How we use low arousal techniques to support a person with autism and Selective Mutism

Guest post by Rachel Tenacious

Low arousal can be used with any person who is having difficulties meeting the expectations of those around them as far as I am concerned but it works especially well with people who need to be in control of their life as much as possible as a way to keep their anxiety at a manageable level. Demand avoidance is a reaction to fear, facing scary situations all day every day is too much for any person, when a person is demand-avoidant it is their way of stopping the world just for a short time so they can breathe.

Our lives are full of demands but many of them can be avoided with a bit of skill and determination. When H was 5 we were told she was controlling us and we have been told this many times over the last 11 years and guess what, yes she is and yes she does but not for the reasons that most of  the so called "professionals" were suggesting. H controls her world because it is very scary. Speaking away from home became scary for H sometime after she started school and this was when she stopped doing it. We believe that she tried asking for help by crying at school but her voice was invalidated so she stopped asking.

Removing H from school allowed us to give her a break from the massively demand heavy environment that she was in every day. Learning about low arousal has helped us to give H a voice and to allow her to live a life of much lower anxiety levels.

The first and most important thing to remember is something first written by Ross Greene who wrote "The explosive child" he said "Kids do well if they can". This is the root of everything!

Before we can genuinely improve that lives of people like H we have to properly understand that. We have to remove blame, we have to believe that the person who is struggling is not making a choice, we have to have a good understanding of Fight, Flight, Freeze and most of all we have to think outside the box.

Living a low arousal lifestyle is completely different from anything else we have ever known, we have to throw away the "Traditional parent, parenting handbook" and we have to get creative. We have developed our own toolbox of strategies and techniques for getting through each day. We are led by H, we never punish, we never cajole, coerce or bribe her. If she needs us to speak for her we do, if she feels able to speak for herself we celebrate [secretly].

We have days with massive successes where she is able to order food or buy a drink verbally. We have lots of days when she can’t do those things but we step in and make sure she doesn’t miss out. We build in loads of downtime and never make direct demands about anything including speech.

We would never expect her to use social greetings but she will occasionally look at people to acknowledge them and sometimes say a quick “Hi” and we always say a general thanks, goodbye etc.

Because initiating a conversation is a massive demand for H and maybe something she never does away from home we sometimes give people information about things that she is interested in. If she is comfortable and talking about a subject she is interested in she can talk freely. And if she isn’t comfortable she can at least answer questions or nod.

We are actually ok with SM and the actually act of speaking has become a less important aim for us. We would like to get H to a place where she is able to be more independent and I think  we are already moving in that direction but whether speaking away from home will be a big part of that I don’t know.

H wants to learn to drive next year so that she doesn’t have to use public transport which is a sign she is  thinking about her future. Finding an autism/SM friendly driving instructor might be a challenge but we are used to challenge.

There is lots of info about low arousal strategies available, we particularly like Bo Hejlskov Elven because he is clear and concise and his book "Sulky, Rowdy, Rude" is easy to read. "The Explosive Child" by Ross Greene is also an amazing book but I found it a little harder to read.

I guess for me the whole basis of low arousal is making life more positive, working together to find out how we can help to overcome the anxiety that causes the challenges and respecting that actually its ok to avoid some situations, we need to look deep into ourselves and think about the things we avoid as adults that we were forced to do as a child and extend that out into our children and into our whole lives.

Rachel Tenacious

A little bit about me, I am a late diagnosed autistic parent with three children aged between 30 and 16. H is my youngest child she was diagnosed with autism at age 9 and selective mutism at 15. We removed H from the education system in 2015 after she had what we now know as an autistic burn-out. The school system didn’t suit H at all but home ed has been amazing. Since my diagnosis I have begun to share some of our experiences at support groups and am hoping to expand this out to schools, colleges and anywhere people want to hear me really.

My thoughts on selective mutism as part of a demand avoidant profile.

Guest Blog by Rachel Tenacious

As background, H had been described as being "Unable to talk when she is anxious" by an Educational psychologist when she was 11. I went further when she was falling out of the mainstream school system and described it as "Effectively Non-Verbal when stressed". Another parent first used the term Selective mutism to describe her difficulties when I  described  H to them.

Sophie Harding and Libby Hill from Small Talk  agreed that H does have SM when she was 15.

