Children with Selective Mutism

Child development stages from birth are characterized by different behaviors among children. Of more importance, the social settings in which children spend most of their time play an important role in shaping their character and behavior. Although many research findings link the condition to genetic predispositions among the affected children, it is undeniable that external factors influence developmental outcomes in children. Considering the adverse effects caused by Selective Mutism, especially to school-attending children, educators have been forced to implement certain strategies in order to ensure quality education for the affected children. In this regard, the following discussion will highlight several aspects of the Selective Mutism disorder and explain how Early Childhood Educators maximize learning and social interactions within the kindergarten environment.

Introduction

Many researchers have described selective mutism in a number of ways following their research findings. However, there is a collective agreement that the selective mutism interferes with speech among children. According to the Child Mind Institute, selective mutism is an emotional disorder among children, where they are unable to communicate proficiently under certain circumstances (2014). In many cases, children suffering from selective mutism communicate effectively in ‘comfortable’ environments. Because many people are unable to discover the inability among their children and tend to think that the behavior results from personal choice of the children. Consequently, many children suffering from the disorder are unattended to or even reprimanded to change their ‘bad behavior’. However, extensive research over the years has helped to develop effective intervention measures to help the affected children.

One of the most striking characteristics associated to selective mutism is the low prevalence among populations. According to Cardiff University, selective mutism is a very rare condition among pre-school children but has a significant consequence on education system whenever it occurs (2009). As a result, not many people, even some in the education system, are aware of the condition. In addition, First and Tasman state that the prevalence rates of the condition do not exceed two children in a thousand, with girls being the most affected lot (2011). These statistics further confirm the low incidences of selective mutism, which further indicates the need to enlighten education stakeholders of the appropriate measures to combat the effects of the disorder in educating young children.

Health professional use multiple approaches in the diagnosis of selective mutism among children. Firstly, health practitioners should interview the parents of the affected child to establish medical history (Wong, 2010). Such interviews are necessary since minor children may not be able to give out critical information that is essential for diagnosis. Moreover, parents are better placed to provide information regarding prenatal and perinatal history, which is important in assessing neurological and developmental associations (Wong, 2010). Of importance, diagnosis using scientific tools, such as Diagnostic Interview for Children and Adolescents, should be performed in order to rule other factors that may affect speech development among children (Wong, 2010). Wong further states that medical practitioners should examine hearing capabilities of the affected children to establish whether physiological hearing could be the cause (2010). Additionally, it is important to assess language fluency because it can be associated to selective mutism (First & Tasman, 2011).

Several factors are considered to cause selective mutism among children. According to the Child Study Centre, anxiety in different social settings is the primary cause of selective mutism in many children (n.d). This is arguably true because children suffering from this condition can communicate effectively when placed in a familiar environment. Wong (2010) also sights psychodynamic causes in which the affected children use silence as a weapon to deal with personal anger against certain unresolved issues. It is also believed that oppositional and passive aggressive behaviors among child could cause selective mutism (Cardiff University, 2009). Very close family relations between the affected children and their parents also contributes to selective mutism. In this case, affected children do not trust foreign relations due to the over protection offered by parents (Wong, 2010). It has also been shown that children with prior experiences that cause Posttraumatic stress disorder also have a tendency of developing selective mutism (Cardiff University, 2009). Further, Cardiff University states that familial genetic and environmental predisposition also causes selective mutism in children.

Selective mutism is manifested by various behavioral and physical characteristic among the affected children. One of the most significant characteristics is the failure to communicate in particular social settings that require speaking (The Child Study Centre, n.d). In this case, affected children can speak in settings they are comfortable with, such as around their parents or siblings. According to the Selective Mutism Anxiety Research and Treatment Center (SMart Center), children suffering from selective mutism are characterized by many anxieties in many cases when exposed to foreign social settings (n.d). Physical characteristics associated to selective mutism include uncoordinated body language, unpleasant facial expressions, eye contact avoidance, withdrawal from group gatherings and unusual habits such as chewing in order to avoid communication (SMart Center, n.d).

Because of the adverse effects of selective mutism, the disorder impacts the families of affected children in a number of ways. Considering the parental care and relationships between parents and their children, occurrence of then disorder can lead to discomfort and concern by the parents (Selective Mutism Treatment and Research Centre, n.d). Parents are always concerned about the future welfare of their children. Therefore, because selective mutism affects social development of their children, occurrence of the disorder leads to increased parental concerns. In addition, parents are also a concern about the disorder because it interferes with educational development of their children.

