There's a Boy in My Class Who Doesn't Talk!

by Gail Goetze Kervatt, M.Ed.

www.selective-mutism.com

The statement was made to me in a casual manner. It was quite disconcerting to learn that a child had attended our school for one full year of kindergarten and no one, except the kindergarten teacher, knew of his disability. Not one of the teaching or specialist staff had been notified.

Nicholas, as I later found out, had not spoken in preschool for two years prior to his start of kindergarten in the public school system. His kindergarten teacher had been advised by the public school psychologist and speech teacher to treat him as any other child and wait to see what would happen.

During his kindergarten year, Nicholas displayed all the characteristics of any six year old child: happy, eager to learn, participating in all activities, as long as he could be silent. He had not spoken in school for three years by the end of kindergarten. He would not use the school toilet. He would not even laugh out loud.  

This child’s behavior has a title: Selective Mutism.   It is a complex psychological disorder with an unknown origin. Generally, it is called shyness for several years until a child enters school and does not function verbally in school and most social situations outside of school. Most school personnel do not have the expertise or experience to deal with a child having this disorder which is caused by anxiety and avoidance. However, much information has become available in the past few years via research studies, the Internet (keyword: selective mutism), journal articles, and publishers.

The following are some common characteristics that have been developed to diagnose a child with selective mutism:

Speaking Characteristics

  • The child does not speak in many social situations; such as at school or other social events.
  • The child can speak normally in other settings; such as in their home or in places where they are comfortable and relaxed.
  • The child's inability to speak interferes with his/her ability to function in educational and/or social settings.
  • Mutism has persisted for at least one month.
  • Mutism is not part of a communication disorder and can not occur with any other mental conditions, such as: pervasive developmental disorders (ie, autism, aspergers syndrome, schizophrenia, etc..)
  • Behavior Characteristics
  • The child is slow to warm up or relax with unfamiliar children or adults.
  • The child is quiet and withdrawn in most social settings.
  • The child is unable to initiate speech in order to play with other children and adults.
  • The child has fears and phobias.
  • The child stares and/or is often expressionless when severely socially uncomfortable.
  • The child is unlikely to take risks and is cautious in new surroundings.

Any child who demonstrates at least four of the speaking characteristics should be evaluated by a qualified psychologist, who has experience with selectively mute children, so that a diagnosis can be made. The psychologist will want to service the child in a clinical setting. This is important for guidance and family support. However, since school and the group setting is the very place the child fears the most on a daily basis, it is critical that an intervention be incorporated into the school setting.

School interventions have proven to be difficult partially due to teacher and administrator lack of knowledge and materials, fear, and inexperience. Thus, the child is usually passed on from year to year and, as in Nicholas’ case, become known as “The boy/girl who doesn’t talk”.   These children quickly learn to use avoidance techniques, as do their teachers, and to use the school environment to accommodate this debilitating condition. Research has shown that the longer the behavior last, the more entrenched and difficult to treat it becomes. Thus, nonsupportive schools begin to do unjust harm to these children.

Upon viewing various Internet message boards, it is evident that teachers who discover a selectively mute child in their classroom do want to help. However, it appears, they have a very difficult time finding research based strategies and a format that can be used in a sequential order within the school setting. The following are a few of the many, many common pleas for help viewed on Internet message boards:

  • I am a special education teacher in New Jersey who has a child with selective mutism in my class. She, otherwise, seems very bright, but refuses to communicate in any way within the school. We have tried incentives for communication but they don’t seem to be working. She is now in second grade and we’re out of ideas. HELP!
  • I have just started to teach a five year old child with selective mutism. I wondered if there were any specific teaching/behavioral strategies that would help. She stops talking at the school gates, but will talk at home. I believe she is bright and I have not forced her to speak. Should I start her on the reading scheme at school as she reads with mother at home? Are there any strategies to get her to start talking in the school? I would really appreciate some help.
  • I am a second grade teacher (27years). I have a female student who has never spoken at school. I know she is suffering. I have started to record her with friends to gain insight into her personality. I was hoping to intrigue her with walkie talkies as I had read this was a break through with one child. I would appreciate any help. Thank you.

