CHAPTER 9
Successful Approaches to
Selective Mutism in School
and Community Settings
As explained in Chapters 1 and 2, some ‘predisposing factors’ for Selective Mutism (SM) (such as children’s temperament) and ‘precipitating factors’ (such as fright on entering nursery) are hard to avoid, but what have been called ‘maintaining factors’ such as the attitudes and behaviour of people around the children can be altered to good effect. Some of the ways in which SM has been successfully challenged will be explored in this chapter.
Using a Play Interaction approach to help children with SM
Our first example has been provided by Jyoti Sharma, a play interaction specialist working in the Leicester City Autism Outreach Service. Fortunately, she and her colleagues are encouraged to provide assistance to some SM children who do not have a diagnosis of autism, but who fail to communicate at school. Notable features of this team’s approach are the absence of criticism of the children and a gentle use of humour, non-verbal support and low-level technological assistance.
Introduction
The Play Interaction Programme has been running for over ten years, working with a wide range of children and young people with SEN (Special Educational Needs), including those with autism, ADHD, sensory impairments and social/emotional difficulties.
In my work as a Play Interaction Specialist I have found this approach to be effective for children described as having SM, enabling them to become more confident and comfortable with social interaction and communication in school.
What is Play Interaction?
The Play Interaction Programme is a bespoke Leicester City training programme for teaching assistants within primary schools. It incorporates a range of interactive strategies to help develop children’s social interaction and communication skills through a play-based approach, drawing on techniques used in approaches such as drama, art work, ‘Treatment and Education of Autistic and related Communication Handicapped Children’ (TEACCH) (Schopler 1997), Intensive Interaction (Nind and Hewett 1994/1996/2001), Music Interaction (Prevezer 1990) and Laban Movement (Preston-Dunlop 1998).
The Play Interaction Programme began in 2000. Its goal was to train staff in school to meet the needs of pupils with social communication and interaction difficulties. Over these ten years the programme has been consolidated into a taught package and manual. Follow-up support is provided to schools that have accessed the full training. This includes opportunities for staff to share ideas and information through networks and briefings.
The Programme and structure of sessions
To initiate training in the Play Interaction Programme, schools have to apply via a member of the Special Needs Teaching Service. The application request includes the needs of a ‘target child’ and any interventions currently being used to meet that child’s needs. The Programme is designed to meet the needs of that particular child, although a parallel aim is to cascade the broader skills of how to teach/support social communication and interaction via the ‘target child’s’ programme.
Initially a meeting is held with the parent/carer, the school and any other key adults. This is a fact-finding meeting to ascertain the child’s strengths and interests, as well as their needs. From this meeting and an observation of the child, a programme is written based on the format in our Play Interaction Manual.
The sessions ideally take place in a distraction-free room, once a week for approximately 30 to 45 minutes for up to ten weeks. The programme is then reviewed with parents/carers and school staff members.
Each session is structured and planned according to the needs of the child. Visual structure and communication support is used, for example: a visual timetable, choice boards, ‘Yes’ and ‘No’ cards and communication symbols. These visual cues help the individual child to reduce levels of anxiety and enable them to know what is expected in the session.
A session usually starts with a ‘Meet and Greet’ activity. This is then followed by two play activities and then a choice of activity as a reward. It ends with a ‘Goodbye’ activity. The programme is initially child-centred, consisting of the adult following the child’s lead through imitating the child’s actions and sharing the child’s interests. This often includes the child’s playing or engaging in his or her favoured activities a number of times before adult-directed activities are introduced. Once the child is ready, familiar peers are invited in as sociable buddies. This is done with the child’s permission. When appropriate, the sessions are generalized with familiar people/peers in other social settings – for example, in the corridor, in the playground and classroom. It should be noted that all of this is done at the child’s pace.
