The Selective Mutism Resource Manual: 2nd Edition (Online Library Resources) [Spiral-bound ed.] 1909301337, 9781909301337

Citation preview

Online resource library

PART 5

ONLINE RESOURCE LIBRARY

339

Appendices Appendix A  Activities to develop confident talking

343

Appendix B  Establishing speech using telephone, lone talking and shaping programmes

379

Appendix C  Examples of programme targets, recording systems and individual education plans

395

Appendix D  Educational, legal and professional support

413

Appendix E  Evidence base and references for The Selective Mutism Resource Manual (second edition)

429

Appendix F  Resources and useful contacts

445

Handouts 1

Talking to the child about speech anxiety – ‘the pep talk’

453

2

What is selective mutism?

454

3

Quiet child or selective mutism?

456

4

What to say when …

458

5

Selective mutism is a phobia

460

6

Firm foundations: building confidence, courage and self-esteem 

461

7

Helping children to cope with anxiety

464

8

Mistaeks happen …!

468

9

Helping young children to speak at school 

470

10a Ensuring an anxiety-free environment for children who have selective mutism 

473

10b Ensuring an anxiety-free environment for young people who have selective mutism

476

11

479

Enabling quieter students to communicate

12 Do I answer for my child?

481

13

Easing in friends and relatives

483

14

Talking in public places

488

15

The informal Sliding-in Technique

493

16

The Sliding-in Technique

495

17

The Sliding-in Technique using telephone handsets

501

18

The reading route

503

Online resource library

CONTENTS

341

Booklet for Teenagers and Adults When the words won’t come out (easy-to-read A4 version)

505

When the words won’t come out (A5 print version)

513

Forms 1a

Parent interview form

519

1b

Extended parent interview form

524

2a

Primary school report form

536

2b

Secondary school report form

542

3

Record of speaking habits 

548

4

Checklist of possible maintaining factors 

549

5

Picture this …! 

551

6

Young person’s interview form

552

7

All about me

556

8a

Primary communication rating scale

557

8b

Secondary communication rating scale

558

9

Worrying thoughts 

560

10

Reactions of family/friends/staff

563

11

Selective mutism: assessment and management checklist

565

12

Environmental checklist for educational settings

567

13

Environmental checklist for home setting

569

14

Target sheet and action plan 

570

15

Talking to strangers (for older children and teenagers) 

571

16

Staff questionnaire

573

Progress charts 1

One-to-one interaction with a range of people 

575

2

Talking in public with increasing numbers of bystanders

577

3

Record of individual/group sessions

578

4

Talking to a new person using the Sliding-in Technique

579

5

Generalising speech from one-to-one interactions to the classroom

580

6

Record of independent social functioning and assertiveness

582

APPENDIX A

Introduction The following activities are grouped into the eight stages of one-to-one interaction (see Table 5.1 in Chapter 5). However, they can also be used as small-group or whole-class activities during the generalisation process. Select activities according to the child’s age, ability and interests, working from low- to high-risk activities (see Tables 10.6 and 10.9 in Chapter 10).

APPENDIX A

ACTIVITIES TO DEVELOP CONFIDENT TALKING

Key to medium- and high-risk activities Symbol

Type of activity

Description

E

Emotive content

All activities have familiar factual content, unless indicated by E. Emotive content raises anxiety due to unfamiliarity or uncertainty.

I

Child initiates interaction (unprompted)

The child is prompted in all activities, unless indicated by I. When it is the child’s turn to ask a question, or give an instruction, ensure that they know what to do but then wait for them to act. Only prompt with a nod and smile or say ‘Your turn’ if absolutely necessary.

SS

Semi-structured

U

Unstructured

All activities involve structured turn-taking unless indicated by SS or U. Semi-structured games do not have a fixed turn-taking sequence when played in groups, and the length of each turn is variable. Unstructured turn-taking relies heavily on calling out and spontaneous contributions to maintain balanced participation.



Eye contact

I

Physical contact

Certain games may be selected to encourage these aspects of communication.

Volume

+

Group activities

Suitable for group work at each stage, eg 6+,7+.

Key to low-risk activities Symbol

Type of activity

Description

R

Reading required

Unsuitable for poor or beginner readers.

Providing a greater sense of purpose and enjoyment Many activities from Stage 3 onwards can be improved by following each successful turn with a token or an action that leads to a pleasing end result. Eg, the child gradually fills a cardboard tube with marbles and pours them down a chute, gains a piece to add to a favourite jigsaw puzzle, or wins a plastic sword, building brick or a throw of the dice, as follows.

P

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Pop-up Pirate® by Tomy After their turn, the child is given a small plastic sword to push into a slot in the pirate’s barrel. The release mechanism is triggered at random to forcefully eject the pirate’s head. Build a tower After their turn, the child is given a building brick, cotton reel or domino tile to add to a growing tower. How high will it be before it topples over? Board games After their turn, the child throws a dice and moves their counter round the board, towards the ‘Finish’ line.

Stage 1 Helping the frozen child to relax Choose activities that are known, or are likely, to interest the child, or follow the child’s lead at first. Join in their games, expressing enjoyment and using limited commentary, rather than asking questions. If the child is still watching from the sidelines after a few sessions, the parent or someone else the child is comfortable with should be invited to help them enjoy activities in the new setting. For example:

★ play with a kitten ★ build a garage ★ make a camp or a hideaway ★ paint a picture ★ have a dolls’ tea party ★ play with jumping/popping/wind-up toys ★ do jigsaw puzzles or formboards ★ look for marbles buried in sand ★ make a necklace ★ cut out pastry shapes ★ print with stamps and stencils ★ demonstrate a computer game ★ play battery-operated or electronic games.

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Stage 2 Helping the child to relax and participate Invite the child to participate or assist in Stage 1 activities and gradually introduce more interactive activities, for example:

★ make something together (eg a greetings card, a puppet, dinosaur biscuits) ★ make a scrapbook or book called ‘My School’ ★ go on a treasure hunt ★ throw and catch a ball ★ play board games which use dice, counters or spinners ★ play ‘noughts and crosses’ (tic-tac-toe) ★ play chess, draughts (checkers) or backgammon ★ learn magic tricks. Physical movement The value of physical movement is to both help and see that the child is relaxed from head to toe. Action rhymes, music-and-movement activities and games such as ‘Simon Says’ are performance- rather than goal-orientated, and often not successful on an individual basis. It is best to use them as group activities, so that inhibited children can join in when they are confident that they will not draw too much attention to themselves. Include small movements and actions which are likely to feel more comfortable for quiet children. Also give them the opportunity to explore and try out equipment outside the main lesson.