. . . and from parents:

  • The situation here has not gotten much better. My daughter is being picked on to the point of coming home with marks from what the other children have done to her. She still hasn’t spoken to her teachers, other students, or therapist. She is starting to withdraw from friends that she has known all her life. She has been diagnosed with sm but her school doesn’t know enough about it, nor does her therapist and it has gotten to the point that the teacher has developed animosity towards me for constantly trying to keep up as a go between.
  • I am out to seek more support for selective mutism. My daughter has gone through school without saying a word. As frustrated as I am, I remained calm when the school district blew her off and then told me they want to hold her back in Kindergarten. I refused and transferred her to another school. My thing is the teachers in the school district are not too aware of this social anxiety. I know its frustrating to me as well as the teachers. I have no clue on what to do next or how to help her. I put her in therapy through my health insurance but I feel like they, too, are not up to helping me because her therapy is scheduled months apart. Her new school is very caring to her, but I want help for her now, not when it’s too late. What steps should I take? She is only 5. I don't want her to take meds so early in age. Please, can anyone give me ideas, tips, anything. Please, contact me. I have felt bad and I am always drilled from doctors. The same question is asked over and over, and that is was she abused in anyway. My daughter has never been abused or mistreated. I feel like a bad parent when everyone ask me what is wrong with her. Kids used to tease her. I feel sooooo bad for her. I just want to keep her home to prevent anymore ridicule brought upon her. As a mother, I have never been so frustrated in my life with the lack of support I get from doctors and school districts.

Nicholas, in my case, was diagnosed as selectively mute by a private psychologist at the end of kindergarten. His parents had asked the schools for help for three years. A conference was held with the classroom teacher, parent, and principal, in conjunction with the private psychologist, to obtain some history and develop a plan to help Nick overcome his fears and work toward speaking in the classroom. This would be the year that he was to learn to read. It was quite a caseload for the first grade teacher.

            The goals, at the psychologist’s suggestion, included such activities as explaining selective mutism to the class, mouthing and/or whispering words at the reading table, arranged playdates, mom visiting the classroom to do some of the talking for Nicholas during “Star Student” time, a monetary goal sheet to reward Nicholas for speech, Nick and Mom staying after school to develop a rapport with the teacher, and a visit by the teacher to Nick’s home.

Unfortunately, most of the established goals were not accomplished during first grade. Most threatening was Nicholas’ fear of speaking in front of a group and this is precisely what he was being asked to do. Nicholas, being quite bright, did learn to read in first grade, actually above grade level. He was tested through tape recordings done at home and was placed in the high reading group for second grade, but still, he would not speak. The flaw in this school’s plan seemed to be “the group setting”.

Treatment of selectively mute children requires many strategies, patience and time, and the involvement of all persons in the child’s environment. Most often, teachers, working alone, have feelings of frustration and anger when the child’s symptoms continue. Everyone in the child’s life including family, teachers, friends, and classmates need to be informed and educated.

Accepted current interventions combine cognitive-behavioral strategies, family participation, school involvement, the selectively mute child’s input, and, if necessary, psychopharmacology. The purpose of a school intervention and treatment plan would be to transfer the child’s speech, that occurs at home, into the school setting and other social situations. This process must be gradual, never trying to force the child to speak. Everyone involved must be patient and accepting of the child’s pace of recovery.

Stimulus fading is a method of providing the child with an anxiety free setting. The teacher and the child would start the sessions in a place where they could establish a good rapport. Nonverbal activities such as shared journal writing, joint story development, or computer games may ensue. Eventually, one more child is added to the group and speech oriented activities such as question/answer games would be used. When the selectively mute child becomes comfortable with the new child, and this may be a child who he/she secretly speaks to, another child is added. This procedure continues until there is a small expanded group. The process may take months to develop and the group size may fluctuate depending upon the selectively mute child’s needs and progress. It is important not to expand the group too slowly or too quickly.

Behavior modification is a method of providing incentives and positive reinforcement for producing speech. It could include the cooperative development, between the child and teacher, of quarterly and weekly goals, activities to initiate the goals, and rewards for completing the goals. The activities would be speech centered, for example, games which require yes and no answers moving toward one word answers, puppet shows, singing activities, tape recordings, and use of the telephone.   Rewards may be inexpensive prizes or as simple as computer time or “get out of homework” coupons. The rewards should be developed with the child’s input so as to be of motivational interest.

Other behavioral interventions that have been employed are systematic desensitization and guided imagery, where scenes depicting situations that have caused anxiety are coupled with muscle relaxation, shaping, in which the child is first reinforced for making nonverbal responses, then for making certain sounds, and finally for speaking at least one word, audio and video feedback or self-modeling, through repeatedly playing an audio tape or viewing a video in which the child is actively speaking, which desensitizes the child’s reaction, reinforcement sampling, which allows the child to play with an object prior to earning it by speaking, and even escape/avoidance procedures, which require the child to make a response before being allowed to leave the setting. Some of these interventions appear to be harsh and are used only by therapeutic clinicians.   School personnel must be careful in employing some of them. The best approach seems to be a multimodal approach in a school based treatment plan.