Case study
When Nina (not her real name) was referred to me for Play Interaction I had been running the programme successfully for ten years but had little experience of working with pupils with SM. I recognized that I would need to rapidly increase my own awareness and understanding of SM. I turned to the following books: Silent Children by Rosemary Sage and Alice Sluckin (2004) and The Selective Mutism Resource Manual by Maggie Johnson and Alison Wintgens (2001). At the time of intervention Nina was eight years old and in Year 5 in a mainstream city primary school. I observed her in the classroom. She did not speak to her peers or adults. She responded to the questions of others by using hand gestures and facial expressions. However, when playing in the playground I heard her speak to one of her peers, but when I moved closer to her she stopped talking. Nina’s mother reported that at home she spoke to her family members in clear Gujarati sentences and was able to understand complex language. She was described as a ‘chatterbox’ at home. School reported that they had long-standing concerns about Nina not speaking to adults and her peers in the classroom. For instance, she would not respond to her name during registration time.
SESSION 1
A couple of days after my observation, I collected Nina from the classroom. She lowered her head and walked stiffly with me to the room. When we got to the room I greeted her and explained that I would be coming to play some games with her. She did not make any eye contact with me.
I used this session to try to form a trusting relationship with Nina. I understood that SM children become very anxious in social situations. In order to help reduce her anxieties I showed her a list of printed activities on the wipe board that we were going to do together, a lot of which involved her making a choice. She agreed to mark a tick next to each printed activity as she completed it. This visual structure was used in the hope of reducing her anxieties within the session, enabling her to know what was expected and how long the session would last.
During ‘Meet and Greet’ I showed her some emotion picture cards: ‘Happy’, ‘Sad’ and ‘Angry’. I pointed to the ‘Happy’ picture card to express how I was feeling today. When I asked how she was feeling, she also pointed to the ‘Happy’ picture card but her facial expression did not display this emotion.
I gave Nina the opportunity to choose a game to play from a choice of two games. She made no response to make her choice known to me. In the end I chose ‘Stack ’em Up’ and she nodded her head when I asked for her approval.
To see how she would respond to me I made some deliberate mistakes. I called her by a different name, and she smiled at this. I then deliberately took her turn in the game; she looked at me and giggled.
In order to discover Nina’s interests, I drew on a piece of paper a spider web of things she might like to play and she wrote down ‘colouring’ and ‘hide and seek’. She later chose to do a drawing of a butterfly; I also drew a butterfly on my piece of paper alongside her. I praised her drawing and during this process I commented on the things that I like to do and asked her if she also liked doing the same. She responded to the questions by pointing to the ‘Yes’ and ‘No’ cards, which were placed on the table.
SESSION 2
Nina’s responses in the next session were the same as in Session 1. Again she chose to do a drawing of a butterfly. I asked her if she wanted to invite a friend in the next session. She nodded her head and then wrote her friend’s name down on the wipe board. She chose the friend she spoke to in the playground. She made brief eye contact with me and smiled when I agreed to this.
SESSION 3
When having her peer in the session, Nina’s body posture appeared very relaxed and not stiff as noted in the previous sessions. She was given the written checklist in order to show her peer what we were going to play in the session. During the ‘Meet and Greet’ slot in the session, when focusing on feelings Nina surprised me when she whispered ‘I am happy’ in her peer’s ear in response to her peer’s question ‘How are you feeling today?’
She actively participated in the miming game ‘Change the Stick’ (a game consisting of a person pretending the stick to be something else by using mimes and others having to guess what it may be). She used mimes to pretend the stick was a spoon and later a lipstick. I heard her laugh for the first time at her peer when she got her answer wrong in the game.
Nina later made some ‘h’ sounds when using the BIGmack (a voice recording device) and enjoyed playing it back. She began to write and draw her responses on a piece of paper. She later managed to do the same within the classroom. In addition, she used the ‘Yes’ and ‘No’ cards in response to being asked closed questions. She was sometimes heard to whisper her answers in a friend’s ear.