Simon Says

2+

This classic game is best played in groups. The adult performs actions, giving a command such as ‘Touch your toes!’, ‘Stand up!’, ‘Scratch your nose!’, and so on. The children copy the adult’s actions, but only if the command is preceded with ‘Simon says …’, (eg ‘Simon says, put your hands in the air’). If any children copy actions that were not preceded with ‘Simon says …’, they are out of the game.

Follow the leader

2+

All the children line up behind the leader. The leader then moves around and all the children have to mimic the leader’s actions. Add noises to some of the actions, just in case the child who has SM feels comfortable enough to do those too.

CopycatI (only if child volunteers) 2+ The children sit in a circle. One of them is chosen as the leader while a second child (the guesser) waits outside. The child who has SM may dread being picked for either role and it should be made clear at the beginning that only those who volunteer will be chosen. The leader performs actions (the sillier the better!)

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which the others must copy, while the guesser stands in the centre of the circle and tries to spot the leader. The followers must be warned not to stare at the leader!

Stage 3 Using non-verbal and written communication The child is still under no pressure to speak, but some non-verbal communication is now required so that the session can continue. Some games involve mime which is useful as part of a shaping programme. The adult also mimes but should maintain commentary-style talk between their turns so that the sessions are not conducted in silence!

Guessing games

I,



1 Prepare two sets of pictures. Spread out one set on the table and place the other face-down in a pile. The child takes a picture from the pile. The adult has to guess what it is and points to the pictures on the table, asking, ‘Is it the duck?’, ‘Is it the tractor?’, etc. The child shakes or nods their head in response and hands over the picture to make a pair when the adult gets it right.

This is then reversed and the child guesses by pointing to the upturned pictures. If the adult nods or shakes their head without speaking, the child will need to look at them to see whether they are right or wrong. Continue until all of the cards have been paired up. With older children, the introduction of two or three maximum guesses brings an extra element of fun.

2 The child hides an object in the room. The adult guesses where it is by pointing and asking, ‘Is it in the cupboard?’, ‘Is it behind me?’, etc. The child responds by shaking their head or nodding. Older children will manage a version of ‘You’re getting warmer/colder’. As the adult moves around the room, the child can nod when they get nearer, or shake their head if getting further from the object. Some may even use their voice (Stage 5) – ‘Mmm’ (for ‘yes’) for getting warmer and ‘Uh-oh’ (for ‘no’) for getting colder.

The game is then reversed, with the child pointing or walking around the room. If the adult also nods or head shakes rather than speaks, a lot of natural eye contact will be generated.

No peeping! Prepare a set of pictures depicting various body parts. The child chooses a picture by pointing to it or holding it up so that the adult can see it. The adult has to find and point to that part of their own body with their eyes tightly shut. A few mistakes (a finger in the ear or up the nose always goes down well!) often make the child laugh for the first time. Then reverse the roles, with the adult selecting and naming a body part for the child to find.

Picture selection Prepare two sets of matching pictures. Spread out one set face-up on the table and place the other set in a pile, face-down. The adult works through the pile, one picture at a time, and describes each one. The child must find the matching picture to win the pair. Pictures can be chosen that provide an identical match (eg ‘a clown with a blue nose’) or an association (eg ‘bird’ goes with ‘nest’).

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What’s that sound? Spread out a selection of pictures. Play a series of sounds and the child identifies each one by pointing to the matching picture. Go to www.freesfx.co.uk to download free sound effects.

Memory game Spread out a selection of pictures on the table and give a clue for each one; for example, ‘This is where I go at night-time’, ‘A hamster lives in this’. The child turns each picture face-down as they solve the clue. Now repeat the clues and the child sees if they can remember where each picture is. If they turn over the right picture, they keep it; if it’s the wrong one, they give it to the adult. This really tests the adult’s memory too!

Facial expressions



Both the child and the adult have a matching set of pictures or photographs of facial expressions. The adult takes three pictures and makes each facial expression as they place the pictures face-down in a row. They repeat the sequence, pointing to each card in turn. The child selects the corresponding pictures and places them in a row, face-up, before turning over the adult’s cards to see whether they match. Note: if the child copies any expressions, it’s a bonus – don’t ask them to do it.

Letter, number or shape tracing

, 3 or 3+

Prepare a matching set of letters (eg Scrabble® tiles), numbers or simple shapes (straight line, wiggly line, circle, etc). Spread out one set on the table; put the other set in a bag. Players take it in turns to take an item from the bag, place it face-down and then trace the character on the other person’s upturned palm with their finger, while the other person shuts their eyes or looks away. Can they find the matching item? If it is too ticklish on the palm, try the back of the hand, or trace the character on the person’s back.



Choices

When offering a choice of two items, rather than inviting the child to point to the one they want, hold out each palm as you say each choice. For example, say ‘Hotdog’ (hold out your right palm) ‘or burger?’ (hold out your left palm). The child then pats your left or right palm to indicate their choice.

Guess the action

I

Two sets of matching action pictures are used, depicting people performing actions that can easily be mimed (eg sawing, cutting, washing, hammering, driving). One set is spread out face-up on the table; the other set is placed in a pile, face-down. The adult selects a picture from the face-down pile and mimes the action; the child sees how quickly they can find the matching picture in the pile. Then reverse roles. This is a big step towards real communication. At first, the child’s gestures may be very small and close to the body (just as whispering may precede speech).

Mime lotto

I

1 Only one board and one set of pictures are required. The adult gives the child the board and takes the cards, which are placed in a pile face-down on the table. One card is selected, but kept out of sight.

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The adult mimes what is on the card and the child points to the matching picture on the board in order to win the picture. Work through the pile of cards and, when the board is full, the game is reversed, with the child miming the pictures for the adult. Note: this is harder than the previous game because miming objects rather than actions requires an extra step of symbolic representation. It is a more conscious process of communicative intent. 2 The same game can be played with any two sets of matching pictures, if appropriate lotto boards are not available. This has the advantage of allowing pictures to be specially selected for their ‘mime potential’.

Complete the puzzle

I,



The picture shapes are removed from a formboard and given to the child. The adult ‘requests’ them by miming each object, and the child hands over the appropriate piece. The roles are then reversed. Any actions near the face to represent items such as food, drink, hat, spectacles or cat’s whiskers will encourage eye contact.

Build a tower

I,

, 3+

This activity works best with a group of four to six people. Each person is given items such as play bricks, cotton reels or dominoes to add to a growing tower. Older children could alternate paper cups with playing cards or stack mah-jong tiles. The adult explains that turns are not in strict rotation, so everyone needs to watch carefully to see when it is their turn to add to the tower. The adult starts by placing an item in the centre, then looks at and nods at one of the others, to indicate that it is their turn to go next. This person places an item and nods at someone else. Repeat this until the tower topples over!