School personnel need to become much more familiar with various types of therapy and know that each child is a different case with different needs. What works with one child may not necessarily completely work with another child. A combination approach can be devised collaboratively with all persons involved in the selectively mute child’s environment. Then, it is necessary for all persons in the child’s social circle, including the teacher and any specialists, to be fully involved in pursuing the intervention.

After an investigation of the research, it became obvious that Nick’s limited intervention needed modification for the following year. My return to school in September was with the firm conviction that a systematic behavioral intervention was necessary, as was employing the appropriate school personnel. Someone had to begin to take responsibility for providing Nicholas with the type of school setting he needed to help overcome, or at least improve, his verbalization.

A review of the case studies about selective mutism surfaced several important points:

  • The longer selective mutism persists, the more delimiting it becomes (Kehle, Hintze, & DuPaul, 1997; Giddan, Ross, Sechler, & Becker, 1997).
  • Selective mutism is a very complex speaking disorder (Brown & Doll, 1988).

           (Selective mutism in now recognized as a childhood anxiety disorder.)

  • Interventions ideally require collaboration between the school psychologist and/or speech pathologist and the home (Kehle, Hintze, & DuPaul, 1997; Richburg & Cobia, 1994; Lazarus, Gavilo, & Moore, 1983; Giddan, Ross, Sechler, & Becker, 1997).
  • Interventions shown to be most effective have employed behavior therapy approaches including contingency management, stimulus fading, escape or avoidance techniques, self-modeling, positive reinforcement and pharmacological treatment.   Effective treatment studies incorporated a combination of behavioral techniques (Kehle, Hintze, & DuPaul, 1997; Richburg & Cobia, 1994; Lazarus, Gavilo, & Moore, 1983).
  • Stimulus fading involves the gradual fading of settings and other individuals, such as the teacher and classmates, into the child’s normal verbal interactions (Kehle, Hintze, & DuPaul, 1997).
  • It is more efficient to first shape audible speech in a controlled environment using systematic desensitization techniques to address the phobic anxiety, than to employ a whole-class procedure to encourage speech. The case study child was gradually pulled into group situations, required to participate in classroom activities, and allowed to become accustomed to the experience of being in a group (Brown & Doll, 1988).
  • Strategies and reinforcers might include task requirements, tape recordings, puppets, animal sounds, games, whispering, a classroom pet, prizes, bubble blowers, telephones, pantomime and masks (Lazarus, Gavilo, & Moore, 1983; Giddan, Ross, Sechler, & Becker, 1997).
  • Once the child begins speaking in the school setting, it is important to expand the speaking to the home setting, community settings and other relatives (Giddan, Ross, Sechler, & Becker, 1997).

Another discussion to resolve this issue was arranged, which included the principal, guidance counselor, speech teacher and me. The research findings were discussed along with a plea for some intervention by the responsible parties. The replies were, “It is not a speech problem.” and “I would not feel comfortable or competent working with this child.” It appeared that in order for Nicholas to receive any help at school, the onus was to fall on me. This is not my area of expertise, certification, or experience. However, someone had to make an effort to help this child. Three periods a week, in my already crowded schedule, were set aside to try to work with Nicholas.

The next meeting was comprised of the principal, Special Services school psychologist, and me. It was my feeling that this situation was a Section 504 of the Rehabilitation Act of 1973, a communication handicapped child. The only assistance offered, however, was a weekly check of my intervention in cooperation with the classroom teacher by the school psychologist.

The place to begin would be with tape recordings, since Nick was already familiar with this type of verbalization. He had tape recorded word lists and pages of a book in first grade.   By now, the class had heard his voice on an audio tape on the first day of school. Nicholas’ response was not terribly positive to the class playback, as he later reiterated to his mother; but, he realized that no one laughed upon hearing his voice.   One of his major fears had already been reduced.

Nick’s mother, psychologist and classroom teacher advised him that this year

in second grade he would be responsible for completing tasks to work toward overcoming his fears at school. Some of these tasks were to be completed during his additional special classes, and some were to be attempted within the classroom. Another list of goals was developed with Nicholas’ input, to be documented weekly during individual and small group sessions. Nick continued to see the private psychologist on a weekly basis, working toward attempts to speak to her.