SESSIONS 4 AND 5
In session 4, we made sound conversation on the mobile phones and on the BIGmack. She enjoyed going out of the room with her peer and listening to a message being recorded on the device. They then brought it back into the room and played it back to me. I had to guess whose voice it was and sometimes I deliberately made a wrong guess. This made her laugh and she pointed to the ‘No’ card. On another occasion the two girls went out of the room to record a voice; they later came back and played the voice to me. To my surprise it was Nina’s voice being recorded! She recorded a quiet ‘Hello’ for me to hear. At this point she pointed to herself and smiled. I was truly amazed at this breakthrough! She actually wanted me to hear her voice! In session 5 she said ‘Hello’ to me on the phone.
SESSIONS 6 AND 7
I asked Nina if she would like to hear my friend say ‘Hello’ on the mobile. She made a sound, which I took as a ‘Yes’. At this point a new adult said ‘Hello’ to her on the mobile from outside of the room. To my surprise she said ‘Hello’ back to the adult. This adult was gradually introduced into the session, though initially from a distance and not engaging in the games.
The girls later engaged in the same miming activity; during this time the adult moved closer to the girls while they engaged in pretend play. Nina began to give one-word responses to identify what the person was pretending the stick to be. She gave quick glances at the adult coming closer; fortunately, this did not faze her. In session 7 she was able to continue engaging and using single-word responses while the adult was sitting within the group.
SESSIONS 8 TO 10
In session 8 Nina took control of the written activities checklist, reading them out to the others. I nearly fell off my chair with surprise!
When it was her turn to share her feelings during the ‘Meet and Greet’ in the session, she pointed to the angry emotion picture card and said, ‘I’m angry because you were late to bring me here!’ When her peer asked her about her weekend, she replied, ‘It was a normal day.’
Later, when someone shouted out the answer in one of the games, she said, ‘Put your hand up.’
When playing with the puppets, she progressed from just handling the puppets to gradually making some quiet sounds for the puppets and then to eventually saying, ‘The little boy (boy puppet) can be the doctor in the story.’ She put on a voice for the puppet as she handled it. She said, ‘I am the doctor, now what can I do for you?’
When doing a shared drawing with the others, she went from just quietly drawing butterflies and making patterns to answering my question about what she was drawing. She said, ‘It’s a butterfly, a happy one because it is colourful and has stripes.’
At this point two more of her chosen friends were invited in the session. We played the game ‘I went to the shop and bought a…’. On her turn she said, ‘I went to the shop and bought my brother’ and then she laughed.
I later explained to the children that we were going to play our miming pretend game in the communal hall because someone else needed to use the room. When carrying out the same activity in another setting, to my surprise Nina continued talking to her peers and adults while other people were passing by her. This was a considerable step forward for her.
In session 10 Nina began to interrupt others talking and at this point we had to introduce the visual group rules for listening and taking turns when others were speaking!
MEMBERS OF STAFF REPORT ON NINA’S FOLLOW-UP PROGRESS
The teacher reported that since the programme Nina was beginning to answer to her name being called out during registration time; she used a normal volume of speech. The teacher also heard her speak to other members of staff on duty in the playground; she initiated a conversation with a variety of adults and peers. On one occasion she commented on how she didn’t have anything spotty to wear for ‘Children in Need day’.
I carried out a follow-up meeting with the SEN teacher on 21 May 2013 to find out whether Nina had continued to speak. The teacher said, ‘We are delighted with the change in Nina. I teach her on Wednesdays so I have been able to witness it firsthand, which has been great. She continues to talk to her peers and to adults. In fact I joked with her the other day when I was on dinner duty – there was such a noise over the general noise of lunchtime that I turned round to ask the culprit to be quieter, and it was Nina. I did say to myself that I never thought I would be asking her to make less noise. Nina laughed with me. Nina takes part in class discussions and puts her hand up to make useful contributions, she really is a part of everything now. In terms of social interaction she really is one of the girls who has got a good group of friends. She is doing well academically. She makes significant contributions in group work; even when she is working with a very confident, strong-minded friend who could easily overshadow her.’
