Selective Mutism

Selective Mutism a single case study 11th Annual SENCo Conference A Workshop Presentation Leslie Crew Deputy Head and SENCo Jane Crocker Teaching Assistant Sonia Hilton Educational Psychologist

Involvement of Services • Referral to Emotional and Trauma Support (ETS) in March 2006 when V was in Year 1 • This led to the involvement of ETS Coordinator following a pastoral care programme (Silent Children video and workbook) which ended in course of Year 2 in 2007 • Referral to Speech and Language Therapy in June 2007: report completed in November 2007 • Parental referral via GP in CAMHS/Clinical Psychology at Booth Hall early in 2008 (school unaware) • Further enquiry to Emotional and Trauma Support January 2008 Selective Mutism

Historical concerns and interventions • Present concerns Establishing the background • School’s senior management team • Lead TA/Mentor To establish the viability of an intervention Conversations with: First Steps Selective Mutism

School • Parent • School-linked SLT • Clinical Psychologist…a little later • Talking Map: a careful assessment of the settings in which a child speaks Information gathering and assessment framework • A member of school staff who has established substantial rapport with the child • A key setting/room in school for talking/speech activities/meetings Identify Steps 1 Selective Mutism

Establish the team: • child • mother • TA/mentor • Educational Psychologist • Agree a start date Steps 2 Selective Mutism

Background • International New Arrival from Lithuania when nursery age • Home languages: Lithuanian, Ukranian, Russian, Polish • Began to attend Harpur Mount PS in Reception year (2004-2005); previously attended a nursery in London Background: communication • Vocalises at home (mainly Lithuanian) with family members • Absence of vocal communication with adults and children in school • Some limited non-verbal communication in school • No concerns regarding understanding and use of language; competent in both Lithuanian and English (SLT report 2007) Our child ‘V’ (d.o.b: 02.03.2000) Selective Mutism

Background: other factors • No sensory or physical difficulties • No apparent learning or wider social communication difficulty • Key stage 1 summative assessment: • Writing 2c Numeracy 1 • Unable to assess ready accuracy and comprehension • Eating and toileting difficulties and possible separation difficulties noted in the past • Noticed to have two friends (girls) Our child… ‘V’ (d.o.b: 02.03.2000) Selective Mutism

Talking Map

A behavioural approach to SM to reduce anxiety Stimulus fading/sliding in technique This enabled us to build on situations where child was already speaking Method 1 Selective Mutism A small steps / hierarchical approach A systematic progression changing one variable at a time: a common and consistent approach across the school person setting talk/activity

Vs Low High rote language economical – yes/no no risk of getting it wrong rehearsed speech/ elicited speech giving alternatives or reasons Wh? questions – giving options or ideas unsure if the answer is acceptable unplanned speech/initiation of speech Classification of activities: communication load Selective Mutism • Stages of confident speaking

Method 2 Ensure that the child is an active partner throughout the process – shared target setting (later) respecting her preferences Sustain ways of talking with the child which acknowledge anxieties and help the child to be comfortable with small steps telling the child exactly what will happen – use of a comfort scale Try to make the intervention programme enjoyable and create an expectation that it will be fun Selective Mutism

Comfort Scale

Stages of Confident Speaking

V talks with mother at home and in the car on the journey to school, but stops talking at the school gates • Extend speech with mother to: • the school playground • the target room in school • Mother ‘slides in’ Jane (to become key worker), by overhearing from outside the room; entering and eventually joining in. • When V is comfortable to use speech with Jane, mother is withdrawn Intervention plan/goals 1 Selective Mutism

Jane repeats the same activities in different settings in school Jane becomes the trusted conversational partner/key worker who can be used to ‘slide in’ others and to establish speech in different settings in school using a small steps approach 2 or 3 times a week Review with parent each half terms to build up the talking map/ matrix to reflect home, community and school. Intervention plan/goals 2 Selective Mutism

Talking Map

Make a talking map/matrix as a baseline Summary Go straight into a programme to establish speech with the child – avoidance of speaking will perpetuate the reluctance to speak Use a small steps approach having regard to the hierarchical stages of confident speaking and communication load Use a behavioural approach –sliding in- is reported to be easier - to reduce anxiety Tell the child exactly what is going to happen ; remove all anxiety triggers and gauge level of comfort, using a 10 point comfort scale Selective Mutism

Too anxious to speak? • Recent research has focused on the link between anxiety and SM • SM is thought of as a social phobia; or a symptom of excessive social anxiety; or a specific phobia linked to expressive speech • High incidence of co-occurring difficulties in the domains of cognition, motor functioning and language development • Thus it is important to consider all possible subsets of SM in order to make individualised interventions for each child Hayley Cleave, 2009.

Please spend 5 minutes thinking about the following and make a few notes on each point. . . • The Selective Mutism Resource Manual. Maggie Johnson & Alison Wintgens, Speechmark ISBN 0-86388-280-3. Final points… QUESTIONS Schools are well placed to support a child with SM. How does your school currently support a child with SM? What else would you like to be able to do? What are the potential barriers to your being able to develop these ideas ? What are the facilitators? Selective Mutism

Thank you! Selective Mutism

Selective Mutism