Draw a person/house/car …

I,

, 3+

The adult tells the group members what they are going to draw and starts by drawing one part such as a circle for a person’s head. The adult then places the paper and pen in the centre of the group and nods at one of the others to indicate that it is their turn. That person adds another component to the drawing, replaces the paper and pen and nods at someone else. Repeat this until the drawing is complete. Note: children may not initially make eye contact when they nod in this and the previous activity. However, they will need to turn their head towards the appropriate person to make their intention clear. They will certainly need to look at the other group members’ faces to spot when it is their turn, so these are good activities for allowing eye contact to develop naturally.

Stage 4  Talking through other people At this stage, the child allows the adult to hear their voice, but is not required to speak directly to them. Voice recordings and conversations with close friends or family make a useful ‘talking bridge’. For example, the child might:

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★ record their voice and play it back to the adult ★ play a game with family members with the adult present ★ work in a pair with a classmate within earshot of the adult ★ talk in unison with another child ★ play a turn-taking game where they talk to a friend or parent, rather than the adult. Activities from Stages 6 and 7 will therefore be suitable in certain contexts, plus any of the following suggestions.

Whispering game

4+

This classic communication game must be played in a group, with the child who has SM sitting next to someone they talk to freely in private. Sentences or messages are written on cards. The adult selects a card and whispers the message to the child next to them. The message is passed round the group until it reaches the last child who says the message aloud. This is compared with the original message to see whether it has been distorted, often with amusing results! Different children can take it in turns to start off the game.

Four corners

4+

This is the whispering game without the whispering. A child stands in each corner of the hall or playground and runs on to the next child to pass the message on. This can be presented as a memory rather than a talking game, but make it clear that there is no need to whisper.

Chanting in unison with peers

4+

Ask the group, including the child who has SM, to say any of the following in unison.

★ Number sequences: counting up in multiples of one, two, five or ten. ★ Days of the week ★ Months of the year ★ Letters of the alphabet ★ Rhymes and songs ★ Repeated lines from familiar stories Voice recordings Suitable recording devices for the next two activities include Talking Tins, Talking Postcards and Language Master® cards (see Appendix F, ‘Talking resources’). The third activity needs just one device, so a tape recorder, smartphone, tablet or computer could also be used.

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Talking hide-and-seek Hide one of the child’s favourite toys and play a series of recorded clues that lead to it by telling the child where to go next. For example:

★ Look in the garden shed. ★ Go to the smallest room in the house. ★ Look under your bed. Then it is the child’s turn to hide the toy and set some clues for you!

Treasure hunts The adult records a series of simple clues. The child listens to the first clue and records the answer without the adult present. If correct, the child and the adult go to that place and find another clue. This is repeated until a prize is found. This is a good activity for talking in different places. For example:

★ This room is where we have lunch. ★ Where do I keep the stars? ★ What’s our class hamster called? ★ What colour is your games bag? To make it even simpler, the adult can record statements that the child has to respond to by recording ‘Yes’ or ‘No’, or ‘True’ or ‘False’. For example:

★ We have lunch in the classroom. ★ The stars are kept in the drawer. ★ Our hamster is called George. ★ Your games bag is red. Beat the clock The child hides one to five objects around the room and records the places to look. The adult then listens to the recording and has one minute to find them.

Turn-taking games with an existing talking partner

4+

Single-word Stage 6 games are played in strict rotation, so that the child who has SM only needs to talk to their parent or a friend, and is not required to respond directly to the new adult. Suitable activities include ‘Pairs’, ‘Association Pairs’ and ‘Letter, number or shape tracing’. When the child can speak comfortably to their parent or friend, the order is reversed, so that they address the new adult. They may not make eye contact with the new adult at this stage but don’t request this –

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wait to see if it develops naturally. When the child’s talking partner leaves the game, the child is working at Stage 6 level, having bypassed Stage 5.

Stage 5 Using voice to make sounds or read aloud The Stage 5 activities can be bypassed unless the child is using a shaping or reading approach to elicit speech.

Sounds Several of the following activities do not require voice but are included to help the child gradually work towards using their voice. There is a certain order of sounds that children will feel most comfortable with: the greater the articulatory effort, and the closer the child perceives the sound to resemble actual speech, the more anxiety they experience. The order is roughly as follows, with the easiest first. However, it is mainly younger children who enjoy the animal and object sounds. Note that voice is used only in sounds 7–9 and 12–15.   1 Percussion instruments that make quiet sounds with small movements (eg triangle).   2 Instruments that require blowing and sucking (eg recorder, mouth-organ, whistle).   3 Percussion instruments that make loud sounds with large movements (eg drum, cymbal).   4 Body sounds not involving the mouth (eg clapping, tapping).   5 Sounds made with the mouth but no voice required (eg blowing, whistling, tongue-clicking, popping cheeks with a finger).   6 Sounds that represent an animal or object and do not require voice (eg hissing for a snake, ‘shh’ for a sleeping baby, tongue-clicking for a horse, wind blowing, creaking door).   7 Noise-makers that require humming (eg kazoo, comb and paper).   8 Sounds using voice that represent animals or objects (eg car engine, telephone ring, dog barking, lion roaring).   9 Animal noises or other sounds that are represented in word form (eg ‘moo’, ‘baa’, ‘ping’, ‘woof’). 10 Whispered letter sounds not involving voice or lips (‘s’, ‘sh’, ‘h’, ‘t’, ‘k’, ‘ch’). 11 Whispered letter sounds involving lips but not voice (‘f’, ‘p’). 12 Letter sounds – adding voice to whispered sounds (eg ‘pu’, ‘tu’, ‘ku’). 13 Letter sounds involving voice but not lips (‘d’, ‘g’, ‘n’, ‘l’, ‘j’, ‘y’, ‘z’). 14 Letter sounds involving voice and lips (‘b’, ‘m’, ‘v’, ‘w’). 15 Vowel sounds (eg ‘a’, ‘e’, ‘i’, ‘ar’, ‘ee’, ‘oo’).

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Musical instrument copycat

I

The child does not need to use their voice until the kazoo is introduced (see below). The child and the adult take it in turns to identify various noise-makers when the sounds are made out of sight. If a matching set is available, leave one set visible and use the other one to make sounds behind a screen (placing them in a large box tipped over on its side works just as well). If only one set is available, each person turns away or shuts their eyes and then copies with the same instrument, rather than using their own set. Initiation is best encouraged by each person being the sound-maker three times consecutively before swapping round. For a harder and increasingly physical version of this activity, make two or three sounds in sequence for the other person to remember and copy. Add a kazoo when the child is confidently making sounds by blowing and sucking.