Further follow-up, however, revealed a different story. After a full term in her new secondary school, although Nina had been observed speaking briefly to peers in the playground, she had not spoken to a single member of staff. Ongoing support and preparation for her transfer had clearly been needed. Fortunately, it will now be possible to brief the senior school staff about SM and undertake some more work with Nina herself.
Snapshots of two other case studies
I implemented the same visual structure and communication support within the sessions with two other children. At the time of intervention Josh (not his real name) was aged eight and was in a Year 3 class in a mainstream primary school. Members of school staff reported long-standing concerns about him not speaking in school. However, his parents reported that he spoke fluently and confidently in the home setting with all his family members in English. It took over eight sessions for Josh to start speaking with two peers and three adults during the sessions. He responded to adults sharing his interest in football. Opportunities were given to him to be in charge of the written activities checklist. He relaxed and laughed when I teased him when hiding the ball. He found it funny that I needed reminders to kick the ball and not hold it in my arms when playing football; this enabled him to use some gestures and later one-word responses to correct my deliberate mistakes when playing the game.
He progressed from making sounds in an echoing microphone and voice recorder to saying single words and short phrases to using sentences. The class teacher and the TA (teaching assistant) both reported that he is now using a normal volume and tone of voice within the classroom. He has also put up his hand to volunteer to engage in role-playing in the Christmas Play. During the session he said, ‘I’m happy because I’m here to play.’ I recall him in the initial sessions having been reluctant and shy when trying out new activities but during the later sessions in the programme his confidence grew.
I also worked with Neha (not her real name) who was in Year 1 in mainstream primary school. Her teacher reported that she had not heard Neha speak at all. The teacher reported how difficult it was to assess Neha’s ability levels in different areas of learning as she did not share her thoughts and views and she would not read aloud. It was also reported that Neha did not participate in the play of others. However, her parents reported that she spoke fluently in Gujarati and in English in the home setting with her family members. During my intervention a significant turning point was noted when Neha recorded her own voice on her father’s mobile at home while reading a storybook to her dolls (this was a suggestion that I had made to her parent). The parent shared the voice recording with the class teacher in front of Neha. The teacher praised and rewarded Neha for good reading and said what a delight it was to hear her voice. The parent mentioned that Neha had asked him to record her voice again while she read a story to her dolls so that the teacher could hear her voice on the recorder again. This demonstrated that Neha wanted the teacher to hear her voice.
Conclusion
The Play Interaction approach provided the children with a relaxed, fun and motivating environment, free from direct demands or pressures to speak. Using individual children’s interests such as football and drawing enabled me to build a trusting relationship with them. I was able to present myself as an equal play buddy. The sessions provided the individual children with opportunities to relate to others in their own time and at their own pace.
I found that incorporating a sense of humour and making deliberate mistakes enabled the children to take on a lead role in order to correct my mistakes. This technique helped boost self-confidence and self-esteem. The gradual inviting of the target child’s peers and adults was similar to the ‘sliding-in’ and the ‘fading-in’ techniques (Johnson and Wintgens 2001). Using activities such as ‘When I went to the shop…’ reflected ‘The Talking Circle’ approach used in the SM manual (Johnson and Wintgens 2001).
Crucially, several factors within the sessions successfully helped reduce anxiety levels in the children. These included the use of visual structures, playfulness and humour, and non-directive play approaches using puppets and toys of particular interest to the children.
According to Sage and Sluckin (2004), ‘the most common reason for a child’s failure to speak is said to be anxiety’ (p.7).
Working with a young man to promote social development and employment
Next, we hear from Jane Kay who is employed as a ‘Connections’ worker to ensure that young people do not disappear into permanent exclusion from society. At the time of publication this service still exists, though with reduced funding and a reduction in what appears to have been a fairly generous time allocation.
Again, the approach involves a trusting relationship, non-verbal support and incorporation of technology.