I had begun to learn about demand avoidance and low arousal before I had heard the term selective mutism.  At fist I was unsure whether H fitted the PDA profile but I needed to gain a better understanding of her if we were ever to attempt formal learning again so I headed off to the NAS PDA conference in Brum in November 2016.

What I learned there was going to be life changing for us. The experts talked about a group of autistic people who demonstrated extreme demand avoidance but were not explosive or aggressive physically.

This was my lightbulb moment. H fitted this group perfectly and always has.

H avoid  everything that makes her anxious and everything she perceives to be likely to make her anxious. 

When she started school H did not have SM but she was massively anxious and was demand avoidant.

At preschool she never managed a whole day because it was too much for her but when school started she suddenly had no choice.

She screamed, kicked, ran away, begged, sobbed and clung onto us in an attempt to stop us from making her go. Unfortunately we didn't listen to her, she was we believe told to put up and shut up by school staff so she did.

I am not sure that H ever initiated a conversation with an adult in school ever and she certainly didn't ever ask for help.

When H is anxious she freezes, she makes it her mission in life to be invisible away from home and yet that is not her true personality. At home and with a  small group of very familiar and chosen people she is loud, funny and very outgoing.

The person that most outsiders see is not the real H, it is the H in self preservation mode. All demands are difficult and speaking is one of the most challenging.

Rachel Tenacious 

[A little bit about me, I am a late diagnosed autistic parent with three children aged between 30 and 16. H is my youngest child she was diagnosed with autism at age 9 and selective mutism at 15.

We removed H from the education system in 2015 after she had what we now know as an autistic burn-out.

The school system didn’t suit H at all but home ed has been amazing.

Since my diagnosis I have begun to share some of our experiences at support groups and am hoping to expand this out to schools, colleges and anywhere people want to hear me really.]

How to get help for Selective Mutism

Smira has worked hard to produce an excellent flowchart about where/how to get help for SM:

Links given on page 1 above:

Search for Private Therapist

• Speech & Language Therapy: www.helpwithtalking.com – go to ‘advanced search’, tick the SM button and extend the distance it reports on as support can be done remotely for you
• Psychology: www.achippp.org.uk or www.bps.org.uk

Check that the therapist has SM knowledge and is registered with www.hcpc-uk.co.uk

Links given on page 3 above:

• Learn online, from the Information section on this website
• Join the SMIRA Facebook Group (it’s a closed group so there may be a short wait while we approve your membership request.)
• See NHS Choices – Selective Mutism

Additional Reading

Details and purchase links for all of the books below are on the Recommended Reading page on the SMIRA website.

• “Selective Mutism Resource Manual 2nd Edition” (Johnson & Wintgens). Most changes in 2nd Edition are for older people with SM and generalising outside school
• “Tackling Selective Mutism” (Sluckin & Smith, ISBN-13: 978-1849053938, ISBN-10: 1849053936)
• “Can I tell you about Selective Mutism?” (Johnson & Wintgens, ISBN-13: 978-1849052894, ISBN10: 1849052891)
• “Can’t Talk? Want to Talk!” (Jo Levett, ISBN-10: 1909301310,ISBN-13: 978-1909301313)

Have a look at the SMIRA website http://www.selectivemutism.org.uk/

How should we interact with a child with SM in early years and primary?

Look out for one on secondary coming soon based upon our survey of young people which will be in the Royal College of SLTs Bulletin soon.

We have more short videos and how-to's in the parent hub. Let us know what you would like us to cover next.

What does it feel like to have Selective Mutism? How you could start a discussion with your child

Guest blog post by Clair Maskell

As an ex nursery nurse, I had done various special needs courses and Selective Mutism was only briefly discussed. I had not encountered it within my 11 years of childcare work and then a few years ago, I was lucky enough to meet E.

E was in my daughters preschool and they started school together. I became friendly with her Mum and through her, I started to get a picture of what life was like for a child with SM and how it effected the family.

It was soon clear that there wasn’t enough understanding of SM. Many teachers seemed to be unaware of strategies to help E and it was also difficult for other children to understand her too.

The more I learnt about E and her anxieties, how she couldn’t cry if she hurt herself at school yet was a live wire at home, how she would bottle up her worries and feelings and leg them all out at home.....I just felt I needed to do something to help people understand her better and also to make her feel like someone somewhere understood.

