In the light of recent discussions regarding the nature of Selective Mutism (SM) we at the Selective Mutism Information and Research Association (SMiRA), the national UK charity for SM, are sharing this update regarding our understanding of the nature of SM and how, in our view people with SM should be supported.
Our view is that in most cases, SM is a complex condition that arises from a combination of factors both within a person and their context or environment; this is also the prevailing view in the research literature (see additional references below). The diagnostic criteria do not specify a cause; they only describe symptoms. Our view is that, if a person who is capable of speech and familiar with the language is persistently and consistently unable to speak in certain spaces or to certain people in line with the diagnostic criteria, then this falls under the umbrella of SM.
Whilst we are aware of and sympathetic to issues with the name ‘selective mutism’, which is often misunderstood, (it is actually a medical use of the word “selective” to mean “specific or non pervasive”), at present, the only ‘official’ condition identified in diagnostic manuals is ‘selective mutism’ and to protect our families and facilitate access to any support they might need, this is the name that must therefore be used in diagnosis. Families are of course free to use any terms that they find helpful thereafter.
Intervention for children and young people with SM, when it happens at all, is too often insufficiently personalised, or not based on a thorough assessment of the child within their context, their priorities and needs.
Intervention for SM should be individualised and not be ‘one size fits all’ because each individual has a different combination of factors contributing to their SM presentation.
- SM is more common in children, but where it is not effectively supported it can persist into adulthood.
- All children presenting with SM symptoms should be able to access suitable informed intervention. Any adult with SM who is seeking intervention should also be able be appropriately supported.
- SM falls under the communication and interaction or speech, language and communication needs category of the Special Educational Needs and Disability Code of Practice (England, 2014), the Additional Learning Needs (ALN) Code in Wales (2021), the SEN Code of Practice Northern Ireland, 1998/ 2005) or the Additional Support for Learning Framework (Scotland, 2017).
- All children with SM, and adults seeking support for their SM, will need a proper evaluation of their situation: their personal history, their context, their experiences, their pattern of communication and their communication priorities.
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- The possibility of a person with SM being neurodivergent should be considered and discussed; co-occurrence, especially with autism, is common (Steffenberg et al (2018)).
- Any ‘small steps’ or graded exposure programme should not be the first stage of any intervention for a child or young person. First, there should be an evaluation as described above, in order to inform about what factors may be contributing to their presentation and to guide what type of intervention might be most suitable. Training – formal or informal – for the team around the child or young person with SM is also vital before direct intervention begins, as SM happens in relationships and in contexts.
- The aim of any intervention should be to establish a sense of psychological safety and a non judgemental relationship with key adults, not specifically to elicit speech. An ability to use speech is often facilitated by the relationship that has been built.
- Building a sense of psychological safety and supporting emotional regulation is likely to include considering and, if necessary, adjusting the sensory environment in which the person is operating. If a child or young person is frequently or constantly in a state of overwhelm in a context that is inappropriate for them, the context will need to be changed as part of a successful intervention.
- Any person involved in intervention with a child with SM should be able to form a ‘bridge’ into other contexts; they should be in the child’s classroom at times, for example, rather than only interacting with the child during discrete sessions. This is why many professionals will support school staff in running interventions rather than running them themselves.
- There are many interventions that can be used for SM including graded exposure, relationship building around special interests and activities that are favoured by the child or young person, art, drama, music and sound therapy, joint target setting on independence and communication goals. This list is not exhaustive; different interventions suit different individuals.
- When running an intervention in a school setting, short, frequent sessions are generally more impactful than longer, more occasional sessions (10 minutes 3 times a week is better than half an hour once a week).
- SM is not just about speaking, but most often about wider communication. It will often impact a person’s ability to initiate any communication including written or picture exchange. This is why simply providing Alternative and Augmented Communication (AAC) for young children may be ineffective; however, it may be helpful in teens and adults where SM persists.
SMiRA has been helping people with SM, their families and professionals since 1992. Our Trustees and Associates have extensive experience of providing advice and support. We continue to undertake research and support other researchers in the field of SM. There are a wide range of free downloadable resources on our website (www.selectivemutism.org.uk) and peer support through our various Facebook groups (search for SMIRA on Facebook).
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Diagnostic Criteria for Selective Mutism
The essential feature of Selective Mutism is the persistent failure to speak in specific social situations (e.g. at school, with peers and/or the teacher), despite being able to speak in other, more familiar situations. For the diagnosis to be made, the condition has to be sufficiently strong to:
- Interfere with the child’s education and social and cognitive development.
- The duration of the disturbance is at least one month beyond the first month as school.
- The failure to speak must not be due to a lack of knowledge of the language.
- The condition cannot be better explained by a communication disorder (e.g. stuttering) or: Any other abnormality.
For unknown reasons, Selective Mutism appears to be more prevalent amongst girls and more cases are reported from migrant and multi-lingual families.
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Appendices: references describing selective mutism:
Dana, D. (2019a). The Polyvagal Theory in Therapy: engaging the rhythm of regulation. Section 1, chapter 3. New York: W.W. Norton & Company.
Dunn, J. (1988). The Beginnings of Social Understanding. Harvard University Press. Page 119.
Porges, S. (2011). The Polyvagal Theory (W.W.Norton). Chapter 3: The Polyvagal Perspective.
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