During the time of this case study I was employed as a Connexions Personal Adviser working intensively with young people who had multiple barriers preventing them from entering employment, education or training. My aim was to support young people by helping them work through their issues and eventually move into training, work or education.
I first met William (not his real name) when he was 18 and due to leave school in the summer of 2002. He was referred to me by a Personal Adviser who specialized in Careers Guidance. He did not speak at school, apart from the odd word to one member of staff. He comes from a large family but spoke very little at home and only to his mother and very young brother. He had stayed on at school as there wasn’t really an alternative for him at the time, but had spent most of his time working alone in a resource room. Our first meeting took place in school just after Easter of that year. William nodded and shook his head appropriately in answer to questions I asked him. I had gathered as much information as I could about him from the referring Personal Adviser, his mother and the special educational needs teacher at school. From this I learnt that he was interested in computers and reading; from questioning William himself, I found out that he held a provisional driver’s licence but had not had any lessons. I was aware of his capabilities from the school statements and also noticed fairly soon that William had an excellent sense of humour.
As a first step, I took my laptop into school along with a CD-ROM which replicates the theory driving test. We managed to undertake this test by me reading out the text from the screen and William nodding at the answer he felt was correct. From this we gathered that William was more than ready to take to the roads, but I myself, who had been driving for over 25 years, should be banished from them immediately!
When the end of term came and he left school, William agreed that I could come to visit him at his home. I didn’t want him to get used to the idea that we would use this as the permanent venue for our meetings so, as it was summer, came up with the idea of walking around the block near his home. After a couple of weeks doing this, as I left him and turned to say ‘Goodbye’, he replied ‘Bye’ back to me! After a while of this routine I suggested that he come with me to look at a local Learning Centre where they offered computer courses. I thought this environment would be ideal as it was small with very welcoming and friendly staff. William agreed to undertake a BBC Webwise Programme at the learning centre. I sat at the next computer to William working on my own projects and helping him as necessary. William’s mother told me that whilst he was at school he had brought books home regularly from their library, so with William’s approval we went by taxi to register him at his local library and from then on made a weekly trip to select his books. Initially, I would choose the books, but eventually he took an active part in looking and selecting them for himself. He also became confident enough to go to the counter to bring them back and get the new ones stamped.
Although we had no proper means of communication, we developed our own way around this. William would nod and shake his head, and his range of facial expressions told me a great deal too. I also developed an idea of five ‘smiley faces’ in a row on a piece of paper. They ranged from downright sad up to really happy. If I wanted to know how strongly he felt for or against something, I pointed to the faces one at a time and he would nod when I was near the face that reflected how he felt. William sailed through the Webwise Programme, so we looked for another course he could study at the Learning Centre.
We had a couple of false starts on courses which turned out to be wrong for William. However, eventually we managed to secure a distance learning CLAIT (computer literacy and information technology) course from a local college using the facilities at the local Learning Centre once more. Again there were difficulties, but William persevered and succeeded in passing the whole course, which was an excellent achievement.
At the end of each term we went out on trips to celebrate the achievements of the past months. The first one was to a local bowling alley in a town a short train ride away. William was very anxious at first, but equally determined that he was going to take an active part in the activity. Eventually, after about 45 minutes of encouragement he bowled the first ball. After this it was plain sailing, even after a group of his peers came to a nearby lane. On the train home he sat by himself and offered the ticket to the attendant himself. We have also visited local museums and always travelled by public transport.
I suggested one week that we could go to a local café to have a drink. William agreed to this but did not want to actually have anything when we got there. After this I asked him if he wanted to go back the next week and he confirmed that he did. The following week he did get a can of Coke and drink it. Every week since then we have done this and William seems to enjoy it.
