During the last few years, I have had the opportunity to cover some students in the private setting on weekends or evenings. I love that I get to do this as I feel it keeps my skill set for all age levels. Last November I completed a language evaluation on a student who was exhibiting signs of selective mutism. Her parents at the time of referral did not know what this disorder was, or what treatment looked like. They wanted an evaluation for expressive language but it was something very different. Through this process I learned some really valuable information I thought I would share.
What is Selective Mutism?
According to the DSM-V selective mutism is classified as a social anxiety disorder that manifests itself through expressive communication. The hallmark of this diagnosis is that the child has the ability to talk in one setting (such as home) but not in another setting where they do not feel comfortable (such as school or the community). It also must be for more than a month's time before a diagnosis can be considered according to most experts. It is estimated that 7 out of every 1,000 people may signs of selective mutism with genders both equally being affected or diagnosed. This disorder is often misunderstood as outsiders may see the child as acting out by not talking. Adults who suffer from this say that is not true. They instead describe selective mutism as a paralyzing fear that actually seems to take over.
Who gives out this Medical Diagnosis?
According to the American Speech and Hearing Association the diagnosis of selective mutism must be viewed as a team approach with the speech pathologist, psychologist or psychiatrist and pediatrician. They do not specify who gives the diagnosis but in my case, the student I evaluated was a 6 years old and when I tested her showed average ability for both expressive and receptive skills so I referred her to get additional psychological evaluation, but told her family we could work on strategies for her to get her needs met in a functional way and ways to address fears about speaking.
Importance of Background Information
When selective mutism is suspected ASHA puts emphasis on gathering background information to make a differential diagnosis from a language disorder. Many times during the evaluation process a child with SM will not talk or talk in only a few word answers and may look like they have an expressive language disorder. Other students with selective mutism do have expressive language issues and this is why asking questions of familiar adults is so important. When reviewing factors, it is important to have a great questionnaire or interview to look at all the factors such as fears or anxieties, bilingualism, expressive and receptive ability and other relevant factors. Here are two great examples of questionnaires I looked at before coming up with my own hybrid for my evaluation:
1. SMQ Questionnaire
2. SMCDQ Questionnaire
The educational history review seeks information on:
- academic reports
- parent/teacher comments
- previous testing (e.g., psychological)
- standardized testing
- hearing ability
- possibility of middle ear infection
- coordination of muscles in lips, jaw,and tongue
- strength of muscles in the lips, jaw, and tongue
- any suspected problems (e.g., schizophrenia, pervasive developmental disorder);
- environmental factors (e.g., amount of language stimulation)
- child's amount and location of verbal expression (e.g., how he acts on playground with other children and adults)
- child's symptom history (e.g., onset and behavior)
- family history (e.g., psychiatric, personality, and/or physical problems)
- speech and language development (e.g., how well does the child express himself and understand others)
Additional Resources:
http://www.asha.org/public/speech/disorders/selectivemutism/
http://www.selectivemutismcenter.org/home/home
http://emedicine.medscape.com/article/917147-overview
I will do another blog post later in the week about working with this child and some other great resources for treatment.
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