Because of the extensive research on because selective mutism, disorder, several intervention and treatment measures have been established. Intervention and treatment methods are categorized as behavioral or physiological depending on the techniques applied in the process. One of the commonly used behavioral approaches is the Stimulus fading, where a new person is gradually introduced into the comfort environment for the affected child (Cardiff University, 2009). Self-modeling, where a child is allowed to identify personal desire behavior, and shaping, where there is positive reinforcement to attain the desired behavior, represent other categories of behavioral approaches (Wong, 2010). Physiological intervention, mainly through the use of medication, is used in extreme conditions or where behavioral approaches do not yield desired results. In this approach, affected children are given anti-anxiety medications, such as fluvoxamine and fluoxetine (Wong, 2010).

Focus on the prognosis and long-term implications of has also yielded significant information about selective mutism. According to Bergman, there is research evidence showing improvement on the disorder after various interventions (2012). As discussed earlier, the different intervention and treatment approaches have been shown to produce good patient outcome when initiated using appropriate strategies. These sediments are also echoed by Selective Mutism Treatment and Research Centre by stating that appropriate treatment results in a positive outcome (n.d). However, it is noteworthy that failing to take appropriate measures can lead to persistence of the disorder in the affected children.

Adaptations

Effects of selective mutism pose an undoubted challenge to the learning process of the affected children. As a result, various initiatives have been initiated by Early Childhood Educators in order to combat the negative effects of the disorder and maximize learning and social interactions within the kindergarten environment. In this regard, teacher support or instructional strategies are some of the common methods employed by Early Childhood Educators to help the affected children. This strategy is implemented by using several techniques that cumulatively lead to positive support for the affected child.

Early Childhood Educators can issue instructions to the rest of the class to improve social relations of the affected child. According to the Selective Mutism Group, teachers should talk to the rest of the class on how to deal with the affected student when not present (n.d). In reality, selectively mute children shy or even hate being talked to about their behavior in the presence of ‘unfamiliar’ people. Therefore, it is import for Early Childhood Educators to establish an appropriate time for discussion the issue. In most cases, teachers instruct the other children on how to deal with specific issues concerning the affected child. For instance, a teacher should instruct fellow students to treat the affected children as if they are normal and not to reprimand them into talking.

Importantly, Early Childhood Educators can help the affected children by talking to them and offering simple instructions. Ideally, teachers should make the instructions simple and easily understood by affected children. For example, teachers should encourage the children by letting them know the different ways they can communicate whenever they feel comfortable (Selective Mutism Group, n.d). Similarly, it is important for teachers to develop prompts that encourage the affected child to communicate either to other children or the teacher (Kearney, 2010). Such interventions not only enable the affected children to develop good communication skills, but also enable them to boost their public confidence.

Early Childhood Educators can also issue instructions relating to particular activities that help to improve communication and social interactions within the school environment. For example, teachers can ask the affected student to help them in class preparation after or before a lesson. In addition, teachers can also request the parents to be present during such periods in order to boost the confidence of affected children. As a result, affected children can adapt communication skills and overcome their anxiety progressively. Similarly, teachers should promote small groups cooperation within the class and assign active responsibilities to the affected children, something that can help to build confidence and communication skills (Kearney, 2010).

On the other hand, Early Childhood Educators can use classroom programming strategies that facilitate learning and social interaction among children. Firstly, teachers should put in place class arrangements that promote interaction between the children. In particular, it is important for the teacher to identify children suffering from selective mutism and address the issue adequately. For example, because children suffering from selective mutism are shy, teacher should consider sitting such children in areas that do not attract much attention from other kids in the class. This is an arguable approach in classroom management because teachers can control various activities in the class through child arrangement. According to Kearney, proper class arrangements enable teachers to manage disruptive activities that can interfere with the learning process (2010). Therefore, Childhood Educators can improve learning and social interaction for children with selective mutism through coordinated classroom arrangements.

Teachers should also incorporate classroom routines that promote learning and social interaction among children in kindergartens. There are several routines that promote cooperation among students and teachers within institutions. For instance, communal activities such as sporting activities can help children to act as a team. In this case, teachers should identify games that suit all children but also favorite to the selectively mute children. In addition, it is important for teachers to group children in small groups in order to create a ‘favorable’ environment for the affected children. This way, selectively muted children can develop their social interaction and also improve their learning process in school.