I was asked to trial a new type of assessment and felt that this would be ideally suited for use with William. He came to my office and I undertook this with him. It was amazing how much information I had actually already gathered from working with him, but it was also very interesting touching on areas that we had not visited before and this gave me a way in to discuss these issues. Through the assessment it was identified that, although he would like to speak to me, our relationship had now become established as a non-speaking one and this was a real barrier to moving forwards. I suggested a couple of ideas about how we could initiate communication to him that I had seen on the selectivemutism.org website but neither seemed to appeal to him. We also identified that William would like to work and eventually live independently. Because of this I put to him the idea that he could go for a psychological work assessment by the Job Centre Plus.
This assessment identified that he needed help and support with his writing skills and spelling. To be effective in the workplace he also needed to have some communication skills. The psychologist also felt a clinical assessment would be beneficial but could not find anyone who dealt with this age group in the area, nor could they find a support group. Without the above, they felt he would not be suitable for placement. I spoke to the psychologist in some detail and she felt that one area that I could look at was his spelling and communication skills. If I played Scrabble with him, getting him to spell out the letters would have a dual purpose.
I managed to find an office which was quiet and local, and initially took William to have a look round to ensure that he felt at ease. He agreed to this and arranged that the following week we would have our first game. When the time came, there was an initial hesitation, but within no time he was putting down the letters and spelling the words out without any problem. As he was so at ease, I asked him also to add up his scores, therefore also improving numeracy. Again, no problem. Therefore I then gave him the target of saying the letters, the score and the whole word – he did it once more.
Shortly after we started our weekly game of Scrabble, he arrived at the office on foot. I asked him how he had got there, ready to go through a list of possibilities which he could nod at accordingly, but he said, ‘I walked here’! From what I had read about SM I felt that I should react in a very low-key way to his speech; however, I also felt that it should be acknowledged, so later in the session I brought it into the conversation and told him I was really pleased that he had spoken. He seemed delighted that this achievement was being recognized.
Each week now brought more words into his vocabulary to the point where, when asked, he told me in a couple of complete sentences how he had injured his foot. He has started driving lessons and also regularly walks into town on his own to meet me or on occasions to take back his library books when I am on my annual leave.
I managed to find SMIRA through research one weekend on the internet and contacted them. I was given Alice Sluckin’s phone number and spoke to her about the work that I was doing with William. She suggested that I write about the time that William and I have worked together. She also suggested that we purchase the SMIRA video, which we did. It gave me the idea of having some planned responses or ‘scripts’ for William to use in everyday situations. Most of us accumulate a ‘bank’ of these responses, but people who have not been speaking in these situations do not. For example: being asked the time or directions from a stranger, or bumping into someone and knocking their shopping to the floor. I wrote out the different scenarios and asked William to tell me what his responses would be. It took a while but he did manage to come up with suitable short answers. We went over them each week until he didn’t need to think before he could respond appropriately.
William also started an Adult Education class where he is improving his writing and spelling skills. He attends once a week during the evening and works alongside other adults. This is a wonderful achievement. More recently, he passed his driving theory test and is communicating with his instructor on his driving lessons. He speaks more at home and this has led to much-improved relationships within the family.
Each week I set him small achievable targets (ones that I check are what he wants for himself) and they are usually reached. If they are not, then we look at the reason for not managing something and adapt them or make notes for future reference of what has happened. By doing this we have a wonderful record of everything he has achieved and can easily remind ourselves of the progress he has made. We can see where he was and where he is now, which gives us plenty of scope for celebration.
William has grown much more confident over the past two years. He has always been determined to move on with his life and is constantly amazing me with his progress. We have a mutual respect for each other; he knows that I will never make him do something which he doesn’t want to. I give him lots of encouragement and we always take things at his pace. When we first started working together, it seemed as if we had a mountain to climb. We are climbing that mountain one small step at a time, but now we can look down and see how far we have travelled.
It later transpired that, like some other previously SM people, William required further support at transition points in his life.
Talking in the community
Next we describe a group of three children aged 9–12 years old treated by specialist SLT Maggie Johnson.