Musical instrument conversations

I,

, 5+

A group of children create a ‘conversation’ of sounds using the instruments from the previous activity. One child plays a few notes or sounds and then looks at another person in the group to continue. Try to create different ‘moods’, eg happy, sleepy, angry, secretive.

,

Hand Snap!

I, 5+

The child does not need to use their voice for this, so it is a good introduction which helps them get used to making a noise. Use any pack of cards which have pictures repeated several times. Normal playing cards will do. Shuffle and deal out all of the cards. Each player places a card on a central pile in turn and, as soon as two matching cards are played consecutively, the first person to knock on the table wins the cards. For a more physical variation, claim the cards by covering the pile with one or both hands. This may be too invasive if children are particularly ‘frozen’ or oversensitive to touch.

Silly noises Experiment with coughing, sneezing, panting, whistling, tongue-clicking, blowing raspberries and popping cheeks!

Puppet play Play a silly sentence game with glove puppets. The adult’s puppet ‘reads out’ sentences such as ‘Fish can swim’ and ‘Cats can ride bicycles’. The child’s puppet responds with a squeak for ‘Yes’ and ‘Uh-oh!’, with their lips together, for ‘No’ (like the buzzer noise used for a wrong answer in the television game show Family Fortunes).

Sound lotto

I

Play like ‘Mime lotto’ in Stage 3 but choose or make pictures that can be represented by sound. For example, a burst tyre (‘pssss’), car, train, telephone, bell, gun, water, creaking door. Choose sounds that do not require voice initially.

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Animal noises

I

Adapt Stage 3 activities such as ‘Lotto’ and ‘Complete the puzzle’ by choosing animal pictures and making animal sounds, rather than using gesture.

Visual feedback Producing sounds can be made more fun by providing some form of visual feedback, as follows. Sound-activated toys The child makes a noise to make something happen. Find toys that respond to sound. For example, we have found a worm that rises out of an apple, a dog that turns somersaults, and a flower that sways from side to side. After a while, make a rule that sounds are made from the throat – loud sighs are a good start. Move the sound gauge (eg on an audio recorder, a computer recording device) Any noise will do at first! Then see which letters of the alphabet have most effect. Computer visualisations (eg Microsoft® Windows Media Player) Spectacular displays are possible when making even short sounds into a microphone and children can be encouraged to experiment with different visualisations. (Alchemy-Random is our favourite!) Letter sound challenge

★ Which letter sounds will blow out the candle? (‘p’ and a very hard ‘h’!) ★ Which letter sounds move the tissue or feather across the table? (‘p’, ‘t’, ‘k’, ‘f’, ‘sh’, ‘h’). ★ Which letter sounds get a response from the sound-activated toy? ★ Which letter sounds make the best visualisations? (see above) Tactile feedback Whispered sounds are made by airflow alone, but voiced sounds are made when the vocal cords vibrate. This vibration can be felt against your fingertips, when placed at the base of your throat over your ‘voicebox’, or as a tickle in your lips when humming against a balloon, no matter how quietly you speak. Encourage children to produce sound as they breathe out (lips together or only slightly apart is fine) and feel the vibration as they ‘switch their voice-box on’.

Humming  Take it in turns to ‘Guess that tune’, playing with a kazoo or a comb and paper. The child will need to either write down or select their answer. Progress gradually to humming without using the comb or the kazoo.

Letter sounds – copying, recalling or recording Follow the order suggested at the beginning of this section. At first, the child may find it easier to record the sound with the adult outside the room. Talking Postcards and Language Master® cards are useful for adding sounds to a letter of the alphabet or a classroom phonic picture.

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Stopwatch Who can say ‘t’ 10 times the fastest? Then try other sounds such as ‘k’, ‘l’, ‘p’.

Reading aloud

5 or 5+

Reading standard text aloud does not involve communication: the individual is not responsible for the choice of words and no messages are exchanged with the listener. Therefore, many older children can read aloud before they can speak freely, provided that the material is well within their reading age. Reading aloud can lead to relaxed communication by gradually introducing taking turns. See the games below, then progress to Stage 6 and 7 activities involving written questions or prompts, before fading out text completely. The following reading activities are suitable for using one-to-one, in groups and, eventually, in the classroom. Until children report that they are comfortable with reading aloud in class, ensure that they are forewarned and have a chance to look at the text beforehand.

Word dominoes

R

Preparation Take a pack of small index cards, or cut out similar-sized cards, and divide each with a line, as shown below. Write a word on each side of the line while making a large rectangle of 16–20 cards. The word on the right-hand side of one card must link to a word on the left-hand side of another. Eventually, the last card will link to the first one. Examples of possible links

★ Characters: Pooh–Tigger; Bart–Homer Simpson; Beauty–Beast. ★ Animal babies: elephant–calf; swan–cygnet; fox–cub. ★ Sports terms: badminton–shuttlecock; tennis–deuce. ★ Past tense verbs: sit–sat; go–went; think–thought. How to play Shuffle the cards, deal out four each and place the remaining cards face-down in a central pile. The first player chooses a card to play and reads out both words. If the next player has a match to either of these words, they place their card so that it links to the corresponding word and read out the two words that belong together. If they don’t have a match, they say ‘Pass’ and take the top card from the central pile. Repeat until all of the cards are played or until one player has placed their last card.

Silly sentences

R

Phrases for people, actions and places are written on cards, shuffled and placed in three piles. Players take it in turns to turn over three cards and read out the silly sentence. For example:

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★ The postman boiled an egg in a handbag. ★ My teacher fell in a puddle, wearing a pair of pyjamas. Reading pairs

R

The first lines of well-known nursery rhymes are written on card, cut in half, and placed face-down on the table. Players take it in turns to turn over and read out two cards, until they make a matching pair which they keep. Cards that don’t match are returned to the central pool. For example: Baa baa Black Sheep

sat on a tuffet

✗

Little Miss Muffet

have you any wool?

✗

Little Jack Horner

sat in the corner

✓

This can be adapted for older children with facts or definitions. Make sure there are some funny possibilities such as ‘Prince Charles is the largest British mammal’! The Moon is

the capital city of England

✗

London is

about 384,400 km away

✗

The red deer is

the largest British mammal

✓

Pot the Lobster (Crossbow Education Ltd, ages 7 to adult)R With a couple of small tweaks, this rummy-based card game is ideal for children with SM who read well. The players take and discard cards until they have a set of cards that make a silly sentence. As an extra clue, correct sequences produce a picture of a lobster. Easy version Read the sentence out loud to win the game. E

Harder version After reading out the sentence, the child turns the cards face-down and must remember it for another round. When it is their turn again, the child must say their sentence from memory. Finally, turn the cards back over to reveal the sentence and score one point per word correctly remembered.