The intervention that ensued incorporated stimulus fading, shaping, and cognitive-behavioral modification techniques. Nick met with me for forty minutes three times a week. Together, we developed a quarterly goal sheet from which Nick could choose speaking activities. Date notations were made on the goal sheet each time that Nicholas completed a goal. As we advanced through the goals, Nick was able to see which ones he had accomplished many times and which ones still needed his attention. The following are some of the goals for October: tape record stories on the computer to be played in the homeroom class, listen to the stories with Mrs. Kervatt in the room, make animal sounds, play board games using a voice messenger to answer yes and no questions, mouth “yes” and “no” to answer game questions, use puppets to make animal sounds, add animal sounds to songs, and whisper “yes” and “no” to answer game questions. Goals that were not accomplished during the first quarter were carried over to a new quarterly goal sheet, in addition to the new goals that were jointly chosen and agreed upon. Another worksheet was developed on which Nick chose and wrote his goal for each week.

Some of the activities that use behavior modification, shaping, and stimulus fading techniques have been described. Other strategies and activities were, also, used. The first session with Nick involved shared journal writing concerning his reasons for being nonverbal. After developing goals and a rapport, Nicholas began working toward producing speech by making animal noises, one at a time. Together, we recorded on the computer. I would read the text part, leave the room, and Nick would add the animal sounds. We would listen together; a step toward me hearing his voice with him present. We acted out puppet shows, through my reading of the text and Nick making the animal sounds. We played board games with questions requiring yes and no answers. First, Nick would answer using a voice recorder on which he had previously recorded “yes” and “no”. We advanced to mouthing “yes” and “no” and, eventually, whispering answers. The board games only included the two of us in the beginning. Each time Nicholas appeared to be comfortable, a child of his choosing was added to, eventually, form a small group. Nick was, occasionally, allowed to phone his home during some of the sessions, in order to become comfortable using his full voice instead of mouthing words or whispering in the room.  

As Nicholas became more comfortable with speaking in a small group setting, he incorporated some speech into his regular classroom during his second grade year. His classroom teacher tried many different strategies to coax Nicholas to speak. Even though he was speaking frequently in a gruff sounding voice in my individual and small group setting, and he was always eager to raise his hand to answer a question in his regular classroom of twenty-three children, the silence within always quickly took over in the large group setting.

Toward Spring of the school year, Nicholas started whispering answers to a friend from our small group, to be imparted to the rest of the class during discussions. He was requested by his classroom teacher to not only write his regular homework, but also to tape record reading selections and answers to questions that had been discussed in class that day. Nick did not like the extra work and came to realize that his speaking disability was affecting the amount of homework he received each day.  

Something happened to Nicholas that Spring of his second grade year. Perhaps, the key was to start with one child in another classroom setting, expand the number of people to whom Nick would talk in a small group situation, develop diverse activities and materials, give Nick choices, and reward goals that were accomplished. These strategies, in collaboration with the private psychologist, the parents, and the classroom teacher, gave Nick a new life.         

The process and eventual outcome took seven months, one small step at a time. Everyone involved realized that patience was the most important factor in helping Nicholas to overcome his fear. There was a fine line between pressure and encouragement to take the next step. That line had to be discovered by all involved.

Nick fearlessly walked into my home with his family in July of that year and began playing with the dog. He was talking in his normal voice and continues to do so to this day. All school and psychologist intervention was discontinued at the end of second grade. His parents have continued to introduce him to outside social settings such as recreation camp, sports, and making inquiries while on vacation. Doing so will help him to become comfortable in those situations with which he will have to deal throughout his life.

Nicholas had a most successful third grade experience, never failing to contribute to all verbal activities within the classroom and school. He now asks and answers questions without hesitation. The classroom teacher stated that had she not been notified, prior to his entering her class, she never would have been aware of any difficulties. She often had to remind herself that this was a child who had a serious social phobia, historically, very resistant to intervention.

Upon considering all the frustrations, difficulties, and insecurities on my part in the beginning, working with Nicholas proved to be one of the most challenging and rewarding experiences of my teaching career. His story demonstrates the complexity of the selective mute’s anxiety disorder. Optimistically, however, it also points out that a school intervention, in one case, without the use of medication, can be successful and will persist.

*For a complete description of the case history, strategies and activities, and resources see: www.selective-mutism.com or email This email address is being protected from spambots. You need JavaScript enabled to view it.