They were clearly anxious children who had each responded well to individual support in their various primary schools but were unable to generalize their speaking beyond their one-to-one sessions. It was not until their failure to talk at school was tackled directly at a behavioural level that observable progress began, for rather than nurturing or counselling they needed a structured programme to extend their talking circle and actively manage the transition to the next year group.
Similarly, progress made was confined to the school setting and the children’s experience of talking outside their structured sessions was limited to immediate family. In order to generalize the progress they were making and continue to challenge their anxiety, they needed parental and professional support to build their confidence in wider settings. For this reason, the SLT ran group sessions in the summer holiday. The summer school comprised nine one-hour sessions of discussion, role play and real-life practice to enable them to extend their ability to talk to unfamiliar people in the community (Johnson and Wintgens 2001 and personal communication).
The importance of our own responses and attitudes when helping SM children is regularly pointed out. One of the tasks of all helpers is to allow the people who are being helped to grow away from the secure base we have provided, so as to experiment with skills and strategies of their own. The more dependent the helped person was in the beginning, the harder this can sometimes be for the helper. Overprotection is no real help.
Once SM children begin to be able to speak outside their easiest circle of contacts, it is helpful to show them how to extend the range of possible people with whom they might risk contact. The slow pace at which this process sometimes proceeds can lead us to think that more protection will be needed than is actually the case. Keeping in mind that independence is the goal, we can provide the children themselves with a method of grading the steps in their own recovery. For example, even after an initial breakthrough, children can sometimes maintain rather rigid boundaries between people and situations they see as ‘safe’ and those which still frighten them into silence. Help with constructing a detailed ladder of difficulty can be effective in making it possible for them to experiment with communicating with an ever-widening circle of contacts. Once they understand that some steps are easy, while others are quite demanding and can be left until later, they will be less vulnerable to feelings of failure and discouragement.
The Selective Mutism Resource Manual (Johnson and Wintgens 2001) provides just such a ladder (form 6; see Fig. 16.1, page 260 in this book). The detailed instructions make it clear that some tasks are at a similar level of difficulty – for example, speaking where a teacher might overhear you and speaking to an unfamiliar child – while others involve taking quite large steps – for instance, asking a policeman a question. On pages 292–294 of the Johnson and Wintgens manual, there is a detailed description of how the boy ‘D’ worked with two other children through such a graded progression toward confident speaking in their locality.
Preparing for success in advance was part of the helper’s task. Techniques were taught and the children came to trust that extremely small steps would lead to success.
Confirmation that they were ready to progress and that the therapist would be standing by and would prepare some of the people they must speak to provided a degree of safety.
Individuals in the wider community were primed to respond encouragingly and equipped with understanding of the enormity of the task from the children’s point of view. Other unobtrusive contributions from the helper were to:
•encourage the children to work as a mutually supportive but slightly competitive group
•equip them with methods of recording progress
•construct, with them, a hierarchy of easy-to-difficult challenges using form 6
•set up intermediate tasks, practice and role play in preparation for the challenges
•involve parents, friends and other contacts as temporary assistants
•provide the participants with a clear understanding of what would constitute success; for instance, some tasks could be skipped on completion of a more difficult item, but each chosen task had to be completed three times before any attempt was made to tackle anything perceived as more difficult
•secure a desirable final reward for each successful child.
As most formerly SM children find that the key to talking confidently in really unfamiliar settings is to be found in breaking down this huge achievement into a manageable number of smaller steps, the Johnson and Wintgens manual, with its detailed photocopiable lists of games and suggestions, has proved invaluable.
Working as a group became useful to these young people by bolstering their courage and motivating them to persist in the face of difficulty. They provided examples for one another, the bravest taking the lead and appearing to fill the most anxious group member with a determination not to be outdone.
Outcomes
Once a behavioural approach was combined with the necessary practice for generalization, all three students made progress.
‘D’ achieved all his practice targets and spoke to a new teacher on the first day of transfer to secondary school. He has succeeded at university and enjoys a good social life, despite having remained on the quiet side throughout secondary school.
