Information for Parents

1. Ensure that your child feels valued and secure
Children with selective mutism are so anxious about talking that the muscles they need for speaking freeze (especially their vocal cords) and they cannot make a sound. Any anxiety, disapproval or uncertainty they pick up from adults will increase their own sense of guilt, failure and fear about the future – they’ll then tense up and find it even harder to speak.

It’s not just teasing that makes children feel bad about themselves. Asking ‘Why don’t you talk?’ or ‘When will you have a go?’ implies that you don’t like them the way they are, wish they were different and worst of all, have no idea what to do about it. They will worry that they are upsetting you and try to avoid situations that are likely to highlight their difficulty. Repeatedly asking ‘Did you talk today?’ or ‘How did you get on?’ makes children dread going to school in case they let you down.

We need to tell children why they find it hard to speak at certain times rather than ask questions they cannot answer. Reassure them that everyone grows up with childhood fears and although they find talking difficult right now, they’ll find it gets easier as they get older. Their fear will go away because they will get used to talking, one tiny step at a time, and meanwhile there are lots of other ways to join in and have fun. Your child needs approval whether they speak or not, so be positive about their efforts and tell them how brave they are when they try new things. The calmer you are, the more relaxed your child will be and the quicker they’ll improve.

2. Try to reduce embarrassment or anger about your child’s behaviour
We have to accept our children as they are and not put them on the spot by pushing them to talk to other people or drawing attention to their speech. Allow them to warm up in their own time, help them to loosen up through physical play, join in activities yourself or give them a job to do which you know they will do well, and they are much more likely to relax sufficiently for their speech muscles to start moving again.

3. Educate family and friends about the nature of your child’s difficulties
This should be no different to telling other people that your child has a real fear of water or dogs and expecting them to make allowances. Never let your child hear you tell people that they can’t or won’t speak, as this reinforces their belief that talking is impossible and can make it very difficult for them to break the pattern – especially when you are present! Your message needs to be much more positive. Explain that when they are worried about talking they can’t get their words out, and that asking questions and putting pressure on just makes it worse. They will be able to speak once they conquer their fears and when they do, it’s important that no fuss is made – everyone needs to carry on as if they’ve always spoken! Meanwhile, help others respect alternative forms of communication – nodding, pointing, smiling, waving, writing, talking through a friend or parent etc.

eg:

• Joe needs a little while to warm up, please don’t think he’s being rude.
• Amy will be full of this when she gets home but don’t worry if she doesn’t talk straightaway. She needs to watch and listen first
• Sam’s having a great time and if we just let him join in at his own pace he’ll be able to start talking.
• Jade would love to play with you. She can show you what her dolls like to do and later she might tell you about them too.
• Sarah’s going to listen while we have a chat. She’ll interrupt or text me if she wants to add anything.
• When Gemma is used to everyone she’ll talk as much here as she does at home!
• Can you please make sure no-one makes a big fuss when Dale starts talking? If you just talk back quietly he’ll find it easy to carry on.
• Ali is getting much braver about talking to grown-ups but to start with it would really help him if you could let him tell his friends what he wants to say.

4. Build confidence by focusing on your child’s achievements
In conversations with your child, your friends and yourself, focus on what your child CAN do, not on what they CAN’T. Support them in their interests and creative talents and find ways in which they can comfortably demonstrate their skills to others.

5. Keep busy and have a routine
Activity and physical exercise are good for mind, body and soul and help to keep anxiety at bay. Sitting around doing nothing increases stress, as does uncertainty about the day’s events. Start each day with a plan that includes exercise – whether this is letting off steam after school for younger children, sweeping up leaves or walking the dog for older children.

6. Remember that avoidance strengthens fear
When we do things for our children or let them avoid activities, we are confirming the child’s belief that these things are too difficult or threatening for them. Of course we do not want our children to fail or become distressed, but by removing the need to engage at some level, we are taking away their opportunities to learn, experience success and become independent. The secret is to make activities easier, shorter or more manageable so that children are less overwhelmed and have a go. In this way, we show that anxiety is a normal part of life and can be managed. If their only way to deal with anxiety is to eliminate it completely through avoidance, they will grow up with no coping strategies.

eg:

• Instead of ordering for your child, ask them to show the waiter what they want.
• Instead of avoiding a party completely, arrange to arrive first when it’s quiet and only stay 15 minutes – chances are your child will ask to stay a bit longer!
• Instead of taking something that is offered to your child, first reassure your child that it’s OK to take it and if necessary, ask for it to be put somewhere handy so your child can take it when they are ready.
• Instead of turning down an invitation, ask if you can go too as a helper.
• Before children opt out of an activity completely, try to work out with them which part they find difficult/distressing and look for a solution.
• If children miss school, do not let avoidance become a fun option. Make sure they stay in bed or do schoolwork during school hours rather than play. Discuss any concerns and enlist the school’s support to ensure a positive return.
• Rather than answer for your child (which quickly becomes a habit!), try one of the following:
  • repeat the question so that your child can look at and answer you
  • rephrase it as a ‘Yes/No’ question so a nod or shake of the head will do
  • deflect it, e.g. ‘I’lI ask Peter that in a moment once he’s settled in’ or ‘That’s a good question – Peter, do you want to have a little think about that and tell me later?’

7. Accompany child but as a general helper rather than their personal assistant
If the only way your child will attend a school trip, Brownies, football etc. is if you go with them, volunteer yourself as a general helper, make a point of talking to other children and get actively involved to assist socialisation rather than dependency.

8. Let children know what is happening
Warn children of changes to their routine and prepare them for new events by talking through what will happen. Rehearse or make a game of real-life scenarios such as going to the doctors, opticians, McDonalds or ordering a Chinese takeaway. Take it in turns to be the patient, doctor, server, etc. and practice/write down phone calls. Visit new schools as soon as possible to meet and educate key staff, take photos to show relatives, throw wet sponges at the summer fair etc.

9. Provide an escape route
Feared situations are a lot easier to tolerate when we have the control of knowing we can opt out if it all gets too much – the signal to the dentist, the rescue text, independent means of transport.. Children have far less control over their escape routes than adults so it’s important to give them the same security. If children are anxious about a school trip or going to a friend’s house for example, arrange to pick them up at lunchtime so they only go for half the day or say you will phone at intervals to see if they need collecting. Gradually extend the time.

10. Don’t spring surprises on your child
Many parents don’t like to warn their children about a forthcoming event because then they see their child worrying for days or weeks and doing all they can to avoid it. They prefer to tell their child on the day and find they cope reasonably well because they haven’t had time to think about it.

This is a risky strategy that increases rather than reduces anxiety. On the surface it works well but it’s a very short term gain. Even when children cope reasonably well with the event that was sprung on them, they will usually have tolerated it in a high state of tension rather than feeling relaxed and in control. In the long term, they are constantly on the alert, waiting for the next surprise, and doubt sets in that they can trust anything to be what it seems. Furthermore, they are being deprived of the opportunity to learn that anxiety doesn’t have to be eliminated, it can be managed through preparation and coping strategies such as educating key people and having an escape route.

