Foreword

I had my first experience of Selective Mutism (SM) or Elective Mutism, as it was then called 30 years ago. Early in my career as an educational psychologist I was asked to ‘see’ a little girl called Tanya who did not talk to adults in school but did whisper to a few close friends, and talked freely at home. I sat down with her in a quiet, private room and got out some blocks for her to use to copy patterns. She soon began to chat to me and over the next few weeks we were able to get her talking to teachers quite quickly, using tape recordings and the ‘sliding-in’ technique described in this book.

I still recall the feelings I and others had at the time. On my part I felt inordinate pride that this little girl had trusted me enough to talk to me, and satisfaction that my professional mystique as a so-called expert had been confirmed to the school’s headteacher (of whom I was somewhat scared). On the part of the child’s teacher, there were complicated feelings of frustration, rejection and even anger at a child who confounded reasonable everyday expectations around communication in the classroom.

In our adult lives, we often experience silence as a weapon, and communication through speech as a gift bestowed. So it was easy at that time for SM to be seen as a deliberate choice made by stubborn children. Fortunately, we have moved on from that now and are able to identify SM for what it is – a particularly disabling form of anxiety.

We have moved on in practice, too, with wider knowledge of how to treat that anxiety and enable children and young people to escape from an identity as a non-speaker in school that often entraps them for years. Much of the credit for these improvements lies with the Selective Mutism Information & Research Association (SMIRA), whose founders and supporters have worked so hard to produce this book.

It is a uniquely helpful book, representing as it does the voices of children, young people and families as well as the voices of professionals. It is full of the vivid stories of individuals, which bring home to us what it is like to experience terror on a daily basis, and the social isolation that can follow. It illustrates the power of small voluntary organizations, such as SMIRA, which bring families, carers and professionals together to share their knowledge and expertise.

The book provides remarkable historical insights: SM acts as a paradigm for developments in psychology over the past 50 years, from psychodynamic to behaviourist to ecological to cognitive behaviourist to neurolinguistic programming theories, and these are well represented in the text.

Finally, and not least, the book provides practical guidance on treatment, highlighting, for example, how advances in technology, such as being able to use a mobile device to film a child talking at home and show this in school, are radically changing approaches to early intervention.

I particularly welcome the book’s very useful accounts of the way different agencies are developing agreed, shared pathways for early identification, assessment and action. This multi-agency approach seems to me the core of what is needed. SM challenges professional boundaries. Is a child not speaking because he or she is learning English as an additional language and is in the ‘silent’ phase? Might the silence indicate secrets that the child has been told to hide? Has the child a specific language impairment, or mental health issues? Is the classroom environment one that makes children feel comfortable?

Answering these questions requires a range of specialist expertise, variously located in educational psychology, ethnic minority achievement, child and adolescent mental health, social work and speech and language therapy services. Yet the potential for children to fall between the cracks of different services is enormous. And at a time when budgets are stretched, the temptation is for services to pass the buck, each saying that meeting speech, language and communication needs is someone else’s job.

One of my major roles as the government’s Communication Champion for Children between 2009 and 2011 was to meet with local commissioners in health, education and social care to communicate the effects on children of this buck-passing, and encourage them to pool budgets and commission integrated pathways of care for all children and young people with speech, language and communication needs.

We are still a long, long way from seeing that happen across the country. Where joint commissioning happens, it is likely to be only for a small minority of children with the most complex special educational needs. Yet SM tends not to fall into that category. What these children need is not an elaborate bureaucratic assessment that takes six months or more. They need a rapid response from a professional with appropriate skills, who might be an educational psychologist or a speech and language therapist, follows an agreed local pathway of care and is able to call on professionals from other backgrounds as needed, while remaining the key-worker for the family and school.

The assessment and treatment of SM, then, provides a paradigm not only for how psychology has developed but also for what we need to do for children with all kinds of speech, language and communication needs. Children suffer when we do not know what box to put them in. They need teachers, therapists, mental health professionals and social workers who work together to transcend professional boundaries, and who see parents or carers as equal partners throughout.

I should not have had to respond to that referral on my own 30 years ago. I should have been able to seek advice from a range of experts. Luckily, in a case where the difficulties were not severe or entrenched, it was possible to find solutions. But I, and more importantly Tanya, might not have been so lucky. These things are too important to leave to chance.

This book represents a major step forward in improving joined-up services for children with SM. I hope it will be read by commissioners, parents, carers and practitioners everywhere.

Jean Gross, CBE, January 2014