SELECTIVE

MUTISM
PREPARED BY:
Daquel, Michelle
Sagaral, Abdel-Aziz
WMSU Timol, Judd-Andrea

WESTERN MINDANAO STATE UNIVERSITY

DEFINITION
 Selective mutism, formally known as elective
mutism, is a disorder of childhood characterized
by the persistent lack of speech in at least one
social situation (school), despite the ability to
speak in other situations (home). Children with
selective mutism will have difficulty speaking,
reading aloud, and singing aloud in front of people
outside of their family or their “comfort zone”.
(Silver, 1989).
It is an anxiety disorder in which a person
who is normally capable of speech cannot
speak in specific situations or to specific
people. Selective Mutism usually co-exists
with shyness or social anxiety. People with
selective mutism stay silent even when the
consequences of their silence include
shame, social ostracism, or punishment.
(Dr. Elisa Shipon-Blum)
Why does a child develop
Selective Mutism?
• The majority of children with Selective
Mutism have a genetic predisposition to
anxiety. In other words, they have inherited a
tendency to be anxious from one or more
family members. Very often, these children
show signs of severe anxiety, such as
separation anxiety, frequent tantrums and
crying, moodiness, inflexibility, sleep
problems, and extreme shyness from infancy
on.
Age of onset

 It is most prevalent between the ages of 3

and 5; onset usually occurs when the child
first enters an educational framework in
which speech is expected, but sometimes
onset is gradual – the child decreases
speech output until he eventually stops
speaking (Silver, 1989)
Signs and Symptoms
Besides lack of speech, other
behaviors displayed by selectively
mute people include:

Shyness,
Social anxiety, fear of social
embarrassment, and/or social isolation
and withdrawal.
Use of gestures to get message across.
Difficulty maintaining eye contact, blank
expression and reluctance to smile;
Stiff and awkward movements.
 Difficulty expressing feelings, even to
family members.
Difficulty eating , or speaking in front of
audience.
Tendency to worry more than most people
of the same age, and sensitivity to noise
and crowds (Silver, 1989).
 A proportion of children with selective
mutism have developmental delays.
DSM V Criteria
 Consistent failure to speak in specific social
situations in which there is an expectation for
speaking (e.g. in classroom), despite speaking in
other situations (e.g. with mom in classroom).
 Disturbance interferes with educational/occupational
achievement or social communication.
 Disturbance must last for at least one month.
 Failure to speak is not due to lack of knowledge of
or comfort with the language in use.
 Disturbance is not better explained by
communication disorder (ex. Stuttering) (APA,2013)
Co morbidity
Selective mutism is co-morbid with a numberof
disorders including:
 Social anxiety disorder / social phobia.
 Expressive language disorder.
 Self-regulation. Ability to adjust arousal and emotion
in appropriate manner.
 Developmental speech delay.
 Enuresis – bedwetting or daytime holding of urine for
prolonged intervals.
 Separation anxiety disorder, depression.
 Motor developmental disorders and oppositional
defiance disorder.
(Steinhausen, & Juzi, 1996)
SELECTIVE MUTISM-STAGE OF COMMUNICATION
COMFORT SCALE
Non- Communicative
-non verbal or verbal. No engagement
- NO responding or No initiating

Stage 1-non verbal communication

-responding through body language, writing, and using of
object to communicate.
Stage 2- transition into verbal communication
- responding via any sound
- initiating or getting someone’s attention via any sound.
Stage 3- verbal communication
- responding approximate/direct speech.
-initiating , approximate/direct speech.
Case Example

• Chloe's parents knew something was wrong when they were told by
the four-year-old's preschool teacher that she had spoken in school
that day for the first time after attending preschool for almost eight
months. When Chloe entered the classroom, she appeared hesitant
and self conscious and avoided eye contact. She would engage in
an assigned task, but not with other children. Her comfort level
dropped in a larger group, and she would not interact with the others
in a group. If the other children talked to her, she would turn away.
• She also did not speak in church or with distant family members, but
she was a chatterbox at home. In elementary school, it was not until
third grade that Chloe spoke to her teacher for the first time after a
devoted teacher did behavioral therapy exercises with her in the
summer and prior to and after school. Now in fourth grade, Chloe
has made much progress and recently read a report on video.
Chloe's battle with this disorder is not completely over, but she has
made tremendous progress. (Adopted from actual testimonials from
the Selective Mutism Foundation)
Treatment
 Behavioral treatment:
The speech-language pathologist may coordinate a
behavioral treatment program to increase
verbalizations. Behavioral treatment is based on the
premise that the child who is selectively mute is
using the behavior in response to anxiety in social
situations. The focus of the speech language
pathologist’s intervention is to reinforce
communication with a gradual progression from non-
verbal to verbal
(Steinhausen, & Juzi, 1996).
 Stimulus fading
In stimulus fading, the speech-language pathologist sets
simple goals (e.g., using a gesture to communicate) and
gradually increases expectations until speech is
achieved.

For example, child and parent may visit the child’s

classroom after school. The child is then encouraged to
talk to parent. A teacher may gradually be introduced at a
degree that she does not stop the verbalization of child.
The teacher enters the room; goes near parent and child,
parents introduce the teacher to child and relay
information between child and teacher. Once the teacher
is introduced the role of parent is gradually faded (Silver,
1989)
 Shaping
Shaping involves rewarding approximations of
target speaking behavior.

For example, the child may be reinforced for

mouth movements accompanied by approximation
of speech (e.g., whispering) until true speech is
achieved. Shaping is often necessary in order to
achieve positive outcome for selectively mute child
(Blake &Moss, 1967)
Self-modelling

Another technique sometimes used, when the

child is willing, is the self-modeling technique
where the child watches videotapes of himself or
herself performing the desired behavior (e.g.,
communicating effectively at home) to facilitate
self-confidence and carry-over of this behavior into
the classroom (Cunningham, McHolm, & Melanie,
2005)
 Reinforcement contingency

It involves rewarding the child for speech behavior.

For example, allow and support parent and child to

visit school before school starts possibly multiple
times. Allow use of a verbal intermediary (parent,
friend, doll, puppet, and recording device) that
makes the child more comfortable in
speaking/communicating. Reinforce verbal AND non-
verbal communication attempts positively; be careful
not to overdo the praise (Cunningham & Melanie,
2005).
 Play therapy

Play therapy aims to create an environment in

which the child feels free to express feelings,
manage conflicts and gives insight into and
control over problems (Blake &Moss, 1967).
• Relaxation training: Individual exercises to
help child release tension. (i.e. “squeeze
lemons” to feel tension and then relaxation in
hands/arms) are taught as well as group
relaxation exercises are also emphasized
(Blake &Moss, 1967).
REFERRENCES:
Dr. Elisa Shipon-Blum -Smartcenter@SelectiveMutismCenter.org

Cunningham & Melanie 2005, Blake & Moss 1967, Silver 1989-
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