11. Remember that it can be just as scary talking to children as adults
Help your child play with other children rather than leaving them to get on with it. Join in with them, starting with activities or games where talking is optional, so you can all concentrate on having fun.

12. Establish safe boundaries with your child so they can take small steps forward
Laughing, singing, talking in unison and talking to parents will be a lot easier than talking to other people. But children are often afraid to do these things in case it draws attention to them and leads to an expectation to speak. Reassure your child:

eg:

• Grandma knows you can’t talk to her just yet, but it’s OK to talk to me and Daddy in front of her.
• It’s hard to talk to your teacher at the moment but it’s OK to laugh.
• It’s OK to join in the singing, no-one will make you talk afterwards.
• It’s fine to talk to us here in a very quiet voice, no-one will make a fuss. You don’t need to speak on your own, you can just try joining in when everyone speaks together.

13. Use telephone and recording devices as a stepping-stone to the real thing
Go to www.talkingproducts.co.uk for lovely ideas for presents and talking practice – children can personalise greetings cards with a recorded message or make a talking photo album for example. If children cannot speak to their relatives or teacher face to face yet, they could leave a message on a mobile phone or have a conversation via a ‘Talking Pod’ or MP3 player. How about encouraging siblings to take it in turns to record the message on your home answerphone? Teachers can listen to children reading to their parents over the phone rather than in the classroom. Finally, children can get used to talking to strangers by practising with voice recognition software (e.g. Train Tracker 0871 200 4950). This builds up confidence, volume and the ability to repeat without panicking, safe in the knowledge that it’s a robot, not a real person. Before you know it they’re ordering a Chinese or pizza over the phone!

14. Push the boundaries, starting with safe strangers
Do not be afraid to let children go without every now and then so they develop that bit of extra determination to confront and overcome their fears. They’ll often surprise you! e.g. Explain you are too busy to stop what you are doing but there is the money if they want to get an ice-cream. Do not get it for them. If the ice-cream van drives away, calmly say, ‘Never mind, you can try again tomorrow’. Reassure children that only a couple of words are needed and there will be no need to have a conversation.

15. Encourage a very quiet voice rather than whispering
Accept whispering on the odd occasion if you can genuinely hear and are in a hurry but do not lower your head so that your child can whisper in your ear. This easily becomes a habit and encourages avoidance. A very quiet voice is much better than a whisper as it will gradually get louder as your child gains confidence.

So, if your child wants to talk to you but is worried about being overheard, either:

a) turn so that you are blocking your child’s view of whoever they are concerned about and, maintaining eye-contact, quietly say ‘Pardon?’ (do not whisper!) or ‘it’s OK, X isn’t listening’. or
b) move far enough away from onlookers so that your child can speak to you face to face rather than in your ear. If you are in the middle of a conversation, ask your child to wait for you to finish and then pull away to speak to your child.

There is no need to explain what you are doing but if your child asks why they can’t whisper, explain that too much whispering will give them a sore throat so it’s better to stand where they can talk normally. Stick to this and very soon your child won’t need to move so far away. N.B. This technique only works for parents and people with whom the child has no difficulty talking when there’s no-one else around.

16. Ask friends, relatives, shop-assistants etc to speak to your child through you if you know they will not be able to respond directly.

eg:

‘What colour would your son like to try on first?’
‘Max, what colour would you like to try on first?’
(Max points to brown shoes) ‘He’d like to try on the brown ones please.’

‘I love Max’s blazer. Could you ask him what school he goes to?’ ‘Max – you like your school don’t you, what’s it called?’
‘St. Joseph’s’
‘Max says it’s called St. Joseph’s.’

If children are relaxed with you in public and know you are not pushing them to talk directly to other people, you will find that they begin to cut out the middle man!

17. Help your child offload their stress safely
Being watchful, anxious and unable to speak for much of the day is a great strain. It’s common and can be challenging for the whole family to get the brunt of SM children’s pent up emotions when they come home from school, but they need you to understand that it is natural to feel this way and to provide a calm, safe place rather than more emotional upheaval. Your child may need a chance to relax completely after school before attempting homework, or a physical outlet for their frustration – trampolining, swing-ball or swimming for example. Violent computer games are NOT a good idea!

When upset, your teenage child may use a flat tone of voice which sounds rude and confrontational. Do not rise to this or you will escalate your child’s stress and make things even worse. Recognise their anxiety, take a deep breath and continue in a calm gentle tone. If they lash out verbally or physically, calmly reflect, ‘I’m sorry you’ve had such a bad day’ and leave them on their own to listen to music, bash a pillow or put it on paper until they feel better. When things are calmer, acknowledge their frustration but explain that the family do not have to suffer their outbursts so will keep out of their way if they try to take it out on other people. Discuss alternative outlets and say that if you know what has upset them there may be something you can do to help.

Finally, look at your own lifestyle. Does your child have good reason to be concerned about your behaviour? They cannot improve while worrying about you.

18. Show your child it is OK to relax and have fun
If parents have unrealistic standards and try to keep their children and house spotless with everything in its place, their children will constantly worry about spilling or breaking something, getting food on their hands or faces, touching something unhygienic or making the room untidy. They will get extremely anxious at school or other people’s houses where they perceive a different set of standards. They will not be able to tolerate lively, unstructured behaviour or engage in normal messy play like finger-painting, papier mâché or digging for worms.

This fear of getting dirty and putting something in the wrong place can spread to a fear of using toilets outside the home and inability to take risks. It will certainly impact on children’s ability to relax around other people and make friends. It is important for all the family to enjoy mealtimes, gardening, cooking and play without fear of making a mess – put away the wet-wipes til the end of the activity!

19. If different languages are spoken at school and home, set a good example
Your child needs to hear you having a go at speaking the school language at school and with their new classmates. Show them learning is fun and mistakes are OK! Ask the teacher if your child can spend some time with other children who speak the same language for part of the day, teaching their vocabulary to English speaking children so everyone sees what it is like to learn something new.

20. Make explanations, instructions and reminders visual
Anxious children quickly feel overloaded, forget things easily and tend to take things literally or at face-value. Anxiety causes ‘brain-freeze’ so we are unable to take in all we hear and cannot think laterally or rationally. Put things on paper so that children have a checklist to follow rather than trying to remember instructions. If they repeatedly ask the same question for reassurance give them a visual reminder and respond to further questions by asking them to refer to it and tell you the answer.

21. Acknowledge anxiety but do not fuel it with an emotional reaction; calmly provide a diversion or clear plan of action
Children need brief sympathy followed by matter of fact guidance and strength – not anger, worried looks or protective cuddles which just confirm that there is something to be afraid of. For example, if they complain of a tummy-ache before visiting a friend’s house say ‘Poor you, I know you’re a bit worried but Josh’s Mummy knows all about waiting until you’re ready to talk. I know what will help until our taxi gets here, where’s that catalogue you wanted to look at?’

