A small minority of SM children will need specialized services such as CAMHS, as their problems are complex and their environment may be problematic. This is sometimes combined with formal CBT. It should be noted however, that unusually minute and gradual steps in the behavioural aspect of treatment are required if the actual speech behaviour is to be changed. Broad, general recommendations are not effective.

The first step in helping a student with these difficulties is to recognize that they are manifestations of anxiety. The student is not choosing to behave this way and is neither unmotivated nor oppositional. Then, Place trusted friends in the same class(es). In secondary school, this probably will require hand scheduling. It is vital that all staff in the new setting understand the nature and implications of selective mutism and that there will be no pressure on the child to speak until they are ready. Reassurance should be given to the child to this effect, both by parents and staff (see Phase 1 intervention for relevant information). Identify a learning mentor / keyworker / support teacher in the new setting who will provide an escape route if necessary and meet with the student regularly to ensure they are happy, not being teased/bullied etc. For example, if the child has been assured that everyone at school understands their difficulty and that they need only talk to their keyworker for the time-being, valuable trust can be lost if other staff try to elicit speech. Or if one person is offering money, chocolate bars or Happy Meals for achieved targets, it should not be surprising that someone else’s stars appear less exciting. Obtaining an audio or video recording of the child speaking at home will enable an assessment of speech and language skills to be made.

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Yes, but early identification is important, so that some form of intervention can be planned. The condition may not improve spontaneously and can become intractable. If the child is not speaking after a time of ‘settling in’, then an Educational Psychologist or a Speech and Language Therapist should be consulted. How can professionals help the parents? Insufficient time has been invested in information sharing, joint planning and monitoring, leading to loss of momentum or the programme being abandoned. Support social connections: identify potential friends and work partners; initiate activities with those students and monitor as necessary; teacher assigns partners rather than let class choose

These two delightful stories tell of how Fiona, indoors a real chatterbox, makes a friend, finds her tongue and is able to talk outside the home. The second tale concerns one day when everything starts to talk to her, even her satchel! The child is not clear about the content of the sessions/the keyworker is not clear about the child’s limitations.Listed below are suggestions for strategies and accommodations that may be helpful for the older student with Selective Mutism. 11Accommodations and modifications may be specified in an IEP or 504 Plan (in the US). Some accommodations are appropriate for almost any student with SM:

Selective Mutism: A Guide for Therapists, Educators, and Parents provides an effective, research-based behavioral intervention plan for the successful treatment of Selective Mutism. This book provides intervention strategies for all team members, as well as a comprehensive treatment plan that can be individualized to any child. The techniques included emphasize a gradual, stepwise approach to increased speech, as well as fun and engaging activities that can be used at each step of treatment.

Selective Mutism Association (SMA):

It is the audience/conversational participants or setting which changes rather than the child’s speech effort. The child talks to a trusted conversational partner (usually a parent) in a minimal anxiety situation and then one factor is changed – an anxiety trigger is introduced. If the child is relaxed to start with and the change is only slight, the child can tolerate the anxiety trigger and keep talking. For example they can tolerate another person gradually coming closer and joining in the activity. Activities like parcels, statues, sliding and swinging developed trust. Musical instruments and puppets (especially squeaky puppets) allowed the children to be legitimately noisy, something they do not normally have a chance to do in the classroom. When outgoing Ryan meets Daniel, a boy who is too afraid to talk in school or other places outside of his home, he befriends the silent boy, defending him in school to the other children. Their friendship grows, and Daniel feels comfortable enough to talk to his new friend. Ryan’s tendency to ‘talk too much’ enables him to help Daniel in the classroom, and he hopes for the day when his friend will be able to talk in school so that the other children may get to know the ‘real’ Daniel. In the meantime, he is willing to continue to be a friend to Daniel until that day. The ideal classroom setting for the selectively mute child: A guide for parents, teachers and treating professionals Avoid calling attention to any new steps the student makes, such as talking in a new situation; other students should be told, without the student present, to not comment if the student with SM talks

Angus has a fantastic roar. It is so loud, it gives his Dad a headache! But his roar doesn’t always work, leaving Angus feeling sad, angry and alone. This book describes what it can be feel like to have Selective Mutism and how even though you cannot express things in words, you can still do amazing things.Do’s & Don’ts at Pre and Primary School: http://www.selectivemutism.org.uk/info-dos-donts-at-pre-and-primary- school/ http://www.selectivemutism.org.uk/info-dos-donts-at-secondary-school/ The Older Child or Teen with Selective Mutism: DON’T ask open-ended questions; instead phrase questions so that the child can respond non-verbally; choose YES/NO questions or questions where a one or two word answer will suffice.