Vocabulary Sentence Rummy (Crossbow Education Ltd, age 7–adult)R Another card game played with the enjoyable rummy format. See Crossbow’s website for ideas on how to make more reading rummy games: www.crossboweducation.com/Rushall’s-inclusion-zone/Get-in-the-zone/ teaching-with-rummy

Telling jokes

R, E

Children bring in jokes from party crackers, comics or joke books to read out loud to the class or group. Then everyone votes for the funniest joke. ‘Knock-knock’ jokes are a good format to introduce interactive turn-taking.

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Reading from a shared text

R

Participants take it in turns to read aloud a line from a poem or one or two sentences of text. Other languages appeal to some children as it makes them feel on a more equal footing with their peers. Also, there is not the same association with conversation in their own language.

Play readings

R

The participants each take on a different character from the script of a play. Then they swap roles.

NarratorR The child is the narrator in a class activity or a school assembly and reads out loud from a script.

Spokesperson

R, E

The class members work in small groups to produce, for example, a list of pros and cons for a proposed school rule, or three things that work well and three that could be improved in something they have designed. The child is the designated spokesperson for their group and reads out the list, while another class member fields any questions.

Reading own work

R, E

The child reads out bullet points from either a PowerPoint presentation which they have prepared or a good example of creative writing.

Questionnaires

R, I

The child prepares and presents a questionnaire to peers or staff members, reading the questions from a clipboard and recording their answers. The participants will need to agree in advance because, at this stage, the child will be unable to get their attention and explain. It will then be up to the child to approach each person, and they should aim to end the interaction by saying ‘Thank you’.

Stage 6 Using single words to communicate Silly or sensible? (‘Yes’ or ‘No’ questions) Young children seem to find the visual images generated by this activity hilarious! It can be adapted to any age or vocabulary level. Write the questions on cards and select them from a pile or bag. Let the child know how many they are required to answer before starting. Don’t put the card down and select another until the child answers: nodding and shaking their head is not allowed! Older children can do this as a timed activity: how many cards can they get through in one minute? Below is a selection of questions to begin with but the list is endless. (A good ice-breaker question is ‘Do noses run?’!)

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Examples of yes/no questions (select according to age and ability)

★ ★ ★ ★ ★ ★ ★ ★ ★ ★ ★ ★ ★ ★ ★ ★

Do pencils eat? Do babies cry? Do dogs bark? Do cats fly? Do flowers dance? Do children eat? Do pencils sing? Do elephants read? Do cars swim? Do trains rush? Do teachers talk? Do footballs roll? Do biscuits break? Do frogs jump? Do carrots run? Do spaceships walk?

★ ★ ★ ★ ★ ★ ★ ★ ★ ★ ★ ★ ★ ★ ★ ★

Do policemen drive? Do parents work? Do mice squeak? Do centipedes crawl? Do parrots paint? Do stones float? Do blades cut? Do rulers measure? Do rocks burn? Do volcanoes erupt? Do sausages chuckle? Does lipstick melt? Do mirrors dream? Do icicles pout? Does nitrogen freeze? Do stethoscopes amplify?

Extend the activity by taking it in turns to read out and answer the questions.R

Pick a sweet Ask the child to choose a sweet by naming the colour of it. And keep a toothbrush handy!

PairsI Spread out one set of cards is, face-down, on the table, and place an identical set face-down in a pile. Take it in turns to select a card from the pile and tell the other person what they need to find. If they find the matching card, they keep the pair. If they turn over the wrong card, they replace it and the original card goes back to the bottom of the pile. Continue until all of the cards have been paired up. There are many suitable cards available such as Animal Snap! but be sure to choose pictures that can be described with a single word. You can also make your own cards with stamps, stickers or photographs, for example: colours cartoon characters

animals familiar objects

modes of transport actions (verbs)

classmates food

Association Pairs

I

One set of cards is spread out, face-up on the table, and a matching set is placed face-down in a pile. Take turns to select a card from the pile and tell the other person what you have. The other person finds the pair and removes both cards. Continue until all of the cards have been paired up.

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There are many suitable cards available but you can also make your own. Choose one type of association at a time, for example: Opposites: long and short Homophones: flour and flower Occupations: doctor and stethoscope

Paired objects: needle and thread Colours: sun and buttercup Classification: ruler and thermometer

Older children can play the same game with written words, rather than pictures.R

Finish the sentence Sentence completion is a good precursor to answering questions because it taps into more automatic, rote-learned language. Younger children can work with pictures; older children (and adults) can work with numbers and phrases. Pictures A selection of pictures is spread out on the table and the adult cues in each one with an unfinished sentence, for example:

★ ‘At night-time I go to …?’ ★ ‘I drive a …?’ ★ ‘Birds make nests in …?’ The child picks up and names the corresponding picture to finish the sentence. Later, the adult sets a target to clear the pictures within a certain time limit, using an egg-timer or a stopwatch. Numbers This is a useful follow-up to rote-counting. The adult cues in the child with sentences that can be finished with a number, being careful to match the information to their general knowledge. For example:

★ ‘Two and two make …?’ ★ ‘Insects have six legs but spiders have ...?’ ★ ‘Clickety-click, sixty …?’ ★ ‘The number that comes after eight is …?’ ★ ‘At midnight the clock strikes …?’ ★ ‘The prime minister lives at number …?’ Make it feel like a reading activity by giving the child the numbers in random order.R The child then finds and either crosses off or removes each number as they say it.

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Automatic phrases Cue in the individual with phrases that are well known to them and ask them to supply the last word. For example:

★ ‘It’s raining cats and …?’; ‘I’m feeling on top of the …?’; ★ ‘Socks and ...?’; ‘Bread and …?’; Thunder and …?’ ★ ‘As cool as a …?’; ‘As brave as a …?’; ★ ‘A loaf of …?’; ‘A cup of …?’; ‘A flock of …?’ Alternatively, choose a theme such as football teams, famous buildings or song titles. For example:

★ ‘The Eiffel …?’; ‘The Leaning Tower of …?’; ‘Canterbury …?’ ★ ‘Blackburn …?’; Leeds …?’; ‘Wolverhampton …?’ ★ ‘Away in a …?’; ‘Hark the herald angels …?’ Picture naming on demand

I

1. Place picture cards face-down on the table. Take turns at turning over a card, naming what is in the picture and ‘posting’ the card in a pretend postbox. 2. Spread out picture cards face-up. Take turns at naming a picture that the other person has to find and post. This could be a timed activity to ‘beat the clock’. 3. Adapt (1) and (2) to be reading activities with words on the cards.R

What’s that sound?