Or, if they don’t want to go to the doctor’s say ‘We can take something with us to play in the waiting room. Let’s choose something and have a game now’.

If they have difficulty separating from you, stay but do not cling to them or put them on your lap – explore the room together and find things to do. If appropriate, explain how you or others are going to make situations manageable for your child.

Older children will need to discuss their fears about starting a new school, changing class, going on a school trip etc. Externalise their anxieties by breaking the events down and writing each component on a post-it note – the coach-journey, taking the right clothes, getting to the toilet in time etc. Then sort the post-it notes into 3 columns – things I don’t have to worry about, things that worry me a bit and things that worry me a lot. Now you can agree on which part to tackle first and strategies to help. Some post-it notes you will leave to deal with another time but already the anxiety will be out of the child’s head and seem more manageable. Unless problems are broken down in this way, children will want to avoid situations completely without understanding the specific source of their anxiety.

22. Answer anxiety questions with another question so that your child becomes the problem solver
Children tend to bombard parents with questions as they try to control their anxiety,
e.g. Who’s going to be there?
How long will it last?
Have they gone?
Are you going to talk to my teacher? etc. etc.

Instead of answering (which rarely alleviates the anxiety) respond with another question so that children start to understand their anxiety, and can think about coping strategies:
e.g. Who do you hope will be there?
How long do you think you can manage?
Why do you want them to go?
If I talk to your teacher, what would you like me to say?

23. Celebrate your child’s unique qualities
We cannot change the personality of SM children – and wouldn’t want to! They are naturally sensitive individuals who take life seriously and set themselves impossibly high standards. The downside is a tendency to be overwhelmed by novelty, change and criticism; the upside is an empathetic, loyal and conscientious nature. When treated fairly and allowed to show their true colours, SM students often display far more creativity and insight than their peers.

Maggie Johnson
Selective Mutism Advisory Service, Kent Community Health NHS Trust

HANDOUT 11 : An advice sheet for parents of children with selective mutism

Do I answer if someone asks my child a question?

The short answer is No!

It’s natural to step in when you see your child freeze. But if a child gets used to someone answering for them, they will adopt the role of silent partner whenever that person is around. One day they will answer and it’s so important to have everything in place for that moment when they are ready to speak out.

A few Golden Rules :

Do not answer for your child. If you adopt the routine that follows, your child will learn that it’s not so bad to be asked a question; everyone seems relaxed about it, whether they answer or not. They’ll be far less wary of social situations in general.

Do not put your child under pressure to answer. Calmly convey that it’s fine if they answer and fine if they don’t. You know they’re trying hard and doing their best.

Do not apologise for your child. They’ll feel they’ve done something wrong. If appropriate you can always explain later that your child wasn’t being rude, or share how it makes you feel that others don’t see your child as they really are.

But now the long answer…
Follow this routine whenever someone asks your child a question, and you’ll be surprised how much easier it gets and how quickly your child succeeds in answering. It’s not usually necessary to tell younger children what you’re doing or why, but if they ask or you want to prepare an older child, see ‘Why does this work?’ below.

1. WAIT for a full 5 seconds (slowly count to 5).
If your child nods or shakes their head for Yes/No, that’s fine. Add a comment to move the conversation on, e.g. ‘Yes, we came last week, didn’t we?’ But with other sorts of questions your child will probably find it easier to answer if you don’t look at them – fiddle with something if it helps!

2. If no response, make it a private conversation between you and your child:

• gently repeat the question or
• turn it into a choice ‘X or Y?’ or
• rephrase it so that your child only needs to say Yes or No or nod or shake their head.

3. WAIT for a full 5 seconds.
If your child answers or gestures, smile and add a comment to move things on. Keep any acknowledgement of this great achievement for a private moment – your child doesn’t want attention drawn to their talking in public.

4. If no response, MOVE THE CONVERSATION ON without answering, e.g.

• say to your child ‘We’ll have a think about that, won’t we?’ or ‘Tell me later’
• ask the other person a question to divert attention from your child
• change the subject
• say your goodbyes

Why does this work? Your child will learn, without any pressure, that:

• questions are for the person who’s been asked – no-one else will answer
• you know they will get good at answering if they keep trying
• it’s not a big deal if they don’t manage it, no-one minds, it’s still a good day!

WAIT   >>>   REPEAT/REPHRASE   >>>   WAIT   >>>   MOVE ON

© Maggie Johnson and Alison Wintgens

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.

1. EDUCATION

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.

2. REASSURANCE

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.

GOOD LUCK!

Practice and memorise this sequence!

WAIT for C to speak…

If no response:
Rephrase question with an alternative, X or Y?
WAIT….

If no response:
Repeat “X or Y?” Pause. Add “or something else?” WAIT….

If no response:
Move on.

Gradually increase complexity of questions

EASIEST

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?’

‘When?’

‘How?’ ‘Why?’

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?’

HARDEST

Joining a Family where there is a Child with Selective Mutism

This information sheet seeks to explain the nature of selective mutism (SM) and provides advice on how to build a happy and lasting relationship with children who suffer from this condition. The advice may initially seem to be counterintuitive but this in no way reflects upon you as a partner or parent. SM has been around for many years but only now is it becoming more widely understood.

Please do not under-estimate the value of your co-operation in following these guidelines. Your support will be a positive investment in both the future stability and cohesion of the family, and the prospective outcomes for the SM child.

Dos and Don’ts

Do…

• If your partner has explained that his/her child suffers from SM or if you suspect this to be the case, it is useful to do some further reading on the subject (see useful references below). Here you will learn that what may seem like stubbornness or deliberate behaviour is in fact an automatic anxiety reaction which the child cannot control. They are experiencing something very similar to stage-fright whenever they are expected to talk to or in front of certain people.
• You may initially get the impression that the child dislikes you – a selectively mute child that doesn’t speak, avoids eye-contact and never smiles, can easily give that impression! This is likely to leave you feeling hurt or even angry. It is important that you recognise that the child is simply reacting to the feelings of anxiety which they always get when meeting someone new. If they feel under pressure to speak they may even run away or hide in order to let their panic subside.
• Understand that it may take time to digest all this information which may go right against your natural instincts. But however hurt, helpless, angry or frustrated you may feel, it is vital that you do not show your true feelings. Any disapproval, disappointment or unreasonable demands will make it even harder for the child to relax and behave normally in your company.
• Be assured that the child’s inability to speak and interact freely with you is only a temporary setback, it will resolve with time, provided you are patient and tolerant.
  Likewise your partner should explain to the child that talking and relaxing will get easier in time. You should reiterate this, and reassure the child that you understand their difficulties.
• Remove all pressure on the child to speak until he or she is comfortable enough for this to happen naturally. You and your partner should continue to speak to the child and include him/her in all family activities as usual but avoid direct questions and make it clear that you are more interested in enjoying their company than hearing them speak. It is good to include siblings (when present) as this provides familiarity and may draw the child’s focus away from you, this will help the child get used to your presence.
• Always respond positively and warmly to any attempts by the child to communicate with you, either verbally or otherwise! Pointing nodding, drawing, listening to a story and sharing activities and are all valuable forms of communication, each a step nearer to talking.
• Whenever possible, please allow your partner and his/her child to take short breaks away from you and the company of others; this will allow the child to talk freely and convey urgent needs, without having to resort to whispering in your partner’s ear. This is particularly important when relatively long periods of time are spent in company.
• To begin with, please allow your partner to have some individual time with his/her child and siblings (if any). This will reduce the child’s anxiety on a regular basis and allow them to use a relaxed loud voice again. You will find that you can join in these sessions after a while if you use a step by step approach at the same pace as the child adapts to your presence – gradually get closer as the child continues to use a normal voice, and pull away as they get quieter.
• Please let your partner remain in charge of their child. The child will respond more quickly if your partner retains full responsibility for their day-to-day discipline and management. Handing over control to you is likely to significantly increase the child’s anxiety. This is true, no matter how well-meaning or competent your parenting skills are! SM is highly contextual in nature; an adult taking on the role of an authority figure tends to be more intimidating than one acting as a trusted friend, so it is important for you to concentrate on building a trusting friendship, rather than feeling pressured into quickly assuming a parental role.
• You or your partner should inform the child’s nursery or school about the change in family circumstances as this may influence his/her behaviour outside the home. SM children find all change difficult, even the little things in life, but with time to prepare, understand and adjust, they can happily adapt to a new situation.

