Selective Mutism: today's brief success story

Selective Mutism (SM) is very prevalent in the UK. A recent survey showed up to 1 in 150 children may suffer. There's huge debate about who should work on it: some speech and language therapy departments say it's them, others refer straight to CAHMS, as its seen as a mental heath issue.

It may be an anxiety based disorder but Speech and Language Therapists are trained to deal with all kinds of speech, language and communication problem and CAHMS are not. Where the two can work together that's great. At Small Talk, we see lots of children with SM and work with a counsellor and clincal psychologist where necessary. I've also studied both CBT and animal assisted therapy which adds more strands to our thinking/therapy.

I met a very anxious child in July before the schools broke up. She talked to her mother and sister only, no other family members. She wouldn't look at me and I did not attempt to talk directly to her. Her shoulders were hunched and she hung her hair over her face. She had no voice even for laughing (her dog found dog biscuit in my jacket pocket and pinned me to the settee, which was funny!). I decided to go into school in September to arrange a small steps programme. I was a little worried because it was an enormous primary with over 100 children per year group. I thought they might be too busy to support my plans.

I met with the SENCO and the TA in September to discuss a small steps programme. I asked for 3 weekly slots of 10 minutes each where she could form a  relationship with the TA. To begin with they'd use non-verbal games to build confidence etc. They were very keen to help and to do anything which would make a difference.

In October, I reviewed the situation and was very pleased; she was now talking in a whisper to one of her teachers. The TA and I discussed activities, aims and how to build on this.

Today, I went in again and she is talking freely to both her teachers in class to ask for help, make requests, comment and even for fun! She looks confident, smiles a lot and joins in everything she's required to. She still doesn't talk to her peers in school, so that's the next steps. I'm going in again in February but they know they can ring me anytime.

It just shows what a major difference can be made if we break the problem down into small manageable steps and put appropriate plans in place. Congratulations to the school and especially the TA!!

Selective mutism

Selective Mutism is a ‘consistent failure to speak in specific social situations, despite being able to speak in other, more familiar situations’. It is now  ‘seen as a manifestation of social anxiety or phobia, occurring in temperamentally predisposed children who are unable to take normal life events in their stride, particularly when the reactions of others reinforce silence rather than speech,’ (Maggie Johnson, 2012).

It doesn't sound too big a  problem does it? Might even be a nice change to have a quiet one in the class, be better if more had it to make life easier for the teachers?

But for the thousands of children and their families who suffer from Selective Mutism, it can be a terribly debilitating condition and one that encompasses all aspects of life.

With this in mind we reviewed and improved what Small Talk Speech and Language Therapy can offer and we are delighted to announce our new  services:

• We have done the diagnosis and management training and extension level training by Maggie Johnson and Alison Wintgens, who are the UK leading experts in SM.
• We will soon be able to use animal assisted therapy using Ralph our lovely therapy dog. This can just be having him the room to reduce stress/take the focus away from the child or he can be involved in a  small steps programme as he loves to do obedience work. We have had training in using him from Humanima which included the theory behind and helped us to prepare the necessary paperwork such as policies/procedures and risk assessments when doing any form of animal assisted activity
• As older chidren benefit from CBT, we are now trained in this so we don't have to refer on to a counsellor. It is a shame to see a child or teenager, build a rapport, diagnose and then pass on. We have a good relationship with an excellent counsellor so we can refer if they need anything else such as EFT.
• We also have excellent links with a clinical psychology team

The therapy for SM involves the people the child's own environment so more often that not we are 'explainers' and facilitators. This means it's straightforwards to see children and families who may live outside Staffordshire and who are prepared to travel for a diagnosis and/or help. If you are concerned about a child please get in touch to arrange an appointment.

Ralph the trainee therapy dog