E

Play a series of sounds and ask the child to identify each one to win the matching picture. (Go to the website www.freesfx.co.uk to download free sound effects.) Choose sounds that can be described with one word initially (eg cat, hammer), then gradually include sounds that could take the child to Stage 7 (eg baby crying, dripping tap, man laughing).

Feely bag

E

Place an item in a cloth bag and ask the child to identify it by touch alone.

Bingo or lotto

I

Use a traditional game board with numbers or pictures on it. First, the adult is the caller and continues until the child has filled up a board. Then the child calls for the adult.

Snap!I See Hand Snap! at Stage 4 but play using the traditional rules, the child calling out ‘Snap!’ when two identical cards are played consecutively.

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Note: many children can play this with an adult but they have great difficulty being the first to call out in a group. It is then better initially to find group activities with a fixed turn-taking sequence and no timepressure.

Letter, number or shape tracing

, E

Repeat the Stage 3 activity but with only one set of letters (eg Scrabble® tiles), numbers or simple shapes, which are placed in a bag. Rather than identifying the selected character by either pointing to it or picking it up, each player says what they think the other person has traced on their palm.

, E

I-Spy and Colour I-Spy

Traditional I-Spy is played with letter names or sounds, while Colour I-Spy is played with colours. to make it more accessible to younger children. For example, ‘I spy with my little eye, something beginning with ‘C’ or ‘… something that’s blue’. At Stage 6, the adult says, ‘You spy with your little eye, something that’s …’, to keep the activity at a single word level. At Stage 7, the child also says the opening sentence.

Questions requiring a single-word answer The adult asks a question either about a picture card (hidden from the child’s view) or from a list. The child wins the card for a correct answer, or receives a token as suggested at the beginning of this appendix in ‘Providing a greater sense of purpose and enjoyment’. The child says ‘Pass’ if they are stuck and the adult gets the card or token. There is a selection of questions opposite but the list is endless.

Reading aloud with questions

R

After reading out a short passage of text, the child answers one to four questions that can be answered by a single word found in the text.

Tell Me Quiz (Rockets Toys, age 6 to adult)

R, E

The child answers a question, read to them by the adult, beginning with the letter they get when they spin the wheel. Questions are divided into two sets for different ages. You can make your own version by writing questions on cards which are placed in a central pile and choosing letters from a bag (eg Scrabble® tiles). Children do seem to love the spinner though! Extend this activity by taking it in turns to read out and answer the questions.

R, I, E

Solve it

E

The adult gives clues about an animal, a classmate or an object, and the child has to see how quickly they can think of the answer. For example, the answer could be a word or a picture on a card, which the child wins when they answer successfully.

Picture clues

I, E

The players take turns at picking up a word or a picture from a central pile. They must now draw it, adding one component at a time until the other player recognises it and says the word or picture on the card.

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Examples of questions for single-word answers (select according to age and ability) Numbers

Colours

How many ... have I/you got?

eyes

How many legs has a ... got?

What colour is/are …?

grass

necks

snow

noses

blood

hands

the sky

fingers

daffodils

legs

the sun

toes

carrots

horse

emeralds

spider

rubies

penguin

sapphires

kangaroo

bananas

fish

crows

wheels on a bicycle?

Personal facts

socks in a pair?

What’s your name?

days in the week?

How old are you?

months in a year?

How old is your brother/sister?

hours in a day?

What is his/her name?

numbers on a dice?

What is your door number?

sides on a square?

How many people live in your house?

sides on a triangle?

What is your teacher’s name?

sides on a rectangle?

What is the name of your pet?

cards in a pack?

What colour is your car?

Functions

E

Animals

E

What do you ...

sleep in?

What can ...

swim?

How many:

E

write with?

fly?

cut with?

gallop?

throw?

bark?

wear on your feet?

squeak?

wear on your head?

make a nest?

ride?

make a burrow?

Note: questions become increasingly difficult when:

E

★ there is more than one answer ★ the child is not sure that you will understand them ★ an assumption has been made (eg that they have a pet) ★ the child does not know the answer.

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Classification games 1 Children pick a card and say which family it belongs to. This can be done very simply by sorting any pack of picture cards into groups (eg ‘jumper’ = clothes, ‘potato’ = vegetable). Or play it as a game with a theme, for example:

★ a shopping game where the children have to decide which shop to go to for each item on their list



★ a house game where the furniture needs sorting into different rooms.

2 Children select a category and then think of an item that belongs to it.

E

As the game gets harder, they have to think of two or three items (good preparation for Stage 7). See below for some starter items – there are lots more! animals birds buildings clothes colours countries desserts/puddings drinks films flowers food footwear fruit jewellery lessons musical instruments occupations pets rivers tools towns toys transport vegetables

FavouritesE As for ‘Classification games’ but, when picking a category, the children have to state their favourite colour, drink, teacher, and so on.

Alphabet Strings

E

Each person takes turns at adding a word to the string; each new word must begin with the last letter of the previous word. Repeats are not allowed. Make it harder with a theme and say ‘Pass’ if stuck. For example:

★ names: Edward, David, Dana, Amin … ★ food: potato, orange, egg, granola … Passing on a message

I

The child is asked to find out something from an obliging adult by taking them a written message; for example, ‘Please tell Jack how many exercise books you need’. If the child has difficulty approaching, the obliging adult asks whether they need anything and answers the question verbally when the child hands over the piece of paper: for example, ‘Please tell [name] I need six books’. The child returns to the original adult and tells them the answer. When the child is comfortable with this, explain how to get the obliging adult’s attention; for example, by knocking on the door, or walking up to them and holding out the note.

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Hangman (depending on age and ability)I The child thinks of a word and writes down the corresponding number of blank spaces. The adult tries to work it out by suggesting different letters of the alphabet. If correct, the child writes the letter in the appropriate space; if not, a section is added to a sketch of gallows. If the child completes the gallows, the adult loses. Then swap roles and repeat.