Don’t…

• Do not feel your partner is being over-protective. It can seem as though your partner has chosen to side with the child; this is not the case. It is your support and co-operation that will ultimately help to forge a positive relationship with the child, and will draw the family closer together, in the long term.
• Don’t ask leading questions such as; “Why are you behaving this way?” “Why don’t you like me?”
  Young SM children are unlikely to be aware of the concept of anxiety, so won’t to be able to explain their behaviour in terms of feeling anxious. In fact they are unlikely to be aware that their behaviour is odd at all! Behaviours such as avoiding eye contact, failure to speak and frozen facial expressions are instinctive reactions to anxiety provoking stimuli. There is no conscious thought involved, on the part of the child; in other words these behaviours are not premeditated! If you suggest that he/she dislikes you, it is likely to lead to confusion on the part of the child, he/she may simply agree with you because you’re an adult!
• Don’t be pressured (or upset) by relatives or friends who advocate a zero tolerance, quick fix approach. SM is not widely recognised or understood by the public at large. so for those unfamiliar with the condition, it is tempting to think that it can be easily dealt with by confronting or correcting the child. As your new partner has probably discovered the hard way, this will only make matters worse! Any parent with experience of an SM child will tell you that patience and perseverance are required, over a prolonged period of time.

Useful references

• The free downloads section on: https://www.selectivemutism.org.uk/ especially the leaflets What is Selective Mutism? and Planning and Managing a Small Steps Programme.
• “The Selective Mutism Resource Manual” by Maggie Johnson and Alison Wintgens especially Chapter 2, Frequently Asked Questions, Chapter 6, Creating the Right Environment and Chapter 9, the Sliding-in Technique.
• ‘Silent Children – approaches to Selective Mutism’ – a DVD produced by SMIRA (Selective Mutism Information & Research Association) and obtainable from the online shop at www.selectivemutism.org.uk. Email enquiries may be made to info@selectivemutism.org.uk.

© Maggie Johnson and Vivienne Ponsonby for SMIRA 2010

Helping a New Partner join a Family where there is a child with Selective Mutism

Generally, children with selective mutism (SM) are most comfortable around those they have always lived with; this commonly includes parents, siblings and other familiar individuals who have always resided alongside the child – for example a live-in grandparent. Integrating a new, less familiar, adult into the home environment can therefore be problematic.

When in a comfortable, familiar environment (usually at home), children with pure SM will speak and interact in ways that are both age appropriate and characteristic of their own personality; however there is a discernible cut off point between the child’s immediate family and people outside their comfort zone. When people outside the child’s nuclear family enter the home, the child will tend to experience a marked rise in anxiety, this is when the characteristic symptoms of SM start to appear. Typically; the child appears more subdued than usual; facial expression may be frozen (unable to smile or react); there is a failure to speak (frequently, even when the child is spoken to); the child may markedly avoid eye contact; may become distressed; may fail to eat while being watched; may try to hide or avoid entering the room; may attempt to whisper to a familiar adult only. Young children may freeze completely when spoken to by an unfamiliar adult. All these responses can seem like rejection or dislike of the outsider if the child’s anxiety is not properly understood.

Integrating a new partner into a family which includes a child with SM can be particularly stressful, both for the child and main carer. In part, this can be because there is an expectation for that partner to assume a parental role and form a bond with the child as soon as possible. When this does not happen, frustration can build in both the natural parent and new partner which only feeds the child’s anxiety. If there is a concern or expectation that the child will be resentful of the new relationship the SM behaviour is likely to reinforce this belief and be mistaken for defiance. The natural parent’s attempt to explain the situation can appear at best over-protective and at worst, disloyal to the new partner.

Thus, successfully integrating a partner into a family with a selectively mute child can be a challenge! But if it is carried through in a sympathetic step-by-step fashion, a trusting relationship can be achieved.

Dos and Don’ts

Do…

• Explain in detail about your child’s condition and back this up with written information. Encourage your partner to go online or do some reading about SM (see useful references and website below).
• Remember that your partner may initially get the impression that the child dislikes him/her and may be feeling confused or disappointed; an selectively mute child that doesn’t speak, pointedly looks the other way and never smiles, may give that impression! It is important that you stress that the child is simply reacting to his/her feelings of anxiety.
• Understand that it may take time for your partner to digest all this information which may go right against their natural instincts. But however hurt, helpless, angry or frustrated they may feel, it is vital to remain calm. Any disapproval, disappointment or unreasonable demands will make it even harder for the child to relax and behave normally in their company.
• Remove all pressure on the child to speak until he or she is comfortable enough for this to happen naturally. You and your partner should continue to speak to the child and include him/her in all family activities as usual but avoid direct questions and make it clear that your new partner is more interested in enjoying their company than hearing them speak. It is good to include siblings (when present) as this provides familiarity and may draw the child’s focus away from your partner; this will ultimately help the child get used to their presence.
• Always respond positively and warmly to any attempts by the child to communicate either verbally or otherwise! Pointing, nodding, drawing, listening to a story and sharing activities and interests such as football, cycling, swimming etc.are all valuable forms of communication, each a step nearer to talking.
• Whenever possible, you and your child should take short breaks away from the company of others, this will allow him/her to talk freely to you and convey urgent needs, without having to resort to whispering in your ear. This is particularly important when relatively long periods of time are spent in company.
• At first, allow long periods of quality time together with your child, in the absence of your partner; this will reduce anxiety; allowing your child to return to his /her normal self and speak freely. Ideally your partner can gradually be included in these periods, first by occupying themselves nearby, then as an observer, and finally by taking part in your game or activity as the child gets used to speaking at normal volume in front of them.
• Reassure your partner that the child’s inability to speak and interact freely is only a temporary setback and with time, perseverance and patience the situation will resolve! Likewise, explain to the child that talking and relaxing will get easier in time.
• Do remain in charge of your child. Retain full responsibility for the day-to-day discipline and management of your child. Handing over control to your partner is likely to greatly increase your child’s anxiety. For many children, SM tends to be highly contextual in nature i.e. an adult taking on the role of an authority figure tends to be more intimidating than one acting as a trusted friend; that is why it is important for your partner to concentrate on building a trusting friendship, rather than quickly assuming a parental role, bearing in mind the child also has an absent father/mother with whom he/she may or may not have a talking relationship.
• Do inform your child’s nursery or school about the change in family circumstances; as this may influence your child’s behaviour outside the home. SM children find all change difficult, even the little things in life, but with time to prepare, understand and adjust, they can happily adapt to a new situation.