I had been dabbling with writing for children for a while, self publishing a book in 2013 and wanting to do more. E’s Mum and I had the same thought at the same time.....why not wrote a children’s book??!!!

And that is how The Loudest Roar cake about. It follows the lovely character Angus, the lion who has the most fantastic Roar, but it didn’t work when he left his home. 

I chose a lion because I was so touched by E’s bravery. Imagine getting up every day and going to school without being physically able to express yourself. That’s bravery and what braver animal to portray that then a lion!

I have been so honoured to have E’s Mums support in writing the story, which my husband Dean illustrated for me. The story is really helping to raise awareness not just here in the UK, but in the US, Canada and Australia too!! 

The whole point of the story is to explain to children what having Selective Mutism feels like and not only is it doing that, but it also is resonating with children with SM, who have given feedback to their parents to say Angus is “just like me”

You can get The a Loudest Roar on Amazon and also follow me on Facebook 

Clair Maskell 

Children’s Author.

Selective mutism training in Staffordshire

Time goes so fast so we're planning what we're going to do for October's selective mutism (SM) awareness month already.

We aim to blitz the local radio shows again with the lovely Natasha Dale who has become a brilliant ambassador for children and young people with SM, we'll have a local press campaign and a training day for parents and professionals.

If you know anyone who would benefit from the training, please let them know, places are limited.

The aims of the day are:

• To recognise and diagnose SM
• To fully understand the causes and maintaining factors
• To relate the above to an appropriate prevention or management plan:

     - educating all key people involved with the child

     - creating the right environment at home and at school

     - talking to the children and their peers about SM

     - considering the need for a formal programme

     - formulating treatment targets

Friday 13th October 9.30am -3.00pm
Uttoxeter Fire Station, Cheadle Rd, Uttoxeter ST14 7BX

£85 to include lunch and refreshments

Book here

We'd love to see you!

My friend Daniel doesn't talk: book review

My Friend Daniel Doesn’t Talk is a helpful children’s book about selective mutism, written by Sharon L. Longo and illustrated by Jane Bottomley. This book is very easy to read and understand and the illustrations add more of an insight in to what it is like to have SM. Although this book is very short and simple, it really focuses on the key points of stereotypical selective mutism. We’re first faced with a paragraph about some of the behavioural characteristics and signs of SM and anxiety, “He played with his shirt collar while his mother talked to our teacher, and his face was frozen”. Immediately we are let into the world of a child with selective mutism and are encouraged to almost feel the difficulty these children must experience. 

The main aim and purpose of this book is explained to be, to help others who don’t have SM, but know someone who does, understand the condition. 

Having had selective mutism myself, throughout childhood and adolescence, I felt this book was somewhat relateable and insightful. I particularly liked that it focused on Daniel himself, his behaviour, his anxiety and how others perceive him, as well as Daniel’s friend. I was really warmed by reading how SM can affect the other children in the class. I think it’s important and useful to take the time to read this book, especially if you yourself have SM, and especially if you’re a child, because it allows you to see that people want to understand, they want to help and they will accept and befriend you. Talking is not a necessity in gaining and maintaining friendships and the people who matter, the people who care about you (your friends) will remain patient and understanding as long as needed.

Daniel’s friend was full of curiosity and asked his mother many questions about Daniel and his SM. When curiosity about Daniel was the topic of the school playground, Daniel’s friend explained, “My Mom said some kids are so scared to talk that their words can’t come out”. Daniel’s friend was incredibly interested in learning about how he could help and be a good friend to Daniel, as were other children in Daniel’s class.

The only concern I have with this book is that it is very much based and focused on stereotypes. Nonetheless, this book still allows us some degree of insight into the condition from a child’s perspective. However, there is one part of the story that I don’t feel too comfortable with, “I’m going to be extra nice to him so he’ll talk to me one day”, as much as this can be read in a completely positive light, and indeed there is much positivity behind it, it also holds some concerns as it is potentially suggesting that there is a pressure to talk if a person is being nice to you, as well as giving the impression that a child with SM is to be treated as special with added attention. Although, of course, these comments and acts of apparent kindness do happen in schools, so I think it does hold some importance in being included in the book. It is important to remember that most children with SM want to be included, they want to be treated fairly and given the support and understanding they need, however they do not want to be singled out. A little further into the book, this is pointed out and rightly so, “we shouldn’t make a big deal when Daniel speaks. That would just make him feel more upset” which I think is an incredibly important key point.

