Saturday, May 29, 2010

Silent Students: How can I work with a child with selective mutism?

Selective mutism can be puzzling for classroom teachers, counselors, and a student's peers. What's the best approach? I did a little research.

I have an 8-year-old female student in my class (who I'll call Jessica), who is classified as having a Learning Disability. She entered the class in November, fresh out of her initial special education evaluation. There was little information on the IEP because the evaluator was unable to get the student to verbally or otherwise engage in the testing. When asked questions, she would look away and put her finger in her mouth. She is recommended for a 12:1:1 bilingual setting, but she currently is in a mono-lingual English speaking classroom and receives no English language instruction, as it is not available in our school. She has Selective Mutism.

Selective Mutism is a low incidence anxiety disorder in which a child does not speak in one or more social settings. It occurs in less than 1% of the population and is more common in girls than in boys. Because children typically speak in the home setting, teachers play an important role in identifying and finding appropriate treatment for students with selective mutism. When asked to speak, they may blush, fidget, avoid eye contact and become increasingly rigid. They may even avoid asking to go to the bathroom. My student places her index finger in her mouth when she is nervous. She does this less now, and it is my assumption that this is in part because she is more comfortable and in part because we have reminded her not to put her finger in her mouth. It's difficult to believe has never asked to use the bathroom during class.

Some claim that the child will naturally grow out of their silence. Many claim that my student will. But researchers contend that this isn't neccessarily the case. Even if the student does begin to speak, she will likely suffer from anxiety in new situations. Even worse, if her anxiety is left untreated she may never speak in the school setting or speak to the degree that is typical of other students. It is important that students are treated for the condition because it decreases opportunities for social interaction and may increase instances of bullying.

Additionally, a student’s silence slows down the progress on word attack skills and oral reading. I noticed that as a teacher, I did not spend as much time working with my student on reading and oral activities because I assumed she would not speak. However, once I realized this, I made the conscious effort to work with her as much as I work with other students.

Students’ silence reduces opportunities for academic assessment from the teacher, especially because the elementary setting relies heavily on verbal assessment. However, students do not typically have academic deficiencies, even though teachers may rate reading skills lower, objective measures show that students with selective mutism perform on level with their peers. Jessica often surprises me with her reading and the amount of words that she can read. However, because of her status as an English language learner, it appears as though she does not have a large English vocabulary and does not know the meaning of many words. Even when she is able to decode the sounds in the word, she is unlikely to blend the sounds together. I do not know if she is anxious and this prohibits her from taking an educated guess or her limited English causes her not to recognize that the word is a true word.

It is important for teachers who work with students with selective mutism to understand that the students’ silence is a symptom of anxiety and not a show of defiance. Pressure to speak from adults and peers may only make the student more anxious. However, no pressure to speak may reinforce the students’ silence. It is important that a teacher’s relationship with a student who has selective mutism has a careful balance of safety and challenge to progress, if even in very small steps. The student must not begin to see his or her own identity as a selective mute, or one who does not speak.

While these students do not speak, they do wish to communicate. In the month of March, I made a conscious effort to engage more with Jessica. I noticed that because she did not speak and did not cause “problems” in the classroom, I did not take much time to give her attention in a social way. I would help her with her work, but didn’t have much of a relationship with her. During a week in March, the class went on two field trips. I sat with Jessica on the bus. We took pictures of ourselves with my camera and looked at them. We laughed. She began pointing to things out the bus window that she wanted me to look at. Since then, we continue to communicate more. Now, Jessica will tap me on the shoulder now when she needs something, as opposed to doing nothing. She will act silly with me, touching my hair or making faces at me. When I say thank you to her, she will respond with “you’re welcome.” Even though these are small steps, I recognize that she is making progress and communicating more.

There are a variety of therapies that are appropriate for students with selective mutism, including behavioral therapy, family therapy, and psychopharmacological therapy. SSRI’s (anxiety treating medicines) have been shown to be helpful to decrease anxiety and effective in getting children to speak in as little as weeks. These treatments have been used with students as young as four years old and the medicine does not typically need to be used for a long duration of time, perhaps a few months or a year. Still, communication between home and school and an intervention plan can make progress even without the therapist.

What should the teacher mindset be? The teacher, first and foremost, should show empathy to the child. The teacher might ask the student if they would like to speak at school in the future and give an open invitation to do so. If the student does say that they would like to try, the teacher can say they will help however they can. In the classroom, the teacher should provide a safe and welcoming environment, observing and paying close attention to the situations in which the student appears the most anxious. The teacher may ask the student (who can answer in writing or drawing): How can I help you participate more in school? When the student does speak, it is wise to refrain from calling attention to the child because this may cause more anxiety.

The teacher may consider, when possible, making a home visit to the child to observe and perhaps interact with the student in the home setting and play with the student using puppets or dolls to encourage speech. In terms of the student-teacher or student-peer relationships, teacher should watch carefully for behavior that becomes too dependent. I am planning to visit Jessica’s home in two weeks. It is late in the school year, but I hope to make as much progress as we can in the little time that is left.

To treat selective mutism in the school, school staff should develop an intervention plan. Crundwell recommends involving individuals with whom the student speaks in “conversational visits." The student may work with the individual with whom he or she is comfortable, for example a parent, in a separate room in the school building, practicing reading or math. The purpose of this visit is to allow the student to become comfortable speaking within the walls of the school setting, and no more. After a while, speech can then be transferred to another setting. The conversational visits then move closer to the classroom and peers.

Jessica’s mother has visited our classroom a few times. However, because she is in the classroom with Jessica and her peers, Jessica is still anxious. If I am able to plan for the visit, I will set up space and a time for Jessica and her mother to interact on their own in a place in the building. I wish I could communicate these strategies more to the parents, but our communication is difficult because Jessica’s mother speaks Spanish and I do not.

From my research, I’ve recognized that it is critical that the steps be small in order for the child to feel safe. After several conversational visits take place, more opportunities can be provided for conversations and interactions with peers. When the student does speak, it is wise to refrain from calling attention to the child because this may cause more anxiety. Teachers should pay close attention to the activities and seating arrangements in the classroom when planning for social interaction. In the classroom, pupils that the student engages with should be used for support. One young boy in my class has taken a liking to Jessica and looks out for her. He interacts with her and tries to get her to speak with him. Sometimes I wonder if he is putting to much pressure on her, but I don’t think he is making her too anxious, from my observations. They seem to interact as typical friends would. When we work in partners, I have Jessica and the student work together.

As the school year comes to an end, teachers and school staff should also plan with parents and the student to think about what can be done over summer break and the next school year to maintain and continue progress. I need to think more about this and gather more resources for the family.

When Jessica first arrived, she did not speak at all. When questions were directed toward her, she would look away and put her finger in her mouth. Because we did not yet have the IEP, Jessica’s history of silence in the school setting was not available. I was told that she was Spanish speaking and the school was puzzled as to why she was placed in my class. As a couple months passed on, Jessica’s speech progressed little by little. When prompted and given choices she would respond with nods. Then, she would respond with a one word answer after being prompted. Now, she speaks in a more audible whisper and will respond to questions without delay and with 2-3 word answers.

During the first week of May, a bilingual paraprofessional came to work with Jessica. She met Jessica and began speaking with her in English, and Jessica did not respond. Then, the paraprofessional started showing Jessica pictures of her dog on her cell phone and speaking in Spanish. Jessica began responding in Spanish in an audible whisper. Throughout the day, the paraprofessional encouraged Jessica to participate and spoke to her in both Spanish and English. When I arrived to pick Jessica up from lunch (at which her para was present), I had never seen her smile so big (and she smiles a lot!) I walked down the hall with Jessica, holding hands. Jessica was so excited that she was bubbling with energy, skipping and squeezing my hand. We returned to the classroom and she continued to talk in a loud whisper when prompted. At the end of the day, another student said, “Wow, I’ve never heard Jessica talk so much before!” The entire class was proud , including Jessica!

3 comments:

韋于倫成 said...

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adam said...

check out London bubbles work in the speech bubbles programme. We have had some success with selective mutism although it wasn't a specific aim of the project. www.londonbubble.org.uk

eko said...

Torey Hayden worked with children who had selective mutism...check out her books. One is "Just Another Child" (kid?). Just another perspective and strategy as they are all different, it may not always be a simple anxiety from being in the classroom but could have some deep seated home issues.

I believe a major component of the success you had with 'Jessica' was that you were kind to her and engaged her.