The 12-year-old continued to view herself as SM at secondary school, but blossomed with a fresh start at college. She is now able to communicate in any setting but recognizes that the years she spent feeling isolated from her peers have taken a toll on her self-esteem.
The youngest girl, though naturally quiet and a little shy, was also brave. With a less entrenched pattern of mutism, she was able to lead the others by example, saying such things as, ‘Oh OK, I’ll do it.’ She made rapid progress and was soon discharged from therapy.
Group treatment appeared to help these students to escape from SM, as they were able to motivate and validate one another, as well as improve one another’s understanding and awareness of objectives and techniques.
A final example
Lastly, a brief, but inspiring story from Sue Johnson, a Special Educational Needs Co-ordinator (SENCO).
John (not his real name) started school in September 2002 at the age of four. He hadn’t attended a nursery school prior to mainstream school, but had been minded by his grandparents whilst his parents worked. He has a sister who is three years older than him who would, on occasion, speak for him. John refused to speak to any adult at school. He did speak to his peer group, but quickly became silent if an adult was within hearing distance. The class teacher went to see the school SENCO and discussed the problem with her and John’s parents, and he was placed on the school’s Special Educational Needs register.
There were no particular anxieties at home which could have contributed to the problem, although John’s mother had stressed very strongly to her children not to talk to strangers and wondered if she could have over-emphasized this. He was not desperately unhappy at school; he attended every day but didn’t like it very much. He did join in all of the activities but refused to speak. Both of John’s parents were worried about the situation, fearing that he would fall behind in his school work, especially with his reading.
John’s class teacher followed the advice given by SMIRA regarding involvement of parents, use of tape recorders, puppets, etc. John’s parents recorded him learning his sounds and reading his book to his mother at home, so that the school would be able to ascertain his educational progress. During this first year at school, John’s class teacher encouraged the whole class to respond to the register using non-verbal communication. One day the children would nod their heads, another day they might click their fingers or wink, clap or wave and, as this became part of the classroom routine, John eventually joined in.
By the end of the reception year John had still not spoken to his teacher or any of the other adults within school. He continued to stop talking to his friends as soon as an adult was within hearing distance, although he participated willingly in all activities. John moved into his new class along with his peers and, for the first week or two, the new teacher continued with the non-verbal responses whilst taking the register. The SENCO suggested that the class teacher should try to encourage John to vocalize, but not verbalize at this stage. So, as part of a whole-class activity linked to the literacy hour about ‘Old MacDonald’s Farm’, the children answered the register by quacking like a duck. This was so successful that the children asked if they could continue to do it the following week, but with a different animal. At this stage John still wasn’t joining in. However, in the second week, again linked to the literacy hour, the children had to hiss like a snake in answer to the register and John joined in with this voiceless response along with the other children. This was John’s fourth term at school and it was the first time any adult had heard him make a sound. The class teacher continued in this way for two or three more weeks. She challenged John gradually to read to a friend whilst she was sitting on a table behind him with her back to him, so that she could hear his reading. Gradually, she moved nearer until eventually she was able to sit next to him.
Within two weeks John was putting up his hand to contribute to the literacy hours. Just before Christmas (i.e. towards the end of his fourth term), he took part in a school assembly, speaking in front of the other children (over 400 of them). John was removed from the Special Needs register at the end of the Spring term, five terms after starting school.
John quickly caught up with his peer group and never regressed. He had lots of friends, with one special friend. He would answer questions when asked, but didn’t really volunteer answers. John is now at secondary school, which he enjoys. He works hard, is well behaved, and in a test given in Year 8 (12/13-year-olds) he achieved a reading age of four years ahead of his chronological age. He is happy to speak in front of everyone, excels at spelling and writing, and is more academic than sporty, although he does participate in sports with his friends. One of his favourite subjects is drama, which is one of his options for GCSE (General Certificate of Secondary Education). He hopes to study drama at university with a view to becoming a professional actor.