Selective Mutism: Sally 8 y/o F (Treatment (Teachers are able to assist in…
Selective Mutism: Sally 8 y/o F
Selective Mutism (SM)
Prevalence of SM affects about 0.47% to 0.76% of the population. It has been noted that immigrant children have a higher prevalence rate (American Speech Language Hearing Association, 2018).
SM is more prevalent in females than males. Ratio is about 1.5-2.5:1 (American Speech Language Hearing Association, 2018).
Children who receive appropriate treatment will overcome selective mutism (Selective Mutism, 2016). Individuals who do not seek treatment have been seen to have comorbidities in addition with SM (Selective Mutism Association, 2016).
SM is characterized by "a consistant lack of speech in specific social situations in which there is an expectation for speaking [such as school] despite speaking in other situations such as when the person is at home" (Oerbeck, Steing, Pripp, & Kristensen, 2015, p. 757).
Symptoms are typically seen more in the school setting rather than in the home environment. A symptom might include withdrawal from playing amongst peers and "shyness"
Social participation with peers in school
In 8 months, client will participate in classroom activities alongside classmates in a structured group setting, independently, in order to engage in social participation.
Client will participate in small group classroom activities with the teacher and 3 peers, for 30 minutes a day, 5X/week, to promote social participation and formal education participation.
Create a safe and inviting environment at home for Sally
-Client will participate in quality time at home with family in a "safe
play tent", requiring 3 verbal cues, for 30 minutes each evening, 7 days/week.
-Caregiver will provide client a "safe play tent" within the living room of her home, within 1 month, in order to provide a spot for family quality time. The play tent will ensure an area for client to regulate emotions.
Self regulation (emotions)
In 3 months, client will participate in deep breathing exercises 3x/day, requiring 3 verbal cues, in order to address emotional regulation needed to deal with stress.
Client will participate in a social gathering activity with family once a month for the upcoming 3 months, with minimal cues to promote social interaction amongst family.
Teachers are able to assist in the treatment process of an individual who is experiencing SM by providing how the child is acting and the behaviors during different settings to the parent or occupational therapist (Martinez, et al., 2015).
Some of the settings that the teacher can provide behavior reporting may include small or large group participation, lunch-time and recess.
Family will be involved in the treatment process to help additional family members fully understand the diagnosis and the strategies to promote social engagement. Once a month there will be a family gathering at the clients house to promote social interactions and play.
Start with smaller sized groups while playing out on the playground to help with "withdrawal/shyness". If/when the child begins to be verbal, slowly incorporate more peers.
Provide the client with alternative communication devices, such as a tablet, white board, or pen and paper, so she can express her feelings and communicate with others during the time before she is ready to verbally communicate.
Family education on how to implement OT strategies in both the home & public settings. Clients family will provide a safe place in the open living room area to assist in social participation amongst family but also giving the client a safe place to have when she is feeling overwhelmed. This strategy will allow the client to be in a safe place and be able to observe that family members are not scary to interact with.
Introduce alternative ways of communication such as: Direct questions which include Yes/ No answers. If the child is not verbal, educate the child and the family on using noises, such as claps and or finger snaps to answer a question (2 snaps=yes; 1 snap=no).
Incorporate an emotions board to use as a visual aide for the child to use to expression her feelings.
Important since most children diagnosed with SM won’t talk to the clinician. Targeted questions will include the degree to which the child is verbally and nonverbally inhibited
Children exhibit most of their symptoms in the school setting, although to get a full understanding of the childs behaviors the parents report is extremely vital for the potential diagnosis of SM (Martinez, et al., 2015).
Determine the severity of the child's social and educational deficits to better tend to the needs of the client.
The School Social Behavior Scales 2nd edition (SSBS-2) is an assessment that can be used on clients from 5-18 y.o, that addresses a students "school-related social competence and antisocial behaviors" ((Case-Smith & O'brien, 2015b, p. 326).
Temperament, quality of interaction, and ability to communicate verbally and nonverbally. Observe the child at school, outside of school, and on the telephone
"Current methods used in the assessment of SM typically include parent measures of child symptoms and clinician observations and interviews (Martinez, et al., 2015, p. 86).
School Functional Assessment (SFA)
Used to measure the child’s performance of functional tasks that support his or her participation in academic and social aspects
SFA is used to assess a child's participation in the school setting and teachers are able to help with assessment by self reporting the child's behavior (Case-Smith & O'brien, 2015a).
Speech and Language Evaluation
Evaluate receptive language, expressive language, and speech. Can be assessed through audiotapes and standardized testing.
Review academic achievement and ask about classroom involvement
Teachers are an essential assessment tool in the diagnosis and treatment process (Martinez, et al., 2015).
"Teachers are professionals who can help with assessments and interventions for children with SM, given the context where this disorder first occurs and is most pronounced" (Martinez, et al., 2015, p. 86).
Client only engages with her mother. Client slowly withdrew from others and is very shy which affects her social participation and play participation with her peers.
Evidence Based Intervention: Educate the family on how to implement OT strategies in both the home & public settings. Help the family set up a "safe place" for Sally to regulate her emotions both at home and at school.
Client struggles with verbal interaction with her peers at school.
Evidence Based Intervention: Helping the teacher to incorporate social skills interventions for Sally during the school day. For example: role play
Sally is being bullied by peers at school and her teachers treat her as if she has an intellectual impairment, even though she does not have one.
Evidence Based Intervention: Having Sally participate in small group activities either on the playground or in classes such as P.E. Once Sally is comfortable and beginning to be more verbal, bigger group activities can be incorporated.
Client is able to follow directions, is physically able, and appears cognitively intact. But she is not progressing in school due to her lack of participate in educational activities with her peers and teachers.
Evidence Based Intervention: Provide Sally with adaptive equipment such as an emotions board and alternative communication devices such as a tablet and whiteboard. This will allow her to participate more in the classroom with her teacher and peers.
Preparatory Methods Intervention
Social Interaction Skills
acknowledges and encrouages
Context and Environment