BattleshipsI The object of the game is to sink your opponent’s fleet before they sink yours. Each player has a 10 × 10 square on which they fill in the squares to depict various vessels (see Handout A1 on page 478). A second 10 × 10 square is used to record the hits and misses when attacking the other player. Players take it in turns to target one of their opponent’s squares, hoping that they will score a direct hit. When successful, they are told what type of vessel has been struck, and this helps guide their next ‘missile’. This is great fun, and a useful lead into Stage 7, as the child is actually saying two ‘words’ together as they name the squares (‘D4’, ‘E9’, etc). In response, single words only are required (‘hit’, ‘miss’, ‘submarine’, ‘tanker’, etc).

Turn up the volume Play games such as Alphabet Strings, Hangman and Battleships, sitting either back-to-back or on opposite sides of the room. The child will need to raise their voice when the adult says ‘Pardon?’, ‘Sorry, I didn’t hear that’, etc. Have some blowing practice first because it takes relaxed shoulders, a deeper breath and more ‘push’ from the lungs to increase volume – the effort does not come from the throat. For example:

★ Blow enormous bubbles and long streams of bubbles with bubble solution and a wand. ★ Blow the upturned cardboard tube from the inside of a toilet roll along the table. (It takes skill and breath control not to knock it over!)

★ Play blow-football with a table-tennis ball or scrunched-up ball of tissue paper. Group turn-taking

6+

When introducing new people and increasing the group size, stick to a fixed turn-taking sequence initially. Repeat familiar Stage 6 single-word activities or Stage 5 reading games which the child plays well on a one-to-one basis. Each child will be prompted by the adult in turn. For turn-taking sequences where children talk to the person next to them, rather than the adult, use Stage 6 activities such as ‘Pairs’, ‘Association Pairs’, ‘Silly or Sensible?’, ‘Tell Me Quiz’, ‘Alphabet Strings’ and ‘Letter, number or shape tracing’, plus the following activities.

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Handout A1 BATTLESHIPS

1

2

3

4

5

6

7

8

9 10

Add to grid:

A 1 battleship

B

5 submarines

C D E

2 tankers

F G H

3 cruisers

I J

BATTLESHIPS!

1

2

3

4

5

6

7

8

9 10

Find and sink:

A B C

1 battleship 5 submarines

D E F

2 tankers

G H

3 cruisers

I J

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Rote sequences

6+

Counting drills Take it in turns to say a number, counting up in multiples of one, two, five or ten. Continue the sequence to an agreed number and then repeat it in the opposite direction. All change! Working with rote sequences (such as numbers, days of the week, months of the year or letters of the alphabet), the adult tries to catch out the next person by raising a hand or crossing their legs to indicate a change of direction.

Random turn-taking

I,



This activity needs at least four participants. Working with rote sequences such as numbers, days of the week, months of the year or letters of the alphabet, each person says one item and indicates the person to go next by looking at them and nodding. At first, children often nod after they speak but, as they speed up, the activity more closely approximates conversational gesture, with the aim of speaking and nodding at the same time. Only a very small nod is needed, with the emphasis on a natural increase in eye contact.

The longest sentence in the world

E, 6+

Each person adds a word to a sentence to set a ‘world record’. There is only one catch – the word ‘and’ can only be used once!

Name throwing

6+

This is a good warm-up activity, which helps participants to connect at a social level. Whoever starts points to someone else in the circle. If this is done with the left hand, the person pointed to says the name of the person on their left, and vice versa. Then it is their turn to point to whoever they choose. Aim to play for 30 seconds without a mistake, and then everyone swaps places.

PictionaryTM (Mattel Games, age 8 to adult)

I, E, U, 6+

This is a drawing game in which players take turns drawing a word while the other players in their team call out to guess what it is within one minute. Reading will be required so they know what to draw, unless picture prompts are used.

Stage 7 Using phrases or sentences to communicate Many of the activities in Stage 7 are extensions of Stage 6 activities, and lead on from a single-word activity, almost in the same breath. Ensure that there is a balance of activities, so the child both responds to questions and initiates, by asking questions and giving clues or directions. There is an increasing emphasis on more emotionally charged questions where the child does not have an answer or cannot be certain that their answer is correct.

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Pick two sweets This is a very gentle introduction to combining words. The child chooses two sweets from a selection by saying the colours. Saying ‘X, Y’ may naturally lead them to say ‘X and Y’. Keep a toothbrush handy!

Colour sequences

I

The child says three or more single words together as a lead into phrases and sentences. Players each need a tub of plastic interlocking cubes. Take it in turns to make a colour sequence of three cubes initially, and keep it hidden while describing it to your partner, eg ‘Red, blue, blue’. The other player has to make the same sequence, and keeps both sequences if they match. This is a good incentive to catch out your partner with a sequence that is too long for them to remember!

‘Yes’ or ‘No’ questions

R, I

This is mainly a reading exercise but the children make up the questions themselves, which is good preparation for Stage 7 communication. Before the game starts, both child and adult write down three to five questions about each other which can be answered ‘Yes’ or ‘No’ (finding out each other’s likes, dislikes and habits works well). The pieces of paper are folded up and put in the middle of the table or in a bag. Then take it in turns to select a question and read it out for the other person to answer. For example:

★ ‘Do you watch [name of television programme]?’ ★ ‘Have you got a pet?’ ★ ‘Do you like spiders?’ ★ Can you swim? The children may introduce questions which can’t be answered by ‘Yes’ or ‘No’ – accept this without comment as it moves into the next activity, ‘Pot-luck questions’.

Pot-luck questions

R, I, E

Play as above but now anything goes! Ask the children to write down questions that start with words such as ‘Who’, ‘What’, ‘Where’, ‘When’ and ‘How’. These usually require more than a single-word answer. For example:

★ What is your favourite television programme? ★ How far can you swim? ★ Where do you live? Fish for pairs

I

Extend the Stage 6 ‘Pairs’ activity by dealing out five to seven playing cards each and putting the remaining cards face-down in a central pile. If players can make a pair, they put it on the table and play with the remaining cards in their hand.

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Then the first player requests a match for one of their cards by asking, ‘Have you got _____?’. If the second player has this card, they must hand it over, and the first player may request another item. If the second player does not have the requested card, they say ‘No’, which signals the end of the first player’s turn. The first player now picks up the top card from the central pile to add to the cards they are holding; if it gives them a pair, they put it on the table immediately. It is then the second player’s turn to request a card. Continue until one player has paired up all of their cards.

LottoI Take it in turns to be the caller. Use boards or selections of cards with similar pictures so that the child will have to expand the description before the picture can be identified. For example, ‘the happy clown’, ‘the boy with red trousers’, ‘the bird in the tree’.

I-Spy and Colour I-Spy

I, E

See Stage 6 for instructions.