Most of all, I thought the guide for parents and teachers, at the back of the book, is extremely useful. This guide explains that this book carries the theme of acceptance, diversity and equality, which is reassuring. I would agree, this book definitely not only helps children who have SM themselves, but it could be very helpful to children who do not have SM themselves, but know someone who does. It answers many questions and solves the confusion felt by many children trying to understand someone who doesn’t speak. Just as importantly, this guide also gives very brief but very accurate points and information on how teachers and parents can help and support their pupil, or child, with SM.

Overall, I would say that this book’s main purpose includes, to reassure children with SM that they are not going to be forced to speak, people will be patient and understanding and true friends will be supportive. At the same time it helps children without SM to understand children with selective mutism, or perhaps even it encourages other children to embrace and accept difference more broadly. My Friend Daniel Doesn’t Talk is a beneficial read and I would recommend anyone affected by SM to read it, whether that be first or second hand; children with SM, children without SM, teachers and parents.

Natasha Dale

Read more from Natasha at https://www.facebook.com/groups/1808261839396436/

Doing what it takes........ a holistic approach

I am a speech and language therapist who sees children with ASD and/or complex communication difficulties including selective mutism. If I was in the NHS I would be called highly specialist. I see children who have many challenges, some of which are speech, language and communication but many also have extreme anxiety. It's a chicken and egg situation because if they didn't have Speech, Language and Communication Needs, they wouldn't be so anxious, if anxious at all, while the anxiety blocks their abilities both to understand and to express themselves. Therefore, to do my job properly, I have to know about anxiety and be able to address some of the issues alongside. Consequently,  have studied and  I use animal assisted therapy (AAT), CBT and NLP as part of my approach with traditional approaches including Social Thinking by Garcia Winner.

I discussed this recently at a RCSLT clinical excellence network. The responses were very interesting: completely polarised. Almost half the audience wanted to know more, took the references and 'where to go from here' information readily, the other half raised their eyebrows and shook their heads. There is a wealth of clinical evidence about all the approaches for counselling but they were disturbed because there isn't in speech and language therapy.

I use the animal assisted therapy by having Ralph (a certified PAT dog) in on sessions where I need the child/teenager to be relaxed so I can get on with the 'other stuff'. It works like a dream as he sits by them while they answer my questions or complete assessments. They can stroke him or ruffle his neck as they think or cry into his neck if they feel like it....he doesn't mind a bit.

The CBT is really just looking at the problem and breaking it down into baby steps, which is actually what most speech therapy is, while the NLP helps to shift negative mind sets.

The Social Thinking is a brilliant way of introducing the idea that social cognition is a vital area for us to get along with our fellow man even if we never wish to have a conversation with him.

I believe that we need to be more creative: there is no one-size fits all approach to these children and young adults. They've usually tried everything else by the time they come to me.

I know this blog-post will receive a polarised response too but I make no apology because my goal is to make a difference and not be just another professional who says they can't help because they don't fit traditional methods. As the saying goes: if we always do what we've always done, we'll always get the same results. We're lucky because we are not bound by commissioners or bureaucracy which imposes limits on what we do.

As a team, we have a wealth of clinical based evidence and that's sufficient for me: we achieve good, if not great, results!

Selective mutism: a personal story

Guest post by Natasha Dale

After struggling with Selective Mutism for many years, I finally found the courage to film and post a video of my story (see below)

 What is Selective Mutism? – Selective Mutism is a severe anxiety disorder where the sufferer displays persistent failure to speak in certain situations. I do feel that the label ‘Selective Mutism’ isn’t very accurate, as for me and many others it isn’t purely about the inability to speak in certain situations, it’s the inability to use many aspects of communication.

 Selective Mutism took control of my life for many years and resulted in me feeling extremely trapped, unhappy and guilty. During this period of my life I could only wish to be able to sing happy birthday to my parents, to give eye contact to those I cared about, to eat in public and enjoy social family gatherings, to walk to a nearby shop independently, to clap and congratulate people who deserved it, to be able to cough when I desperately needed to, to cry when in pain, to laugh when happy, to be able to ask to go to the toilet, to answer the register, to say thank you when I was given help, to tell someone if I felt unwell, to make friendships and to live my life as myself; instead of a tiny bit of myself with a huge amount of the disorder that is Selective Mutism.