Classroom intervention programs also help in promoting learning and social interactions among children in kindergartens. According to the Centre for Excellence and Outcomes in Children and Young People’s Services (C4EO), intervention strategies such as whole-class strategies incorporated with small group tutoring helps in improving learning and social interactions among students. Such interventions enable the teacher to gauge the nature of student interactions at the level of classroom and individual when engaged in small group management. As a result, it is possible to identify and implement appropriate measure to help selectively muted children to overcome their challenges.

Adaptation by use of relevant furniture, equipment and material can also help to maximize learning and social interaction process among children in a kindergarten. Because selectively muted children are challenged by face-to-face communication, it is important that Early Childhood Educators invest in equipment and materials that facilitate alternative modes of communication. For example, provision of gadgets used to provide answers through pointing or passing over can substitute face-to-face communication. In addition, kindergartens should be furnished with classroom furniture that promotes quality classroom management by the teachers. In this case, teachers can use the use the available furniture and their expertise to manage classrooms in a manner that encourages social interaction and learning among children.

Another important aspect used to maximize learning and social interactions in kindergartens is through building social interactions and relationships with peer groups. As discussed earlier, behavioral approaches in dealing with selective mutism include a gradual introduction of foreign people in a ‘comfortable environment’ for the selectively mute children. On this note, Early Childhood Educators can initiate interactions and social relations among children by encouraging selectively muted children to interact with extrovert colleagues. This can be achieved by initiating activities that encourage cooperation for the children. Social interactions in the kindergarten environment can also be encouraged by letting ‘trusted’ people such as parents and siblings to be part of the school development process.

Community Agencies and Support Services

There are several community agencies within Ontario, Toronto that provide services to children with a particular exceptionality and their families. These community agencies were initiated with the aim of alleviating social and health challenges faced by families during the child development. One of these urgencies is SickKids, located at 555 University Avenue Toronto, Ontario, Canada, M5G 1X8. The telephone number for general inquiries in the SickKids program is 416-813-1500. The SickKids Hospital is an affiliate of the University of Toronto and is mostly involved in research aimed at improving healthcare status for children in Canada and beyond.

The SickKids Hospital offers various types of services to children and the family at large. For example, the hospital provides creative art therapy to support development of children and emotional support to people attached to affected children. Of more importance, the hospital utilizes both behavioral and therapeutic approaches to managing social and developmental needs of the affected children. In particular, the hospital provides music therapy and therapeutic clowning as the available alternatives. Moreover, the hospital is equipped with inter-professional staffs that facilitate efficient service delivery in the facility.

The referral process at SickKids Hospital is simple and facilitates efficient service delivery for patients. Two methods, namely electronic Child Health Network (eCHN) e-Referral and the original Ambulatory Referral Management system (ARMs), are used to refer affected children. In the former method, parents or teachers of the affected children complete online electronic referral forms while the latter represents an automated online response in relation to applied referrals. In addition, urgent referrals to the hospital can be offered by calling the eCHN’s helpdesk directly.

Another support organization located in Toronto is the Moss, Rowden, Freigang & Associates. The agency, which has been in operation for more than 15 years, offers services to people locate in the Greater Toronto Area, Peel and the Halton Region regions. The street address for the organization is 341 Main St. N., Suite 200, Brampton, ON, L6X 3C. In addition, Moss, Rowden, Freigang & Associates can be contacted via telephone number, 905-874-4737 or Emails speech@mrfservices.ca and psych@mrfservices.ca.

At Moss, Rowden, Freigang & Associates, children, family members and teachers can receive a full range of services provided by a team of qualified personnel. Specific services offered by the organization include consultation services, assessment services, psychological services, speech and language services, Autism Spectrum Disorders services and remediation/coaching programs. Of more importance, the organization is equipped with professionals from multi-disciplinary areas hence better placed to handle individual needs of particular patients.

Referral system at Moss, Rowden, Freigang & Associates is simple to facilitate efficient service delivery. The organization accepts personal referrals, referrals from family physicians and other professionals, including teachers. Interested people can book for appointments online by sending Emails to the respective departments. In addition, appointments can be organized following a direct call to the organization, using the above contacts.

Self-Reflection

The topic of Selective Mutism in children is of interest to me as a teacher trainee. After carrying out informed research on the topic, I have learned several aspects about Selective Mutism, which I was not aware of. For example, I have learned that Selective Mutism is a disorder that requires close attention from teachers and parents. In particular, I have learned that teachers are best placed to help the affected children to overcome the condition. Moreover, the topic has also enabled me to learn behavioral characteristics of young children in different social settings.

