School-based assessments for children with selective mutism are becoming more common, and many of us aren’t sure where to start. We often take verbal communication for granted, and when a child isn’t speaking at school, our minds try to fill in the blanks. Is it defiance? Trauma? Anxiety? A language disorder?
If you’re working on an evaluation with a non-speaking child, you might be overwhelmed with who to include, what assessments to use, and what recommendations to make. We’re here to help!
Meet Quinn.
Imagine it is the week before winter break, and your school administrator emails you a referral packet for a 5-year-old kindergartener named Quinn. Quinn has not spoken to their teacher all year but has been observed to speak to a few peers on the playground. Quinn has difficulty separating from their caregiver in the mornings and often moves to the back of the classroom during whole-class instruction. Quinn requires support to transition between classes, which looks like hanging onto an adult’s arm. When adults speak to Quinn, Quinn visibly shakes. Quinn often holds their hands over their ears throughout the school day.
Your administrator noted that the teacher discussed these concerns with Quinn’s caregivers during their Fall conference. They reported that at home, Quinn talks with family members and is known as a “playful prankster.” Quinn’s family has noticed that Quinn often hides behind their caregivers when out in public. Quinn’s family also reported noticing that Quinn covers their ears in the grocery store and is often “shy” when cashiers talk to them. Quinn’s family shared that Quinn is healthy and has no medical diagnoses.
Who should you invite to Quinn’s consent meeting?
As you read the consent packet, you realize that you will need to assess for selective mutism. But who else should be invited to Quinn’s meeting?
Quinn’s caregivers are key stakeholders and should be included in this meeting. Quinn’s teachers and school counselor should also be invited. Because Quinn is having difficulty communicating at school, the speech-language pathologist (SLP) and assistive technology facilitator should also be invited. Finally, Quinn’s sensitivity to sounds may indicate sensory difficulties, so the occupational therapist (OT) should be included.
Okay, We now have consent for Quinn’s evaluation… but what exactly is selective mutism?
Selective mutism is an anxiety disorder. It is often related to shyness, social anxiety, and inhibited temperament. Children with selective mutism often avoid speaking situations, and this avoidance is often reinforced over time (https://www.selectivemutism.org/). Selective mutism is relatively common. One in 140 children are affected by selective mutism, and it is more prevalent in females (2:1 ratio of females to males). Most children are identified with selective mutism between 3 and 6 years of age, and approximately 70% of children with selective mutism will also meet criteria for a social anxiety disorder (Sharp et al., 2007).
As with many other disorders, selective mutism is often accompanied by other symptoms, which may include oppositional behaviors, speech and language problems, sensory processing difficulties, and features of developmental disorders (Cohan et al., 2008; Brimo, 2018).
The diagnostic criteria for selective mutism includes:
- Consistent failure to speak in specific social situations in which there is an expectation for speaking (e.g., at school), despite speaking in other situations.
- Lack of verbal communication that interferes with educational or occupational achievement or with social communication.
- A duration of mutism that lasts at least one month (this cannot be only the first month of school).
- Mutism (or failing to speak) cannot be attributable to a lack of knowledge of, or comfort with, the spoken language required in the social situation.
How do we assess Quinn?
With a multidisciplinary evaluation, of course! This is a complex child who needs support in a variety of areas, so we want to coordinate with all our practitioners for this one. That being said, it can be daunting to coordinate multidisciplinary evaluations, so we’ve included some guidance for your team members to support a positive, child-centered evaluation.
Every member of the team should:
- Build a relationship with Quinn’s family to understand Quinn’s strengths, developmental and health history, sociological background, family dynamics, emotional functioning, behavior responses, and daily living skills.
- Observe Quinn in different educational settings.
- Talk with school staff who interact with Quinn, including the classroom teacher, guidance counselor, and specials teachers (PE, Art, Theatre, etc.).
- Communicate with other team members to collaborate and create multi-disciplinary recommendations for interventions and support.
The school psychologist (SP) should:
- Work directly with Quinn to complete cognitive assessment with a nonverbal battery, academic assessment, and emotional/behavioral assessment (which may include projective measures).
- Determine whether Quinn meets eligibility criteria for Emotional Disturbance.
- Serve as the team facilitator and evaluation report lead.
The speech-language pathologist should:
- Use multiple information sources, tools, and strategies to evaluate Quinn’s language comprehension, language expression, social communication, articulation, voice, and fluency which involve both formal and informal measures.
- Include caregivers in the assessment as they may need to assist in test presentation.
The assistive technology facilitator/specialist should:
- Collaborate and coordinate with the assessment team and caregivers to consider trials of AAC, which may include no tech options (communication boards) and high tech. options (portable tablet with communication app).
- Work with Quinn to determine if they are comfortable with AAC and technology.
- Monitor trials of AAC to ensure that technology does not add anxiety.
The occupational therapist should:
- Evaluate Quinn’s sensory system to determine if there is dysregulation to see if environmental supports and modifications in the educational setting are needed.
What type of recommendations will best support Quinn?
Unless you have experience working with children who have selective mutism, you probably don’t have a recommendation bank to help inform your recs. Resources like ASHA, NASP, and the Selective Mutism Association have some great information.
You’ll probably want to include recommendations to address the following needs:
- Direct collaborative counseling services, provided by the school psychologist with support from the speech therapist.
- Indirect (consultation) services provided by the school psychologist, speech therapist, and other service providers, which could include the occupational therapist.
- Training and support for AAC device (if recommended).
- Family support (in-home parent training).
- Classroom and campus education.
- Collaborate with Quinn’s family and teachers about selective mutism with peers.
- Focus on honoring all forms of communication, supporting AAC in the classroom for communication and literacy, and providing verbiage to school staff about how to discuss selective mutism with peers, other educators, and school support staff.
- Create a sequence of communication expectations (refer to this resource).
We’re here to support you throughout the process. Please don’t hesitate to reach out with questions.
Resources & References:
Free online course for selective mutism: https://selectivemutismuniversity.thinkific.com/
Brimo, K. (2018). More than shyness: Selective Mutism and its link to sensory processing disorder. The Undergraduate Journal of Psychology, 30(1), 1-to.
Cohan S. L., Chavira D. A., Shipon-Blum E., Hitchcock C., Roesch S. C., Stein M. B. (2008). Refining the classification of children with selective mutism: a latent profile analysis. J. Clin. Child. Adol. Psychol. 37, 770–784.
Gordon and Marilyn Macklin Foundation. (2023, June 29). What is selective mutism?. Selective Mutism Association. https://www.selectivemutism.org/
Kearney, C. A., & Rede, M. (2021). The Heterogeneity of Selective Mutism: A Primer for a More Refined Approach. Frontiers in psychology, 12, 700745. https://doi.org/10.3389/fpsyg.2021.700745
Sharp, W. G., Sherman, C., & Gross, A. M. (2007). Selective mutism and anxiety: A review of the current conceptualization of the disorder. Journal of anxiety disorders, 21(4), 568-579.