 I began my journey into recovery at the age of 18 when I joined an agricultural college and worked alongside animals. Here I was given 1:1 support every second I was on the college grounds. This intense support along with being around animals, seeing a counsellor once a fortnight and of course the constant support from my family, allowed me to begin to recover.

It is now my passion to help those with additional needs and my ultimate goal is to be able to work with people struggling with Selective Mutism. I am not fully recovered yet, but I am so very close. I am happy to be able to use my experience with the disorder to raise awareness and to help others going through what I did for all of those years.

Can I tell you about SM: an excellent addition to the ‘Can I tell you about..’ series

Title:   Can I tell you about selective mutism 
Author:  Maggie Johnson and Alison Wintgens
Publisher:  Jessica Kingsley Publishers

Selective Mutism (SM) is still a largely unknown and mis-understood condition, and to date the majority of books are written primarily from an academic point of view. ‘Can I tell you about Selective Mutism’ is an excellent addition to the ‘Can I tell you about..’ series of books and has been effectively written in two parts. The first half of the book is written from the point of view of a young girl named Hannah, who describes what it is like to live with SM and how it affects her relationships with other people; creating a sensitive and personalised undertone throughout the book. The second part of the book provides functional and practical strategies that can be used by parents, carers and teachers. Maggie Johnson and Alison Wintgens are pioneers in the world of Selective Mutism and have worked with this unique client group for over 20 years; they currently work with the leading UK charity SMIRA to support families of people with Selective mutism. 

The informal style of this book makes it an accessible and invaluable aid to all readers and I highly recommend it as a fantastic introduction when first learning to understand the condition. I have used it many times with families that I have worked with; as an engaging resource to read with the child when helping them to understand and explain the internal world they experience every day. ‘Can I tell you about Selective Mutism’ helps to dispel common myths that Selective Mutism is a refusal to talk by providing a powerful first-hand insight. There is still much debate about whose professional remit SM falls into and I recommend this book to be read by any professional supporting a child with the condition including speech and language therapists and psychologists.

It is available from www.speechtherapyactivties.co.uk

Natasha Hallam

Natasha Hallam, Specialist SLT, Small Talk SLT
Rating:  5
ISBN-10: 978 1 84905 289 4

Staffordshire Early Years SLCN Conference

Come and join us for our first annual Staffordshire SLCN Conference

Sat 16th April
The Conference CentreJohn Taylor High school Dunstall Rd, Barton-under-Needwood, Burton upon Trent, Staffordshire DE13 8AZ

Registration - 9.30am

Selective mutism:  the way forwards Libby Hill is a consultant speech and language therapist and one of the very few in the UK who is trained to work with children with selective Mutism. With 1 in 150 being diagnosed with the condition, we all need to know how to deal with it. Libby will discuss how to identify SM from reluctant talkers and practical ways to manage in your setting.

Behaviour is communication: Kathryn Stinton is a specialist early years teacher who has worked in mainstream and specialist settings for twenty years. Kathryn will look at the typical development of social skills and factors which can impact on this, as well as the role of the environment in promoting positive behaviour for both adults and children.  A range of practical strategies will be discussed.

The development of language for learning: a Blank solution Natasha Hallam is a speech and language therapist who works in mainstream and special schools settings. Natasha will look at the development of children’s language for  learning and give you practical ways to both assess the children’s levels and tailor your activities accordingly.

2 year olds not talking; how to measure what they can do Margaret Gomm and Georgina White are both speech and language therapists with a great deal of experience of working with younger children in children’s Centres and Nurseries. They will look at the common issue of 2 year olds who cannot talk. They will give you practical ways to record communication before words and tips for working with non-verbal children.

Closes - 3.30pm

Buffet lunch provided

FEES & PAYMENT £85 per delegate £65 early bird until 28th February 2016. 

Places are limited to 50 so please book early to avoid disappoinment.