Don’t…

• Don’t feel that you have to choose between the child and your partner! Try and get your partner on side, his or her co-operation will ultimately bring the family closer together in the long term!

• Don’t ask leading questions such as “Why don’t you like John?”
  Young SM children are unlikely to be aware of the concept of anxiety, so won’t to be able to explain their behaviour in terms of feeling anxious. In fact they are unlikely to be aware that their behaviour is odd at all! Behaviours such as avoiding eye contact, failure to speak and frozen facial expressions are instinctive reactions to anxiety provoking stimuli. There is no conscious thought involved, on the part of the child; in other words these behaviours are not premeditated! If it is suggested that the child dislikes someone, it is likely to lead to confusion on the part of the child, he/she may simply agree with you because you’re an adult!
• Don’t be pressured and try not to be upset by relatives or friends that advocate a zero tolerance, quick fix approach. SM is not widely recognised or understood by the public at large, so for those unfamiliar with the condition, it is tempting to think that it can be easily dealt with by confronting or correcting the child. This will make matters worse as you will no doubt have discovered already! Any parent with experience of a selectively mute child will tell you that patience and perseverance are required, over a prolonged period of time.

Useful references

• The free downloads section on: https://www.selectivemutism.org.uk/ especially What is Selective Mutism? and Planning and Managing a Small Steps Programme
  “The Selective Mutism Resource Manual” by Maggie Johnson and Alison Wintgens especially Chapter 2, Frequently Asked Questions, Chapter 6, Creating the Right Environment and Chapter 9, the Sliding-in Technique.
  ‘Silent Children’ DVD available from SMIRA https://www.selectivemutism.org.uk
  ‘My Child Won’t Speak’ – documentary made by Landmark Films, shown on BBC1, Feb 2010

© Maggie Johnson & Vivienne Ponsonby for SMIRA 2010

TRANSITION PLAN

Preparing to change School, Class or Teacher or start at school or nursery

Time invested in agreeing and implementing a Transition Plan will ensure that the child adapts quickly to a new environment, builds on progress made and develops in confidence and independence.

A change of class and/or teacher can be a stressful time, particularly if a child is doing well and parents are afraid of losing momentum. However, if the transition is managed well, children can leave old memories and associations behind and gain confidence and independence in the new setting.

The following recommendations also apply to starting school or nursery for the first time.

1, It is vital that all staff in the new setting understand the nature and implications of selective mutism and that there will be no pressure on the child to speak until they are ready. Reassurance should be given to the child to this effect, both by parents and staff (see Phase 1 intervention for relevant information). Identify a learning mentor / keyworker / support teacher in the new setting who will provide an escape route if necessary and meet with the student regularly to ensure they are happy, not being teased/bullied etc.

2. Preparation should start several weeks in advance with positive comments about the move and familiarisation with the building, classroom and staff.
eg:

• social visits with parents for summer fair, concerts, charity events, play schemes etc
• look round school/class when building is empty (during holiday or after school)
• take photos and make a booklet about My New Class/School
• meet the head and classroom teacher/key staff in as informal a situation as possible.
• include younger siblings if available and appropriate.
• routine visit with current class plus one extra visit with familiar adult or friend
• new teacher/teaching assistant (TA) to visit child in current class or at home. (Home visits likely to be extremely beneficial – SMRM page 131).
• slide-in new teacher/TA before end of term (Phase 2 intervention)

3. If it is not possible to meet new staff in advance, try to ensure continuity by
eg:

• keeping the child with a best friend
• arranging for previous teacher/TA to spend some time with the child on their first day
• ‘borrowing’ previous keyworker to hand over to new keyworker at beginning of term (Phase 1 or 2 intervention)
• keeping current keyworker (but beware of child becoming too dependent on one adult over a long period of time)

4. It will be helpful if new teachers/teaching assistants (TAs) can make some time for a few minutes of rapport-building with the child on a one-to-one basis during their first week in order to achieve as many of the following as seem appropriate:
eg:

• reassure the child that they will not ask them questions or pick them for demonstrations unless the child volunteers
• enlist the child’s help and then praise for a job well done
• reassure the child they will be checking they are OK, have a friend to sit with, understand the work, have been to the toilet etc.
• give the younger child confidence to respond by playing games that initially only require pointing, nodding, shaking the head etc.
• reassure older children they can contribute/ask questions by writing things down until they feel relaxed enough to talk.
• explain that they will need to use a loud voice sometimes but this does not mean they are angry (SM children are very afraid of getting things wrong and will withdraw rather than risk being told off).

5. Foster friendships with other children as actively as possible, particularly outside school by inviting peers home to play/have tea. Try to find out in advance if there are children nearby that attend the same school/playgroup and make contact with their parents. Teachers can help by suggesting which children would make good friends and introducing parents after school if parents find it difficult to make the first move.

6. Parents should stay with children in pre-school settings until the child is comfortable for them to leave. Do not EXPECT the child to be anxious, as this anxiety will be conveyed to the child. Parents need to stay relaxed and calm themselves and praise the child for being brave and staying on their own for longer each day. Do not delay the initial separation too long however, as it is only by facing their fear and successfully coping on their own that children will learn not to be afraid.

7. If children are finding it hard to join in at pre-school/reception class, parents can come early and join in the last few activities/story with the child so they leave with a positive experience. Alternatively, a parent can stay for the first half an hour, joining in the activities and helping the child to integrate/make friends/build rapport with a designated adult (SMRM page 132). This may occasionally be necessary in Year 1/Year 2.

8. Pupils preparing for transition to secondary school or college need to focus on developing their independence outside school and confidence in talking to strangers as much as possible during their final year, e.g. making phone calls, running errands, dog-walking, ordering pizza, banking birthday money, earning money car-washing and baby-sitting, going swimming, joining clubs, developing interests etc. etc. (SMRM page 170). The summer holidays are a good time for shared activities and trips with friends who will also be attending the new school/college, and for meeting new people who know nothing of the child’s difficulties. Confidence grows through achievement and as the child becomes their own person, the seeds can be sown that a fresh start in a new educational establishment is exactly what they need. If they can talk to strangers, they will be able to talk in a new environment.

