Once upon a time, there was a girl named Susie.

This is Susie.

Susie is 6 years old.

Her favorite color is lime green.

Her favorite doll is Josephina, one of the newest and coolest American girl dolls.

Susie wants to be a ballerina when she grows up.

This is Susie’s little sister Olivia.

Sometimes, Olivia makes her mad, but most of the time Susie loves being a big sister.

Susie and Olivia love to watch the Fresh Beat Band and the Wiggles early Saturday mornings.

(Mom and Dad like that too)

Right now, Susie is teaching Olivia how to tie her shoes. She is so proud of her!

Susie is in first grade at Willowbrook Elementary school.

Her favorite activity is recess.

These are her classmates.

On the right is her best friend, Annabelle.

This is Susie’s teacher, Ms. Honey.

Susie likes Ms. Honey because she gives good hugs and has a jar of lollipops for Superstars of the Week!

She also lets someone take Bunny, the class hamster, home every weekend!

At home, Susie is a chatterbox!

When she goes to Ms. Honey’s class,

she doesn’t know why…

but she can’t speak.

Her classmates don’t understand.

Ms. Honey is frustrated.

Even Susie doesn’t know what to do.

Why is Susie refusing to talk?

She’s not.

Susie has Selective

Mutism.

This means Susie wants to speak at school,but sometimes, she just can’t.

Selective MutismThe current edition, DSM-IV-TR (APA, 2000) states that the following criteria must be met in order to qualify for a diagnosis of selective mutism:

• An inability to speak in at least one specific social situation where speaking is expected (e.g., at school) despite speaking in other situations (e.g., at home);

• The disturbance has interfered with educational or occupational achievement or with social communication;

• The duration of the selective mutism is at least one month and is not limited to the first month of school;

• The inability to speak is not due to to a lack of knowledge of or discomfort with the primary language required in the social situation;

• and, The disturbance cannot better be accounted for by a communication disorder (e.g. stuttering) and does not occur exclusively during the course of a pervasive developmental disorder, schizophrenia or other psychotic disorder.

Did you know?...

Up until the 1994 DSM-IV edition, Selective Mutism (SM) was called elective mutism because it was defined as a refusal to speak

Now it is recognized as a failure to speak.

SM is often co-diagnosed with an anxiety disorder such as social phobia

How common is SM?

This is rare!

Less than 1% of individuals coming into mental health settings present with SM*

*As a newly defined and stigmatized disorder, the prevalence of SM in the population is likely greater than this statistic indicates.

Who has SM?

More females than males

Usually diagnosed before the age of 5

These children often have normal communication and language skills

What’s the difference?

While some children have difficulty speaking in social situations, this is not the same as SM

SM is NOT…• Children who are reluctant to speak in the first

month of school• Immigrant children who aren’t confident in

their English

SM should be distinguished from…

Phonological disordersExpressive language disorder

Mixed receptive expressive language disorder

Stuttering

Lack of knowledge of the language

Pervasive developmental disorders

Schizophrenia

Other psychotic disorders

Severe mental retardation

Susie and other children with SM often have these behaviors…

Avoiding eye contactLack of facial expressionFidgeting

Will Susie have SM forever?

The disturbance usually lasts a few months, but it can last up to several years

What will Susie’s doctor do to help?

Susie goes to see Dr. Smith, a psychologist, on Tuesday afternoons.

Susie, Mom, and Dr. Smith spend time talking together. Last week he brought in another psychologist that Susie hadn’t met before.

Dr. Smith wants Susie to be able to continue talking even when someone she isn’t comfortable with is in the room.

This is called stimulus fading.

Dr. Smith rewards Susie for trying to talk, even if words don’t come out.

Sometimes she makes gestures, whispers, or mouths words.

Rewarding Susie for this progress is called shaping.

Susie and Dr. Smith watch videos of herself speaking at home where she feels comfortable.

This builds her confidence for speaking in scary places like school.

This is called self-modeling.

What do nurses do to help children like Susie?

Form trusting relationships

Decrease anxiety by creating a calm, safe environment for communication

Provide positive reinforcement for efforts to communicate

What about at school?

What can Ms. Honey do to help?

• Encourage communication

• Form small groups within the class because they are less intimidating

• Start off having Susie communicate with nonverbal symbols or cards, until she is more comfortable using words

Susie is now 7 years old. Her favorite color is still lime green.

Her favorite doll is still Josephina and she still wants to be a ballerina when she grows up.

Olivia knows how to tie her shoes now. The sisters are too cool to watch the Wiggles, but they still love the Fresh Beat Band.

Susie is now in the second grade at Willowbrook Elementary school.

This year, her teacher is Ms. Eller.

Susie is still a chatterbox at home.

And now, she isn’t afraid to speak up in class!

Tomorrow, Susie is going to a birthday party for one of her new friends…

And she can’t wait.

The end.

Credits

• Presentation created by Betsy Hauer, Kristin Jasek, and Liz Williams, Duke University School of Nursing.

• Music credit: “We’re Going on a Holiday,” Les Enfants

• All images retrieved from Google Images.• Information retrieved from:

www.asha.org/public/speech/disorders/selectivemutism.htmwww.selectivemutismfoundation.org