Do you know for sure that your child is talking at school? That may seem like an outrageous question, but let me tell you why I am asking...
I’m going to give an example of the type of child that I often see. Little Ariel just started preschool. At home, she is a chatterbox. She seems to be very bright, already reciting the alphabet and numbers. At school, Ariel has never spoken. I don’t mean that she is shy or slow to warm up. She has literally never said a word. Her teacher assumes that Ariel is non-verbal and she was just not informed at the start of the school year. She does not think to communicate this to Ariel’s parents. At a parent-teacher meeting in December, Ariel’s teacher casually mentions that Ariel does not speak. Her parents are shocked. Their little chatterbox isn’t speaking at school?? Ariel has now missed speaking opportunities for 5 months. Following the meeting, Ariel’s parents have to research what might be the cause of her not speaking, decide if it warrants treatment, track down one of only a handful of providers who are knowledgeable in this thing they Googled called “selective mutism,” and, if they are lucky, Ariel might begin treatment after she has already not been speaking in school for 7-8 months.
Selective Mutism (SM) is an anxiety disorder in which children speak readily in one setting (usually home/with caregivers) but they fail to speak as expected in other settings and with lesser known people (e.g., at school, with grandparents, at soccer, with family friends). (Note: It would not be SM if the child has a communication disorder, does not speak the language at school fluently. etc.) The lack of speaking rises to the level of a disorder when the child misses out on social and academic opportunities and is not able to meet their needs through speaking. If Little Ariel has SM, early intervention is imperative. Every interaction where speaking does not occur reinforces the cycle of negative reinforcement that these children are stuck in, leading to less and less likelihood of speaking.
Now, if you are a parent or educator reading this, I want you to understand the urgency without panicking! Obviously the earlier the better for most interventions, and it doesn’t mean that it is hopeless to catch something like this late... even years late! Treatment still works whether the child has been going without speaking in public for 3 months or 8 years.
I am highlighting the need for early intervention because someone who is not familiar with SM (a pediatrician, a school principal, etc.) might say to take a “wait and see” approach. The problem with this is that the child might end up going a full academic year or longer without receiving any intervention. For a child who is not speaking at all in at least one setting, it is worthwhile to at least have an intake with an SM-trained mental health provider to see whether treatment would be helpful.
The current psychology treatment for SM falls under cognitive-behavioral therapy and exposure therapy, with the most well-known protocol being Parent Child Interaction Therapy for SM (PCIT-SM). For younger children, treatment involves training their caregivers and school personnel to serve as speaking coaches. In therapy, youth practice speaking in a variety of settings and with a number of people until they learn to tolerate their speaking-related anxiety and to be able to consistently use speech to meet their needs (e.g., asking to go to the bathroom).
Because there are so few providers familiar with SM, many of the major research/treatment facilities offer what are called “intensives,” a 40-hour week of therapy for kids and their caregivers. Examples of these include the programs at Kurtz Psychology, Child Mind Institute, and Florida International University. Of course, qualified therapists can also provide your typical once-a-week outpatient therapy. You can find these providers here.
I am a PCIT-certified therapist and I have a specialty in SM. I have worked with many children, families, and schools and provide free support groups so that the community can learn from each other. Please see my previous post for free resources for SM.
P.S. Most people are unfamiliar with SM yet it affects 1% of children! Please share this post to help get the word out there to caregivers, educators, and others who care for children.
Comments