Research information obtained from this topic is valuable in informing my teaching practice. In particular, the information about adaptation strategies in dealing with Selective Mutism is useful in developing sound approaches in teaching practice. For example, the information about classroom programming and routines is essential in improving the quality of education services offered to kindergarten children. In addition, information relating to the adaptations by use of social interactions and relationships is essential for enabling teachers to identify fruitful associations among children.

Although I had prior knowledge about selective mutism, I was surprised by the research results on this topic. In particular, I had not imagined that selective mutism requires intensive and well-programed approaches to enable affected children to overcome. In addition, I was surprised that the disorder requires intervention using multi-disciplinary approach, where professional from different areas of expertise are involved, for effective intervention.

Consequently, the research results on selective mutism have changed my initial assumptions about the disorder. Prior to the research, I had assumed that the condition is mainly contributed by personal decisions of the affected children. In addition, I had presumed that approached such as forcing the affected children to get involved in social activities would help them to overcome the condition. However, it is evident that coordinated strategies are invaluable for successful interventions.

Based on my hypothesis for the research, I would recommend that a section explaining ‘what does not work’ to be include. Considering that selective mutism is a rare condition, many people are not aware of the appropriate measure to help the affected children. In addition, many people do not understand the principle causes of selective mutism and may consider using methods that do not work for the condition. Therefore, researching on what ‘does not work’ would help the readers to understand why some approaches are deemed inappropriate for use when handling children with selective mutism disorder.

In conclusion, selective mutism is a rear disorder among children. Research indicates that the disorder affects more girls compared to boys. Of more concern is that the disorder negatively impacts the learning and social development of the affected children. It is, therefore, important for teachers and parents to implement adaptation strategies enable affected children to overcome the condition quickly. In addition, it is important for Early Childhood Educators to monitor affected children carefully in order to devise appropriate methods for school-adaptation. Because of the adverse impacts caused by selective mutism in the society, several agencies, such as the SickKids Hospital and the Moss, Rowden, Freigang & Associates, have been established to provide expertise-solution to the problem.

References

Bergman, R. L. (2012). Treatment for Children with Selective Mutism: An Integrative Behavioral Approach. Oxford: Oxford University Press

Cardiff University. (2009). Too Anxious to Speak? The Implications of Current Research into Selective Mutism for Educational Psychology Practice. Educational Psychology in Practice, 25, 233-246. Retrieved from http://psychdemo.cf.ac.uk/docs/dedpsy_topup/Cleave.pdf

Centre for Excellence and Outcomes in Children and Young People’s Services (C4EO). (2011). Effective Classroom Strategies For Closing The Gap In Educational Achievement For Children And Young People Living In Poverty, Including White Working-Class Boys. Retrieved from http://archive.c4eo.org.uk/themes/schools/classroomstrategies/files/classroom_strategies_research_review.pdf

Child Mind Institute. (2014). Selective Mutism. Retrieved from http://www.childmind.org/en/health/disorder-guide/selective-mutism

First, M. B., & Tasman, A. (2011). Clinical Guide to the Diagnosis and Treatment of Mental Disorders. Hoboken: John Wiley & Sons.

Kearney, C. A. (2010). Helping Children With Selective Mutism And Their Parents: A Guide For School-Based Professionals. Oxford: Oxford University Press.

Selective Mutism Anxiety Research and Treatment Center. (n.d). What Is Selective Mutism? Retrieved from http://www.selectivemutismcenter.org/aboutus/whatisselectivemutism

Selective Mutism Group. (n.d). Classroom Strategies for Teachers of Classroom Strategies for Teachers of Selectively Mute Children. Retrieved from http://www.selectivemutism.org/resources/library/School%20Issues/Classroom%20Strategies%20for%20Teachers%20of%20SM%20Children.pdf

Selective Mutism Treatment and Research Centre. (n.d). How to Treat Selective Mutism: Information for parents. Retrieved from http://www.selective-mutism.org/treat1.htm

The Child Study Centre. (n.d). Selective Mutism: Causes. Retrieved from http://www.aboutourkids.org/families/disorders_treatments/az_disorder_guide/selective_mutism/causes

Wong, P. (2010). Selective Mutism: A Review of Etiology, Comorbidities, and Treatment. Psychiatry, 7(3), 23-31. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2861522/

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s


%d bloggers like this: