Selective Mutism: Silent and MisunderstoodBy Eileen Dame
Introverted. Anti-social. Withdrawn. Is there any teacher who has not encountered such a child? Not the merely quiet and reserved student, but the silent kid, the one who cannot make eye-contact, the one who does not speak to more than one or two other children, if that.
Max (not his real name) was sullen, somber, alone. He never smiled. He rarely looked up. He spoke to no one, and no one spoke to him. Socially awkward students in middle school are not uncommon, but Max’s isolation was extreme. I was sure something was terribly wrong, and made it my mission to help. He tolerated my efforts: he did not avoid me, he listened patiently to my words of encouragement, my offers to help. And yet, he never answered even the simplest question. In fact, the more time we spent together, the more remote he became. Head down, face blank, eyes averted, foot tapping. What was wrong? He trusted me. Why couldn’t he talk to me?
Max could not talk to me, nor to anyone else, because he suffered from Selective Mutism.
Selective Mutism (SM) is a social anxiety disorder which renders children unable to speak in select social settings. Children with SM can and do speak when they are at ease, at home and with friends. School, however, can be an enormous challenge. When placed in this social pressure cooker, “on the spot” in front of teachers and other children, a child with SM reacts with extreme anxiety. Like a deer in the headlights, he freezes. The name has changed from Elective Mutism to Selective Mutism, but both labels are misleading. The child does not select when he can and cannot speak; he is not exercising choice. He is not “simply shy,” nor is he being stubborn and manipulative. He literally cannot speak.
There was nothing about SM in Max’s file. This is not surprising. SM is often misdiagnosed, according to the Selective Mutism Group (SMG). SMG is a non-profit 501 (c)(3) organization whose mission is to increase awareness of SM. SMG notes that many parents are told their child will outgrow shyness, while other children are misdiagnosed as having disorders such as Oppositional Defiant Disorder (ODD), Pervasive Developmental Disorder, or Autism. These errors are made in spite of the fact that SM is twice as prevalent as other well-known disorders such as obsessive-compulsive disorder and Tourette Syndrome. Moreover, recent studies suggest that the rate of children suffering from SM may be as much as seven times higher (Bergman et al., 2002, Elizur & Perednik, 2003). Untreated and misunderstood, older children with SM may develop serious problems. In her article, What is Selective Mutism, Dr. Elisa Shipon-Blum, President and Director of the Selective Mutism Anxiety Research and Treatment Center, cautions that untreated children with SM are at risk of becoming depressed, abusing drugs and alcohol, under-achieving, dropping out of school.
Of course, I had broken every one of these guidelines with Max.
Hoping to boost his confidence, I called on him when I was certain he knew an answer. He ignored me. I met with him one-on-one and encouraged him to share what was troubling him. The real trouble was that I was talking to him! When he did speak, I would try positive reinforcement, making comments such as, “Nice to hear your voice today, Max.” He’d cringe. If Max set aside his classwork, I would conclude that he must be tired or ill or sad. I now know those were times he needed my help accessing the material.
My good intentions were insufficient. Without a fundamental understanding of what he was struggling with, I was incapable of helping Max. In fact, my attentions were exacerbating his distress.
The burden of the school day eventually became too much. Although Max had made a few friends by third quarter, he also began developing many of the problems Dr. Shipon-Blum lists. He ignored schoolwork. His absences and tardies spiked. He smelled of pot. He neglected his physical appearance, was unkempt and unclean. Max was in a rapid downward spiral. Though I had consciously been cultivating a relationship with him since September, in March he still would not speak to me, let alone to a nurse or adjustment counselor. Alarmed, we brought in Max’s father to discuss his decline, but we left the silence out of the conversation. It seemed to be the least of his troubles. In truth, it may well have been the source.
My utter failure to reach Max prompted me to research silent students. It was then that I encountered the term Selective Mutism and the Selective Mutism Group website, www.selectivemutism.org. Of course, I was in no position to diagnose this or any child, and yet, all the pieces fit. I devoured information on SM, then shared my speculation and insight with Max’s team of teachers. We began working with Max as if he had SM.
The transformation was astonishing. Within weeks, Max stopped self-medicating and resumed regular attendance. His hygiene improved. He took advantage of an Academic Recovery program, allowing him to pass the term. Max was working well in small groups, raising his hand more often, and, remarkably, reading aloud. He even began fooling around in my class from time to time, a sure sign that he felt at home. After seven needlessly painful months, we had finally created an environment where Max felt comfortable and, therefore, could thrive.
What of Max’s father? I worked with my administrator and adjustment counselor to communicate appropriate and important information. It is tricky business, suggesting a mental health concern to a parent. If teachers avoid doing so, however, how are parents to understand? Symptoms are at their peak at school; educators must share observations and concerns. With appropriate interventions, children can overcome SM. The earlier the diagnosis, the better. It is more difficult for older children, as nonverbal behavior becomes habit. Treatment for a child diagnosed with SM may include a 504 or an IEP. Educators involved in writing such plans may be interested in a list of accommodations compiled by Joleen R. Fernald, MS CCC-SLP. It is available on the SMG website. Here is how I applied a few of her ideas:
- Small group work. I learned not to pair Max with either very loud or very quiet students. The more structured the activity, the easier it was for Max to work with a non-friend peer.
- Give advanced notice of changes in routine, field trips, outside speakers. Breaks from routine could be difficult for Max. I explained in advance what would happen on a field trip, what a spree day looks like, etc. When determining groups for trips, I assigned at least one friend to Max’s group, and told him so before-hand to allay any fears.
- Allow nonverbal communication; Verbal intermediary. Even without his speaking, Max and I were able to communicate. Max answered my yes/no questions with head movements. When I had to share a lot of information and wanted to spare Max the pain of a one-on-one conversation, I would write notes. In time, Max would have peers give me messages.
Looking back, I suspect I’ve had one student with SM every year. I recall one student in particular; I spoke to “José” in Spanish, theorizing we might connect better using his native language. It was May before he was able to whisper to me, “I don’t speak Spanish!” I believe every educator will encounter a Max or two or twenty in her career.
Though he never spoke to me, Max and I were close. He and his buddies handed me silly gifts crafted from lunchroom recyclables. A friend was dispatched to tell me that Max had been accepted into a competitive high school. And on the day of our eighth grade promotion ceremony, Max bravely lifted his head to face my camera, then let me pat his hair on the way out the door.
There is much more to Selective Mutism than is described here. In fact, the inability to speak is only one of a number of symptoms which manifests in a child with SM. If you suspect you know a child with SM, please visit www.selectivemutism.org.
Note: October is Selective Mutism Month
Eileen Dame teaches eighth grade in one of her city’s public schools, Worcester East Middle, Massachusetts. An article on her non-traditional grading policy was published in the October 2008 issue of Middle Ground (“Trying Out a Different Idea: The ABI Grading System”). Her students are the top scorers in the school on her state reading assessment. Last March, Mrs. Dame was inducted into the Unum Educators Hall of Fame, an honor recognizing six educators in the city of Worcester. A fan of Harry & Rosemary Wong, Mrs. Dame has been a joint presenter on the topic of classroom procedures at the Eagle Hill Institute. She is always looking for a better idea, and has recently begun blogging her experiences in abidame.blogspot.com.