• See Danielle aged 15 in BBC Documentary ‘My Child Won’t Speak’

SMRM = Selective Mutism Resource Manual, Johnson & Wintgens, 2001, Speechmark Publishing Ltd.

Copyright Maggie Johnson 2011.

Implementing a small steps programme

The majority of selectively mute children have developed a chronic anxiety reaction in situations where they are required to talk to people for the first time, especially when they can be overheard (a phobia of speaking). As a result, they have a very limited talking circle and are only able to talk to certain people in certain situations.

Following assessment, all work to overcome this type of difficulty starts with ensuring that people in the child’s school/home environments understand:

a) what to do to encourage communication and the confidence to try new things, and
b) what is unhelpful and maintains the mutism.

This might be achieved by arranging a meeting in school with parents/key staff using the Silent Children DVD(*1) as a springboard for discussion and information-sharing, both in general terms and in relation to the individual child. One crucial step will be to begin talking to the child with open acknowledgment and explanation of their difficulties.

For younger children, a change in other people’s reactions and expectations, together with encouragement and support to enjoy non-verbal communication, can be sufficient to facilitate a progression towards verbal communication. When no change is noted however, selectively mute (SM) children are likely to benefit from a more formal behavioural programme designed to reduce their anxiety and extend their talking circle.

Such programmes use three behavioural techniques to elicit and generalise speech:

a) ‘stimulus fading’
It is the audience/conversational participants or setting which changes rather than the child’s speech effort. The child talks to a trusted conversational partner (usually a parent) in a minimal anxiety situation and then one factor is changed – an anxiety trigger is introduced. If the child is relaxed to start with and the change is only slight, the child can tolerate the anxiety trigger and keep talking. For example they can tolerate another person gradually coming closer and joining in the activity.

When this is carefully planned and broken into very small steps we call it ‘the sliding-in-technique’. At first the child talks freely to a member of their family with the keyworker outside the room; this is repeated with the door slightly ajar, then with the door open and finally with the keyworker inside the room. If the child is able to maintain some voice at this stage, the keyworker can move forward and join in the activity. Direct eye-contact is generally avoided until the child is talking more confidently. The process is further facilitated by setting specific targets and starting with very short, undemanding turn-taking activities, such as counting to 10, which are gradually extended to longer sentences. Specific target-setting is only appropriate for older children who understand the principles involved and are motivated to overcome their difficulties, having reached a point where the selective mutism has become well entrenched and beyond their control.

b) ‘shaping’
It is the speech target that changes. The child starts with non-verbal communication with a keyworker in a minimal anxiety situation and then takes tiny steps towards verbal communication by gradually increasing articulatory effort, voicing, eye-contact, syllable-, word- and sentence-length etc.

c) ‘desensitisation’
The child gets used to the thought of doing something they previously believed they couldn’t manage by carrying out related, but less-threatening activities. For example they allow a teacher or classmates to hear their voice on tape. Or they talk to a classmate over the phone before trying it face to face.

Stimulus fading or shaping?
In practice we use a combination of techniques depending on the age of the child, how anxious they are and whether the parent(s) can be involved. Desensitisation activities can play a valuable part in both stimulus fading and shaping programmes but should never be allowed to become a substitute for speech.

a) Up to 6-7 years
Shaping works very well with the very young or less anxious SM child and leads on from rapport building with a familiar and trusted staff member (keyworker) in the child’s school setting. The children benefit from both individual and group sessions where they feel absolutely no pressure to talk, but are gradually encouraged to move from non-verbal communication and action-rhymes, to sound-making, singing, humming, speech sounds and words. At the same time, parent(s) spend time in the classroom/playgroup and at home using the stimulus fading principle to help the SM child speak near to, and eventually with, other children and adults. Other professionals (speech and language therapists or psychologists) have a valuable role with overall coordination, supervision and support. As they can represent an extra pressure, they should avoid direct involvement with the child unless there are other concerns about the child’s language development, learning, behaviour, or family dynamics.

a) parent supports generalisation to other people and places and slides out as child’s confidence grows (omit this step if parent not available)
b) rapport-building with keyworker
c) shaping games with keyworker to elicit speech
d) keyworker/parent supports generalisation to other people and places including transition to new school/class

b) 5-6 years and above
After working through the above strategies, more anxious children may need a specific programme to elicit speech with a keyworker. They need to feel in control of their anxiety, so are made fully aware of each target and record their success at each step. Stickers etc. are a confidence boost and provide a natural break which reduces the anxiety level between targets. For most children, stimulus fading with the parent provokes far less anxiety and yields quicker progress. Some teenagers find it difficult to work in front of their parents and prefer shaping however. And sometimes there is no talking partner available so stimulus fading is not an option.

How often and how long will it take to elicit speech?
A shaping programme to elicit speech should only be attempted if the child can be seen individually for a short time three or more times a week for at least a term without a break.
Any less than this and it’s like starting again each time for the child.
Stimulus fading also needs a commitment of three sessions a week with close collaboration between home and school or clinic, but speech is usually elicited with a familiar keyworker after 2-4 sessions. Once the child is talking comfortably to the keyworker, sessions need to continue on a twice-weekly basis to slide-in other significant adults and children and transfer back to the classroom. Once talking in the classroom, targets can be managed within the school day and extra sessions need only be arranged to manage transitions from one year group to another.

Transitions between schools and classes must be carefully managed as part of the programme. It is relatively easy to elicit speech with key adults and friends, but generalisation to other children and adults in all situations can take several years, depending on the age and anxiety levels of the child. What we can be sure of is that the earlier we start and the more we do, the quicker the difficulty will be overcome.

Specialist involvement?
Sometimes it may be appropriate for an outside professional to establish speech with the child in the first instance – for example a speech and language therapist may already have established rapport with a child during assessment, or be able to capitalise on a holiday period to get a programme underway in preparation for a new term. Or the child may have put up so many barriers at school that they need to gain confidence and belief that progress is possible on neutral ground. Equally, therapists and psychologists will benefit from the experience of working with at least one SM child in order to advise and support more effectively in future. But whichever approach is chosen, it is essential to find or hand over to a keyworker in the child’s school as soon as possible. Only staff on site have the day to day contact necessary to sensitively and effectively manage the generalisation phase.

