The speech-language pathologist works as part of a collaborative, interdisciplinary team consisting of the pediatrician, a psychologist or psychiatrist, the teacher(s), and the family. The speech-language pathologist will conduct a thorough parental interview , as most children who are selectively mute will not talk to the clinician. Use ProSearch to find a speech-language pathologist near you.
This interview seeks information on:
the child's symptom history, especially focusing on the onset of the behaviors. The majority of children with selective mutism do not have a sudden onset of symptoms[CHS2]
the degree to which the child is verbally and non-verbally inhibited, which mayvary from setting to setting. Parents may be asked to provide information about the child's relationships with friends or to describe how the child communicates in social situations outside of school (e.g., interacting with other children and adults on the playground or talking on the telephone).
associated problems (e.g., schizophrenia, pervasive developmental disorder) that could be contributing to the failure to speak. It is possible to rule out selective mutism if one of these are present.
the child's speech and language development, as well as current use and comprehension of language. Does the child understand what people say to him or her? Does the child understand questions and follow directions? Is the child able to find the words needed to express ideas? The parent may be asked to describe the child's speech production (i.e., pronunciation of words, quality/tone/pitch of voice, fluency of speech) to help rule out any other speech and language disabilities that could be causing or exacerbating the mutism. Current studies show that 20-30 percent of children with selective mutism have other speech and language disabilities; however, these are not the cause of the mutism. It is important to address these speech and langaugedifficulties so the child can become more comfortable with communication.
any environmental influences (i.e., learning more than one language at a time or not having adequate language stimulation) that may affect the child's comfort and confidence with the language.
family history of psychiatric (e.g., social phobia, obsessive-compulsive disorder, or other anxiety disorders) and personality (e.g., extreme shyness) diagnoses that may be predisposing the child to mutism. The clinician reviews the child's medical history to rule out physical problems (e.g., neurological delay) underlying the mutism.
The speech-language pathologist will also review educational history via academic reports, parent/teacher comments, and standardized testing. Do these reports indicate concern about the child's communication skills with peers or adults in the classroom? Are teachers concerned about the child's academic achievement? The clinician reviews the reports of any previous testing (e.g., psychological) to assess whether other diagnosed disabilities could be causing or exacerbating the mutism.
The speech-language pathologist will then conduct a speech and language evaluation. The childÂ’s anxiety level should be taken into account. Accommodations should be considered in order to evaluate the child in comfortable surroundings and with familiar people. A parent might be present to help facilitate communication. If any evaluation procedures are too anxiety provoking they should be discontinued.
The clinician interviews the child to observe the quality of verbal and non-verbal communication . This is done through informal play activities (e.g., playing together with a dollhouse and using the dolls and accessories to stimulate dialogue and social interaction). If the child is having difficulty participating in these play activities, the clinician should try another type of activitiy. Drawing may be used as a means to explore non-verbal communication skills.
Comprehension of language is evaluated using standardized tests (e.g., the child is shown a set of four pictures and is told to point to one of the pictures) and informal observation.
The parent may be asked to do structured communication activities with the child (e.g., have the child retell the plot of a story or describe a picture) to create an informative videotape. The parent may also be asked to provide a videotape of the child's speech at home during regular conversation. These samples enable the speech-language pathologist to evaluate expressive language abilities (word knowledge, use of grammar, ability to sequence a set of ideas, social communication skills). The speech-language pathologist may attempt to conduct an oral-motor examination to evaluate the strength and coordination of the muscles in the child's lips, jaw, and tongue. Muscle weakness or incoordination may signify a neurological impairment that is may lead to a diagnosis other than selective mutism.
Screening test for hearing and middle ear function should also be part of the evaluation.