Wednesday, 16 May 2007

Some more snippets of info I'm trying to make sense of

I've taken out the snippets I feel useful at the moment. Articles often seem more geared towards school-age kids. The emphasis on a 'team' of professionals and a more structured approach also has me slightly concerned. All that's happening now with H. is quite haphazard. But then are we making an issue out of something that may have gone unnoticed if he'd been at home instead of nursery from an early age and then gained his confidence before being thrown into the 'real' world? Allah knows best and it' something else to feel guilty about. However can imagine if had kept him at home and he'd been mute in school / later on, the lack of nursery attendance would've been blamed, no-win situation.
Here's parts of an artlicle by Robert Schum:
SLP = Speech and language therapist.
'The SLP can also use techniques to help reduce the general anxiety of the child with selective mutism through direct intervention and collaboration with the classroom teacher. Routine and structure often help an anxious child. Clearly understanding activities and having a predictable schedule reduce the unknown. If a schedule is changed or a new activity occurs, a preview of this change can be helpful. Anxious children sometimes appear to be "slow to warm up." They might not jump right into a new activity, but first prefer to observe other children doing an activity until they are sure that they understand what to do. Once they engage in the activity, they may require some adult assistance at first, and then have the adult fade the assistance as the child becomes more confident in the skills. For example, in a kickball game, the child might want to first observe other students play, later start playing with adult assistance, and then independently join in.
In working with children who are mute, I usually use terms such as "shy" and "nervous" to describe feelings when they are reluctant to speak, and "brave" when they extend themselves in therapy or in the classroom. Most of my patients understand these terms, and I find them helpful to use with teachers and parents. UmSuhayb comment: Have read shouldn't use term 'shy' with the child?
Because children with selective mutism often show other anxiety symptoms, another treatment goal in the schools is to promote more spontaneity in behavior. In individual therapy, I often use various media to help the child be more spontaneous and less constricted in actions. For example, we draw with markers, cut paper, use modeling compounds, and get messy with finger paints. The approach is to reduce the child’s self-consciousness and inhibition. These media also afford the child opportunities to communicate in a nonverbal fashion. The SLP should know that the duration of mute symptoms is highly variable. I have had young patients show improvement in symptoms in several months, with no more than 12 sessions of therapy. I have had other patients whose symptoms have persisted for several years. I recommend that in consulting with teachers and parents, we caution them that it may take some time until the child is comfortable speaking spontaneously at school and in other social settings.

In this context, it is important to remember that the mutism is only one specific symptom of the social anxiety. Many times we can note improvement in other, nonverbal symptoms of anxiety. If we focus only on the mutism, we can become discouraged by the slow progress in the improvement of that symptom. However, if we take a broader view of the anxiety, we can often identify encouraging progress over a wider array of behaviors. The SLP can be of great help in counseling patience with other members of the team, including parents and teachers.

This integrated approach to therapy promises the best opportunity for the child’s success.
Additional references can be found in The ASHA Leader Online at
Robert Schum is a clinical psychologist and associate professor in the Department of Pediatrics at the Medical College of Wisconsin. His specialty is the assessment and treatment of children with communication disorders. Contact him by email at '

Also have advised nursery to try activities involving blowing,using mouth but not actually speech, eg bubbles, pingpong balls with straws.
Plus his preference for playing with younger children (less of a threat ?)

Need to advise re anxiety reduction (pictorial timetable, letting him know who he'll be with, relaxing activities, dough, baking, painting..)

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