Payment and booking is all managed online: BOOK HERE

For more information: Libby Hill Small Talk SLT Ltd 

office@smalltalk-ltd.co.uk www.private-speech-therapy.co.uk

Selective mutism: another success story

Ralph, the speech therapy dog

Lucy (not her real name) aged 17 years had suffered with Selective Mutism all her life. It had blighted her school days and she was longing to leave school and escape her 'dreadful life'. She had been dreaming of the days she could finally do this, for years. Then over the summer, she thought about it and the reality hit her hard: nothing was really going to change unless she got some help to change herself.

Lucy's mother contacted Small Talk in August 2015 to see what we could offer. We discussed that we have done Maggie Johnsons's extension level SM training, animal assisted therapy, so we can use our team member Ralph the labrador, and CBT which is really useful for teenagers or older clients. A meeting was arranged at our clinic for the following week.

It's accepted that having  communication difficulty must get in the way somewhat but almost all the aspirations of a teenager such as getting a job, applying for college, passing your driving test, getting  a boyfriend/girlfriend etc all require confident communication. To be petrified of talking makes these things appear unattainable.

Lucy decided she wanted Ralph and her mother in on the first session and very bravely talked about her difficulties. Her mother added  detail so I was able to diagnose the SM which hadn't been done previously. Lucy cried into Ralph's neck and got lots of encouraging licks!

Lucy's story was one with which I am all too familiar and which makes me sad and angry in pretty equal measures. There had been a huge pattern of ignorance since she had started nursery aged 3. She'd had a variety of staff who had either ignored her SM or tried to force her to speak. At age 7 she'd seen a psychologist who had questioned her home life and accused her mother of 'some sort of abuse which would account for the mutism'. Bloody Hell!! Excuse my language! Her peers, apart from a  few, had called her names, ignored her or talked about her as if she wasn't there e.g. 'don't talk to her she doesn't speak'.

I explained that my role is to educate others, facilitate, encourage and support. We made a plan and I showed her how to set small steps to what she wanted. We started with applying for a Saturday job (part of the bigger goal of affording driving lessons). We looked all the aspects such as sending the application, thinking about the interview, imagining all scenarios, what questions etc. We broke it down into really small, achievable goals. She worked through these at a rapid pace.

In December, she got a part-time job at a well known supermarket. They were great and very keen not to discriminate against her because of her SM. They chose a role away from the public to begin with and would then be happy for Lucy to have a 'get out of jail free card' as she called it, which read, 'I'm sorry, I have a communication difficulty but I can take  you where you want to go'. She practised smiling while showing the card.

Lucy was surprised how easy the process was with someone to show her how to make it all seem more manageable. She decided she would do her own small steps to asking a special boy out!

Lucy now has a part-time job and a boyfriend but more importantly she knows how to achieve what she needs. On Friday, we discussed the driving lessons as the next target but she is confident she will only need me if she can't do it herself. Perfect! The positive Lucy who walked into my clinic last week is far removed from despondent one whom I met just a few months ago. She will encounter set-backs I'm sure but she told me that, 'It's easier not to try but if you don't try  you don't get anywhere either'.

I love my job!!

www.private-speech-therapy.co.uk

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!!

October is SM Awareness: please help

The ‘Make a Noise for Selective Mutism Awareness Campaign’ is the social media arm of SMIRA’s Awareness Campaign for October 2015.  It involves an activity that we hope all ages can take part in, from grandparents to toddlers and even the family dog! Groups, school classes, etc. can also participate in any way they feel appropriate and it can also be expanded for use as part of a fundraising event, even without the video element.  Just be creative in what you do!

SMIRA’s aim is to raise awareness of selective mutism generally but also to raise funds to provide much needed training opportunities, particularly for health and education professionals and anyone who may be involved in the care and welfare of selectively mute children.

 Let’s help ‘our’ children find their beautiful voices!

How to take part in the ‘Make a Noise’ campaign:

·         First of all, think of creative ways to make a noise.  This could be using homemade musical instruments, household items, machinery or anything at all, then prepare to make a short video.  Wear fancy dress if you like, or do anything that might liven up your recording.  Our Music Therapist friend Kate Jones has provided some suggestions for making a noise – see below.

·         At the start, participants could say to camera that they are ‘Making a noise for selective mutism awareness, and ask (or nominate) xxx to do the same’.  Feel free to add any other comments that you feel might be relevant.

·         After completing the ‘noise making activity’ please either speak, hold up a card or add information under your video, saying ‘To donate, please text MAKE 15, followed by the amount, to 70070.’  (Our suggested amount is £3 but of course the donation can be for any amount).