If a school-based keyworker has been identified:
a) elicit speech with keyworker at home or at school using sliding-in technique with parent or shaping programme
b) fade out the parent either at home or school so that child can talk to keyworker without parent present (omit if parent not involved)
c) keyworker facilitates generalisation to other people and places at school including transition to new class/school
d) when half the class have heard child’s voice, conduct activities during class time
parent supports generalisation in wider community

If the keyworker has to be a parent (not ideal but sometimes unavoidable):

a) parent visits school regularly to slide-in selected children and adults in a room where they will not be disturbed, and slides-out for part of the session as child’s confidence grows with new people
b) new adult (e.g. teacher) introduces new activity while parent is out of the room
c) if possible, new adult starts next session and parent arrives later to take over
d) parent transfers activities to the empty classroom
e) parent continues generalisation to other people and places including transition to new class/school, always sliding out for part of session.
f) when half the class have heard child’s voice, conduct activities during class time
g) parent supports generalisation in wider community

If the initial keyworker is not school-based:

a) elicit speech with keyworker A at home, school or clinic using sliding-in technique
b) slide out the parent either at home, school or clinic so that child can talk to keyworker A without parent present (or do this after next step)
c) keyworker A hands over to a school-based keyworker B
d) slide out keyworker A
e) keyworker B facilitates generalisation to other people and places at school including transition to new class/school
f) parent(s) support generalisation in wider community

Full details of target-setting are set out in ‘The Selective Mutism Resource Manual’ (SMRM)*2.

Common practices that prevent or hinder progress

Firstly it must be stressed that although there are many factors that can impede progress, they can all be resolved or avoided! It is never too late to repair the situation after a setback, with open discussion between all involved to identify and modify the relevant factors.

1. The programme was started too early.
Inadequate assessment may lead to an inappropriate diagnosis and/or intervention plan.
a) The child may have additional problems such as autistic spectrum disorder, attachment disorder or receptive language difficulties which need to be addressed alongside the mutism.
b) Their reluctance to speak may be due to cultural or personal inhibitions which need to be addressed in the first instance.
c) Factors at home or at school which may be reinforcing the child’s mutism or raising their anxiety may not have been fully explored and addressed.

It may be helpful to revisit the child’s speaking habits and to use the Parental and School Interview forms in the SMRM(*2) as a tool to obtain more information about other concerns and possible maintaining factors.

2. Lack of teamwork, information or support.
Insufficient time has been invested in information sharing, joint planning and monitoring, leading to loss of momentum or the programme being abandoned.

An on-going team-approach involving both home and school is paramount and will be flagged up again in point 5, for any unaddressed anxiety or inconsistent handling will undermine the effectiveness of direct work with the child. Even when parents are not able to contribute to the programme directly, every effort should be made to forge a home-school link as parents can provide information, ideas and back-up that are crucial to the overall success of an intervention plan.

It must also be recognised that working with SM children is emotionally draining and keyworkers need ongoing support and regular opportunities for reviewing progress and sounding out ideas with the school SENCo, class teacher or visiting specialist. Outside agencies should note that leaving a programme in school without building in this support is rarely successful. Inexperienced keyworkers will need help to plan targets with encouragement and reassurance to maintain momentum. Never put the onus on a keyworker to make contact only if they have a problem, as this implies failure if the need arises. Review meetings should be set in advance and then cancelled if not required, with additional telephone contact arranged within a week or two of leaving a programme. Aim to review progress once a month for the first term and twice a term thereafter. By the second year, once a term is usually sufficient but contact can be maintained between meetings via telephone or email.

3. There has been inadequate discussion with all involved about the nature of intervention and the time it is likely to take.
Some schools may not have been aware of the time commitment required to successfully address selective mutism, nor appreciate that a relatively small time investment now, will eliminate the need for prolonged intervention and anxiety in later years. Other schools may be committed to the long haul but have allocated a keyworker to the child for only one or two over-lengthy sessions per week.

Frequent 10-15 minute individual sessions will be required to establish speech initially
(minimum three times a week), with a gradual reduction in frequency in the generalisation phase (sessions can now be increased to 20-30 minutes). Generalisation to other people and situations, and the transitions into new classes and schools must be managed as part of the intervention plan.

4. The child is not an active partner in the intervention process.
i) There has been little or no discussion with the child about the nature and resolution of their difficulties. Never ask children WHY they do not talk – how can they possibly know why this is happening to them?! All they know is that talking fills them with dread and they will do anything to avoid that feeling.

Instead, TELL them why. Before embarking on a programme, children need reassuring that you understand why they cannot talk in certain situations and know they are not doing it deliberately – it is anxiety that is stopping their voices from coming out of their mouths. Go on to tell them that this anxiety developed when they were much younger – they got scared when first separated from parents/teased for speaking/found it hard to use a new language/felt different or awkward in a new/noisy/crowded environment etc.

Explain that this happens to lots of children and it’s nothing to worry about – as they get older and braver the anxiety will disappear.

ii) There has been insufficient reassurance that progress will be made by moving one small step at a time at the child’s pace. The child therefore has no sense of where each activity is heading, leading to heightened wariness and anxiety. Do not fall into the trap of thinking you can fool SM children into talking or that it is somehow kinder to avoid explanations! They can only control their anxiety by knowing exactly what is happening and what is about to happen.

Breakdown at this stage often leads to a sense of being ‘tricked’ into talking and a dread of further consequences. Many children fear that if they talk to one person, they will immediately be expected to speak to everyone else as well – the secret will be out! They need to hear from everyone involved – parent, keyworker and teacher are the usual minimum – that time is NOT the essence, and that they can get used to talking to just one new person at a time. Only through trusting that what the keyworker says will happen, actually does happen, will children be able to relax sufficiently to take new risks. For example, if told they will be working alone they need to see a ‘Do Not Disturb’ sign on the door, rather than worrying that someone will come in at any moment. They should be given opportunities to help plan their programme.

5.There has been a lack of overall co-ordination with consequent inconsistency for the child.
For example, if the child has been assured that everyone at school understands their difficulty and that they need only talk to their keyworker for the time-being, valuable trust can be lost if other staff try to elicit speech. Or if one person is offering money, chocolate bars or Happy Meals for achieved targets, it should not be surprising that someone else’s stars appear less exciting.

It is worth emphasising that rewards are a valuable incentive – they are fun to win and provide tangible evidence of progress – but they are NOT bribes. The value of a reward lies not in its material worth, but in fostering the child’s belief that success IS possible with an opportunity to enjoy that success.

6. There is a poor relationship between the child and designated keyworker.
Young children need very regular contact with a keyworker in a familiar place to gradually feel comfortable and confident in their company. Sessions therefore need to be either at home or school in the early years with an appropriate adult who is part of the child’s day to day routine.

Perhaps there has been insufficient time to develop rapport before attempting the sliding-in technique or the keyworker has little understanding of the condition and conveys impatience or insensitivity. Sometimes the keyworker has not been particularly sympathetic to the child in the past and the child has a clear memory of this. A genuine apology and fresh start can work wonders!

7. The child has no clear indication about how often sessions with a keyworker will take place or how long they will last.
There is no warning that sessions are about to take place and no explanation if sessions are missed. Or there is a rather ad hoc approach to the sessions with no agreed time-limit (10-15 minutes recommended). SM children need to know exactly what is happening, otherwise they worry which is counter-productive to ‘having a go’ and taking risks. Many selectively mute children have a heightened sense of ‘abandonment’, and it is vital they believe that, all things being equal, their keyworker is not going to let them down.

