Understanding SEND: Selective Mutism
“Selective mutism is a severe anxiety disorder where a person is unable to speak in certain social situations, such as with classmates at school or to relatives they don't see very often.” Selective mutism - NHS (www.nhs.uk)
The signs of selective mutism usually develop in early childhood, between the ages of 2 and 4. It is noticeable as a child starts interacting with people that they are not familiar with, such as when starting nursery. A child becomes so anxious and panicked that they cease to talk and at times appear frozen or rigid with no movement or expression. It is comparable to ‘stage fright’.
Selective mutism does not mean that children are fully mute. They may talk freely to their immediate family and familiar friends on a daily basis. Their mutism is purely circumstantial and occurs when they are out of their comfort zone, such as being faced with unfamiliar people or situations.
Children who have selective mutism are often unfairly perceived as being rude, shy, or difficult, with the word ‘selective’ in the title not helping to diminish these opinions. However this is distinctly not the case.
The child is not purposefully choosing not to talk, they are physically incapable of doing so. They are so overwhelmed by anxiety and fear they become paralysed and cannot meet the expectation of speaking to someone or responding to comments. In severe cases a child will appear not to acknowledge what has been said to them at all and they will become completely immobile.
Selective mutism can be resolved with treatment and early interventions. Most treatments consist of building confidence and self-esteem, giving reassurance and being patient, although in some cases medication and therapy are prescribed to reduce anxiety (it should be noted medication is unlikely to be given to young children).
Visible improvement can be seen over time once positive relationships have been established (such as the child’s key worker). Children gradually learn how to respond using gestures like nodding or shaking their head, then by whispering one or two words, eventually learning how to communicate clearly and frequently once they are comfortable to do so.
In some cases, a child may overcome most of their anxiety while at nursery and begin speaking (for example, if they have been there for a couple of years), but then they may regress when starting school. This is to be expected due to having increased levels of anxiety and being in a new environment. Gradual improvements will be apparent throughout school years as they become more familiar with their surroundings and those in it.
The exact cause of selective mutism is not known; however, it is considered to be linked to anxiety. Experts classify selective mutism as a phobia (fear) of talking to certain people or being in specific situations. Many children who suffer from selective mutism may also struggle with other phobias, changes in routine, or going to unfamiliar places.
No matter the cause for selective mutism, there are effective ways practitioners can adapt teaching methods to assist children with their development of speech and communication.
Being educated on how to recognise selective mutism must come first. The earlier that the signs are recognised, the sooner the child can start getting the support they need. Holding regular training for all team members will ensure they are familiar with signs to look out for.
Using suitable assessments practitioners can identify any delays a child may develop and can take necessary steps to support their progress. In more severe cases external agencies may need to be involved. SENCO’s should be putting referrals through at the correct time, following them up, feeding back to staff and parents and giving support for all before and during their involvement.
Adults should monitor how a child settles into a nursery. It is not uncommon for children to be shy and quiet upon starting a new setting, however if a child continues to show no signs of communication after a month or two, interventions and additional support may be needed. Observe how children are trying to communicate and consider whether they are meeting expected levels of learning.
Children with selective mutism will not be able to verbally express their needs, so practitioners must create relationships with them to understand when their needs are not being met. For example, children with selective mutism are more likely to contract urine infections as they cannot confidently convey their need for the toilet, or when they need a drink. Practitioners can resolve this by getting to know they child, making them feel confident enough to at least point to what it is they need.
There are many ways practitioners can promote positive relationships with children who have selective mutism. Being patient and calm are the key tools at their disposal. Relationships cannot be forced and will come in good time. For children with selective mutism, one prominent adult should be making a strong connection with them, rather than several practitioners meeting their needs between them.
Be establishing a relationship with one adult they will learn how to feel comfortable around them, opening up communication along the way. Preferably this would be the child’s keyworker, however some people are more compatible with others, so key workers should be changed if a child shows a natural connection to a different staff member.
Children with selective mutism can show little to no interest in joining in with activities, so practitioners can play nearby, offering a narration to the play and interacting with other children. This will slowly encourage the child to get involved and they may choose to join in or start playing a little distance away.
As relationships strengthen, children will feel more comfortable ‘asking’ practitioners for help. This may not be verbally but rather tapping the practitioner to get their attention and then pointing to a desired item or need (such as to the toilet).
A child with selective mutism will not get any closer to opening up if they are made to feel guilty or singled out. During group activities they should not feel shamed or embarrassed for not joining in verbally. They should still be involved as a group with additional support given.
Relationships with parents should also be considered. The parents of children with selective mutism can become increasingly frustrated with their child. They should be reassured that they are doing all the right things and appropriate techniques should be shared with them.
Methods to Implement
1. Be a commentator
Provide a recap of what the child is doing (“I see you’re pointing to this picture”, “I see you are drawing a circle”). This helps to convey interest in what the child is doing, building on relationships, and providing a narrative to support developing vocabulary.
2. Wait 5-10 seconds
After asking a question, wait for several seconds without repeating the question or letting someone else answer for them. Rather than waiting for a response, this pause can help them learn how to tolerate their anxiety. If no gesture is given do not put an answer in their mouths, instead offer a comment such as “that’s ok perhaps you can show me later.”