·         SMIRA has a special ‘Makeanoise4SM’ page on facebook where you can upload your video, or use your chosen social media outlet adding the hashtag #MakeaNoiseforSM  or tag @InfoSmira  on Twitter.   

·         If you are too shy to appear in a video, you could if you prefer post a photo along with a text description of the event.

If you wish you can copy, paste and edit this underneath your video or photo:

·         Thank you XXX for my ‪#‎makeanoise4SM nomination. I have donated £3 to SMIRA. Now I would like to nominate XXX and XXX to make a noise for Selective Mutism awareness. Please text MAKE15 to 70070.
For more information on the campaign and Selective Mutism click here:http://www.smira.org.uk/

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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

Selective Mutism; a phobia of talking

I went to an excellent course on Friday by Maggie Johnson on Selective Mutism (SM). Thinking on this has changed so that it now needs to be considered as a phobia; a phobia of talking. Consequently, our approaches need to change. 

If we had a child who was scared of spiders we wouldn't expect then to confront their fears head-on immediately e.g. by sitting in a bath of spiders or putting their hand onto a box full. We wouldn't cajole, coax, bribe or order them to do it, yet we do all of those to children who are speech-phobic or selectively mute. If we had a child who had a phobia, we would use very small steps in any programme to help them overcome their fear. Similarly, we need to use very small steps with children who have SM.

Maggie recommended an excellent website www.selectivemutism.co.uk who produce advice sheets and resources. They also do videos. This is an interesting one, take a look:



If you are concerned that your child may have selective mutism, we can help: www.private-speech-therapy.co.uk

Selective Mutism

There will be some children who started school in September who aren't saying anything in school. Its always very difficult for a class teacher to know if its just shyness an underlying receptive language difficulty, an expressive language disorder or whether it could be selective mutism. 


Selective Mutism occurs when children who can speak and understand language perfectly normally at home are unable to speak elsewhere e.g. school or nursery. Unusually, there are many more girls who have selective mutism. It's also apparent that when boys display this condition they often have other social interaction or learning problems as well.


Selective Mutism used to be known as elective mutism, as people including professionals believed that children were choosing not to speak, and were therefore thought to be challenging and manipulative. The term Selective Mutism reflects current understanding that the children’s silence is not something they can control. It can be seen as a type of extreme social anxiety or phobia.


Michael Jones, specialist speech and language therapist has done a lot of work on this subject. This is an extract from his excellent article featured on his website.

How does selective mutism (SM) develop?

Michael says that 'SM can begin as shyness, but for various reasons children become progressively unable to speak in public, and especially at pre-school or in school. No single cause has been identified, though emotional, psychological and social factors may play a strong part. In some cases trauma can be an important factor, perhaps in school or hospital. Some children with SM are also anxious about new or unfamiliar situations and activities, and may be overly worried about taking risks.


Children may have other behaviours, such as limited eye contact and facial expression, physical rigidity, nervous fidgeting and withdrawal. SM often develops as children get older. It may not always improve spontaneously, and in some cases can become an intractable condition that severely limits young people’s life chances.

How can children be helped?

Early identification and appropriate support is of vital importance. If a child is not speaking at pre-school or school after a period of ‘settling in’ then a Speech and Language Therapist should be consulted. The most important form of help is to establish good links between home, school and any professionals who are involved. Maggie Johnson and Alison Wintgens, two Speech and Language Therapists, have produced a practical and comprehensive book about SM. ‘The Selective Mutism Resource Manual’ offers practical and effective strategies for helping children and young people with anxiety about talking in public. Their approach to developing confident speaking is a comprehensive guide to research and literature about SM, as well as offering effective advice to parents and professionals.


Maggie and Alison identify two very important ideas: that children with SM do want to talk, but need help to become confident speakers; children need a step-by-step approach that involves the family and school working closely together'. read more at http://talk4meaning.myhomepagemanager.com/selectivemutism.php


The Selective Mutism Information and Research Association (SMIRA) support families and schools by providing information and advice. Their DVD ‘Silent Children: Approaches to Selective Mutism’ is an excellent introduction to SM and to effective strategies.

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• Selective Mutism: Diagnosis of the Week (helpingpsychology.com)
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• Selective mutism - All Information (umm.edu)