8. The child is not clear about the content of the sessions/the keyworker is not clear about the child’s limitations.
The keyworker is attempting to build rapport through general chat rather than specific target-setting activities. This is appropriate for shy children but not SM children for whom social conversation carries the highest ‘communication load’ and generates acute embarrassment when they cannot respond. Provide an outline of the session (e.g. 10 minutes on targets, questionnaire about bullying, check to see how coursework is going) and give students the option of choosing the order (they may prefer you to choose). Younger children may simply be working on targets.

9. The programme has come to a standstill.
The child is enjoying the keyworker’s attention but little or no progress is being made. Perhaps the keyworker lacks confidence and is holding the child back by their own fear of failure. They are repeating tasks excessively rather than moving on each time. Or perhaps the keyworker is getting a boost from the unique relationship they have built with the child, and is sub-consciously delaying the generalisation phase while genuinely believing that the child cannot cope with more pressure.

Sometimes children are given too much control and are allowed to set not only the pace of the programme, but also the content. They then avoid taking risks and choose to repeat ‘easy’ anxiety-free activities. It is important for children to be given options, but only within an overall structure or progression which has been set by the keyworker.

In order to move the programme forward, the keyworker may need to reiterate their role (point 4) and remind the child that they are there to help the anxiety (‘nasty feeling’) go away so that the child can have friends and fun, get help with their work and so on. The phrase ‘I can’t do that because then I wouldn’t be helping you’ is a useful one to have ready! Keep the child’s favourite activities for rewards rather than time-fillers, and terminate sessions early if the child is not ready to try something new (see point 12).

10. The rule of changing only one variable at a time when setting a new target has not been adhered to.
The child is being expected to cope with too many changes at once. Variables include the identity of those present, the number of people present, the location, and the task.

If new activities are carried out within earshot of other people, perhaps through an open window or door, this alone represents a significant change for the child. Similarly, if group-size is increased, it is unreasonable to expect the child to cope with a change of activity at the same time. Either the number of people present should be increased or the complexity of the activity, but not both together.

So, if succeeding in a withdrawal room with the keyworker, the next step should be to either repeat the same activity in the classroom with no-one else present, or to repeat the activity in the withdrawal room with an extra child or adult of the child’s choosing. Or if the child talks to a teacher at home, they could try the same thing at school in an empty classroom with a parent present. Repeating the activity without the parent is a separate step.

11. Only one variable has been changed but it has been too big a step for the child.
How can the step be made smaller? Many factors can influence anxiety levels, so it is important to understand which factors are operating for a particular individual. For example, does it make a difference if the listener looks at the child or is turned away, if the child is required to silently mouth or use voice, or if a visible or hidden articulatory movement is involved (as in ‘p’ vs. ‘s’)?

More detail is given in the SMRM2, but essentially the keyworker should try to reduce or modify one or more of the following factors:

• the choice of person present
• the number of people present, either as part of the task or hovering in the background
• the extent of physical involvement (articulatory effort, eye-contact and gesture)
• the length of the task (keep it short and specific rather than open-ended: ‘read 5 words’ or ‘read for one minute’ cause far less anxiety than ‘read to me’)
• the ‘communication load’ of the task itself

The communication load is low when using rehearsed or familiar speech, minimal responses and factual language, and high when a child is required to initiate, express opinions, use complex language or hold open-ended conversations.

With regard to the choice of person present, care must be taken to ‘slide-in’ the child’s teacher at the appropriate time. If the child has little rapport with their teacher, sees them as an authority figure, is afraid to fail or wants to succeed almost too much, their anxiety level may be too high to allow the sliding-in technique to be successful. They will gain more confidence if the keyworker slides in a child or less ‘threatening’ adult first. Sometimes the child has such strong associations of failure with their current teacher, having tried to speak and failed on many occasions, that it is better to develop their communication with a classroom support worker in the first instance, and work towards generalising speech to the teacher in the next year group.

12. The child is being rewarded for silence rather than communication.
The child has failed to meet a target but was still rewarded – either with their usual token ‘for trying’ or by spending the remainder of their special time with the keyworker repeating anxiety-free activities. This reinforces silence and lack of risk-taking, and leads the child to view the keyworker as someone nice to spend time with, rather than someone who is there to help them move forward (see point 9 for related discussion).

Children should never be allowed to feel they have failed – only that their anxiety was too great to allow them to succeed. The keyworker’s job is to make the steps toward a challenging target smaller, giving reassurance that this will make it easier for the child to manage. This can either be done immediately with a shorter or simpler task (see point 11), or by terminating the session early with a very casual “Never mind, we’ll try again next time”. The experienced keyworker will use both these options to the child’s advantage, but less experienced workers are advised to opt for early termination. This provides breathing space and planning time, and means the child will feel disappointed that the session is over, rather than relieved that the pressure is off. If they have a good relationship with their keyworker (point 6) they will look forward to the next session, remaining motivated to attempt activities or discuss other ways forward. Fixed times for the sessions (point 7) ensure that the end is always in sight and that both child and keyworker usually finish ‘on a high’.

13. The child has been moved through the programme using a whispered voice.
Generalisation will be significantly delayed if this is the case, for whispering indicates audience-awareness and extreme tension around the vocal cords. It will be necessary to back-track with the sliding-in technique, moving more slowly (see point 11) so that a quiet but audible voice is maintained throughout, reminding the child to ‘use big voice’ or ‘switch voice-box on’. For example the keyworker may need to enter the room backwards to prevent reversion to whispering, or join in talking games while still outside the room. As long as the child is relaxed, volume then usually increases naturally as short manageable tasks are achieved and confidence grows. Activities involving silly noises and humming may also be helpful, as are blindfold or barrier games where the keyworker cannot lip-read and says ‘Pardon?’ if unable to hear.

N.B. It is perfectly acceptable for children to whisper at other times outside the special time allocated to working on targets. Any communication in natural settings is to be accepted until the programme helps them to feel better about using a stronger voice.

14. The programme has been discontinued too early with not enough attention paid to transitions.
It cannot be assumed that once a child is talking to one or two people they will now improve spontaneously and transfer easily to a new class or school. Change can sometimes be an advantage as mentioned in point 11, but for most children the generalisation phase needs to be closely monitored and facilitated. Prepare children for transition by introducing them to a new school or teacher in the term before the move, and take advantage of school fetes, informal visits and existing friendships to establish positive links and associations. Examples that help children settle include exploring and talking in a new school when it is empty, looking forward to sitting with a friend in a new class, having the continuity of a support-worker across two year groups, and being visited by a new teacher before the transfer for rapport-building and sliding-in.

Maggie Johnson
Speech & Language Therapist Advisor

Alison Wintgens
Consultant Speech & Language Therapist

(*1) Silent Children: approaches to Selective Mutism, 24 minute DVD made with grant from DfES, available from SMIRA, email: smiraleicester@hotmail.com.
(*2) The Selective Mutism Resource Manual, Maggie Johnson and Alison Wintgens.
Speechmark Publishing, 2001, ISBN 0 86388 280 3.