3. Use labelled praise
Such as “good job for showing me by nodding your head”. This helps the child know specifically what they are being praised for and promotes motivation.
4. Rephrase questions
Rather than using closed questions, which require a yes or no response, rephrasing questions to encourage speech should be used. For example, “do you want the car sticker or the star sticker?”, is more likely to prompt a verbal response such as “car” or “that one”.
5. Practice echoing
While there may not be any speech to echo, try to paraphrase what they are trying to communicate. This will reinforce they have been heard and understood, helping to build up self-esteem.
6. Breathing techniques
As selective mutism is closely linked to anxiety, teaching simple breathing techniques can help children feel more relaxed and allow them to manage their anxiety. An example would be breathing in slowly for 3 seconds and counting out for 5.
Singing songs and nursery rhymes is an enjoyable experience for children which helps to build up their vocabulary. Some children may not sing along straight away, but they may get involved by clapping along to the tune.
Makaton and basic sign language are effective tools for communication, however, it is important that practitioners recognise it should be used as a resource for supporting language, not as a replacement for speech. To ensure this, adults should always use signing alongside speech, demonstrating the sign and its verbal equivalent simultaneously. For example, using the sign for ‘drink’ while saying the word “drink”. Children with selective mutism can start using these signs as a means for communication, developing their language over time.
While official Makaton is a recognised method, practitioners can use their initiative and create their own simple signs for different words. Children will also come up with their own gestures which should be acknowledged by adults, rather than trying to replace them with ‘correct’ ones. Trying to rectify misused signs can be confusing and may deter children from trying to communicate further. Any attempts to communicate should be recognised and praised.
Visual picture cards can be used alongside speech, providing another form of communication for children with selective mutism. Examples can be found online, or practitioners can create their own.
These should be readily available for the children, who can access them when they need to communicate a need, such as going to the toilet, needing a drink, or requesting a particular resource. Ideally they should be about the size of a child’s palm, laminated for durability and either on a lanyard or with Velcro or another adhesive material on the back which can be displayed on a board or in a book (Special Needs Communication Cards ).
Words should be displayed around classrooms, helping children recognise words associated with items. Children will not necessarily be able to read words and labels, but adults can use them as another visual aid for them. Once children make the connection between the item and a word, they can gesture towards the word, knowing what it is associated with, for example, a car box might be labelled with the word “Cars”, so if a child wanted to play with a car, they would be able to point to this word.
Setting an Example
Follow the children’s lead and do not force them to interact in false or unproductive ways. Children with Selective Mutism for example should never be ridiculed or treated differently for not engaging verbally.
Practitioners need to demonstrate patience, consistency and empathy working with children who have speech delays. Adults should wait for children to instigate activities or attempted conversations, responding sensitively to their cues and setting examples of suitable reactions.
It is not uncommon for other children to point out children with selective mutism, saying things like “Billy never talks”. These comments should not be ignored but instead corrected, with responses such as “Billy doesn’t feel like talking today, but that’s ok, maybe he will tomorrow.” Showing compassion to all children encourages children to mimic this behaviour, allowing them to develop kindness and empathy.
Practitioners should also know how to comment on children’s play, recognising when it is better to narrate instead of asking a question. Sometimes interrupting a child’s interaction to ask a question causes it to end, whereas commenting on a situation encourages children to continue.
A good example would be “I like how you are using the big blue bowl to carry more tasty fruits to the wooden table”. Narrating for children in this way exposes them to descriptive words which they can go on to use in their play, further developing their language skills.
When a child with selective mutism does choose to speak, it is important that practitioners do not overreact. Obnoxious overreactions can cause the child to feel embarrassed or even shocked, discouraging them form speaking again anytime soon. Simply continue with the interaction as if you were speaking with any other child or thank them for telling you what they did.
Children learn best when they are engaged and having fun. The inability to talk and communicate effectively can be a frustrating and tiring situation for the children and the adults around them, so practitioners should be mindful of how to make learning fun.
Sharing ideas with parents can also make for a more enjoyable atmosphere at home. Parents shouldn’t keep talking to their child about the fact they don’t talk at nursery, as this will heighten their anxiety. Instead, useful techniques and reassurance can be offered. Working closely with parents not only eases the pressure for them, but also creates a holistic learning experience for the children, helping them to progress more swiftly.
Things to Remember:
- Selective mutism is linked to anxiety disorders and can be considered as a phobia.
- If not addressed, selective mutism can cause problems later in life, such as low self-esteem, social anxiety, isolation, and depression.
- Children should be made to feel relaxed, not embarrassed, singled out or ridiculed.
- Do not pressurise them into to talking, focus on having fun and learning.
- Praise small efforts of interaction and attempts to communicate, but not in an over-powering way.
- Do not act surprised if the child talks, react warmly how you would with any other child.
- They can be more susceptible to urine infections as they are unable to ask for the toilet, so ask them regularly if they need to go.
When working with children who suffer from selective mutism, be patient and supportive, encourage them to step out of their comfort zone and treat them like all the other children.