 5 seconds) and then repeat X or Y if necessary, e.g. “2 or 3?” Pause. Add “Or a different one?”
- WAIT again and don’t worry if C doesn’t answer. F smiles and says something like “I can see you’re thinking really hard about that” and moves on. F talks to P for a while before trying again.
- F repeats with more ‘X or Y?’ questions.
- After C has answered a couple of times, take a break – such a massive achievement can be exhausting for C.
- When C can answer ‘X or Y?’ questions easily, F asks ‘Wh___?’ questions, e.g. “Where do you keep your rabbits?”. WAIT…
− ‘What?’ ‘Who?’ ‘Where?’ questions are easiest as they can be answered with single words and short phrases.
− ‘When?’ is harder as it often requires a longer answer.
− ‘How’ and ‘Why’ should be avoided until later as these questions often require more explanation than C can manage initially.
− Be aware that ‘Which?’ can often be answered by pointing.
- If no answer, F prompts C by falling back on an ‘X or Y?’ question, e.g. “Do they sleep outside or indoors?” WAIT for an answer.
- Hopefully natural conversation will follow if F shows an interest, e.g. by helping to clean out the rabbit hutch or asking C to show them how a phone App works. But a good way to help conversation along is by introducing games or activities where C needs to give F clues or ask F questions in order to reach a solution.
6. TALKING TO FAMILIAR ADULT ALONE
The final step is for C to talk to F without the comfort of P’s presence:
- As soon as C appears to be comfortable with F, P should be withdrawing for short periods, so that C and F are engaged in an activity without P. P can stay in the room but needs to concentrate on something else.
- Once C can talk to F, P must make excuses to leave the room for a while so that C does not have time to associate talking to F with P’s presence.
- On subsequent visits, P should always be present initially, but leave sooner and for longer until all C’s anxiety around talking to F has subsided.
Practice and memorise this sequence!
WAIT for C to speak…
If no response:
Rephrase question with an alternative, X or Y?
If no response:
Repeat “X or Y?” Pause. Add “or something else?” WAIT….
If no response:
Gradually increase complexity of questions
Questions that can be answered ‘Yes’ or ‘No’ (can be answered by nodding or shaking head)
Which one? (can be answered by pointing)
‘What?’ ‘Who?’ ‘Where?’
Reasoning questions, e.g. ‘Can you explain…?’ ‘What’s the difference…?’
Personal questions, e.g. ‘How do you feel about…? ‘What do you make of that?’