‘Yes’, ‘No’ or ‘I don’t know’ questions

E

Ask a selection of simple ‘Yes/No’ questions such as ‘Is grass green?’ and ‘Is snow black?’, but mix in a few questions that the child could not possibly know the answer to. For example:

★ Is my middle name Fred? ★ Have I got a tissue in my pocket? ★ Is my birthday in June? ★ Was the school built in 1972? Later, mix in questions that are simply too difficult, to give the child practice at responding appropriately. Stress that it’s OK not to know the answer. For example:

★ What’s 35 times 126? ★ How deep is the Atlantic Ocean? ★ Where will you be living 20 years from now? ★ How do you say ‘tickle’ in French? Yes! No! Game (Paul Lamond Games, age 8 to adult)

R, I

This game involves answering in phrases and is great practice to expand on simple ‘yes’ and ‘no’ answers which can sound rather blunt or uninterested. The game includes a series of question cards and a bell. One player reads out the questions, the faster the better to trip up the other player. The other player must answer them without saying ‘Yes’ or ‘No’. When they do, swap roles and repeat the game.

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Finish the sentence

R

Use easy sentences which the child has to read aloud, supplying the missing word. For example:

For breakfast I had ______. My eyes are ______. My hair is ______. Today it is ______. My birthday is in ______.

A hat goes on your _____. A boot goes on your _____. A car goes on the _____. A boat goes on the _____. A plane goes in the _____.

Guess Who? (MB Games, age 6 to adult)

I, 7 or 7+

This popular game has a repetitive language format which provides a comfortable structure for asking questions. It can be played with one or two players on each side, taking it in turns to ask questions such as ‘Is it a man?’, ‘Is he wearing glasses?’, to identify a character by a process of elimination. You can make your own version using photographs of children in the class or pictures of famous people or cartoon characters.

Guess what?

I, SS

Using picture or word cards, place them face-down in a central pile. Take it in turns to select one and give clues to elicit the target word from your partner. For example:

Target word = ‘socks’ Child: ‘They go on your feet’. Adult: ‘Shoes.’ Child: ‘You put them on before your shoes’. Adult: ‘Socks.’ Child gives the card to the adult or places it face-up in a discard pile.

InstructionsI Using a cue card, the child must tell the adult what to draw, or how to move objects on the table into the same position. Preposition cards and mapping work are useful here. For example:

★ Put the spider in the bath. ★ Put the pig behind the tractor. ★ Draw a blue circle on a red line. ★ Draw a line from C3 to G6, and from G6 to J3. The adult may seek clarification if needed (eg ‘Which pig?’). Later, encourage the child to give clarification early if it looks like the adult is about to make a mistake: SS

Questions where a one-word answer won’t do ‘Where?’, ‘When?’, ‘What happened?’, ‘How?’ and ‘Why?’ questions tend to elicit phrases rather than single words, with a greater range of possible answers. ‘Why–Because’ cards are useful and help to demonstrate that there can sometimes be several answers to the same question.

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AlternativesE Ask the child questions which require more than one answer, for example:

★ How many uses are there for a piece of string? ★ What reasons can you think of for walking instead of going on the bus? ★ What could this man be angry about? ★ Why do people give each other presents? Reading aloud with questions

R

After reading out a short passage, the child answers one to four questions that can be answered by a phrase or sentence found in the text.

Crosswords

R, I, 7 or 7+

Two players have a small crossword puzzle each but the clues are separated and swapped round. Players take it in turns to ask for a clue (eg ‘seven across please’) which the other person reads out. Write in the answer if known. This can also be played with two teams of two people. Note: if the clues are difficult to solve, players are instructed to say ‘Pass’

E

Saying ‘No thank you’

I, E

Put all of the pieces needed to complete two Mr Potato Heads, or two Flounder puzzles (Rockets Toys), or your names in Scrabble® letters, into a bag. Take it in turns to be in charge of the bag, reach in and offer a piece to your partner. They must say ‘Yes please’ or ‘No thank you’ and then take one for yourself. Put unwanted pieces back in the bag, give it a shake and repeat. Continue to see who gets all their pieces first. Then swap roles.

Practice at contradicting

I, E

The adult describes the child, for example, You’ve got long hair; you like swimming, you drive a Porsche’. After each sentence the child has to agree or disagree – but one-word answers are not allowed! Acceptable responses are ‘No, I haven’t!’, ‘Yes, that’s true’, I’m too young to drive’, etc. Then the child writes down five statements about the adult and the roles are reversed. (This is a safe lead-in to asking and answering questions about each other.)

Impossible commands (practice at negating)

(R), I, E

Write various commands on cards, some of which are impossible, for example:

★ Click your fingers ★ Stand on one leg ★ Lick your neck

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★ Touch your elbow with your nose ★ Stand on the wall ★ Break your leg off. Place the cards in a pile, face-down, and take it in turns to pick up one from the pile and read it out. The other person must either follow the instruction or say ‘I can’t’, ‘It’s too difficult’, ‘That’s impossible’, etc. Invite the children to make up their own instructions! Picture version For non-readers, play this with two piles of pictures of body parts. Take it in turns to pick up a card from each pile and connect them in an instruction, for example, ‘Stick your finger in your ear’; ‘Put your chin on your foot’. This is good for readers too, as they now have to generate a sentence.

Answering the telephone

I

The adult calls the child from an extension, home or mobile phone. The child can be given a secret message to retain until they are asked for it the next day. There may be long silences at first. It is advisable to get into the habit of remaining silent when the child picks up the phone. If nothing has been said after a while, the adult should hang up. Children soon get better at saying ‘Hello’ when they realise it has a purpose. Later, it is useful to role-play conversations with the child, in preparation for phone calls to other people.

Make a request

I, U

An obliging adult asks the child to get something from an adult they respond to in sentences, but do not yet speak to spontaneously, using a phrase which cannot be telescoped to one word (eg a packet of blue envelopes, the book in the desk). The child does not need to speak to the first adult but must bring the request into conversation with the second adult. If the child appears to ‘hover’, the second adult may assist by saying, ‘Can I help?’ or ‘Did you need something?’ but avoid anything more specific like ‘What did Miss J want?’

Compare likes and dislikes (expressing opinions)

E

One person goes through a list of foods, films, or activities, etc, expressing an opinion. For example, ‘I love sweetcorn’, ‘I quite like cabbage’, ‘I don’t mind beetroot’. After each comment, the other person immediately agrees or disagrees: ‘So do I’, ‘I hate it’, ‘Me too’, etc. Then swap roles and repeat. Use pictures or written lists to begin with but, as the child gains confidence, simply choose a topic (eg school subjects, drinks, television programmes) and generate three to five comments per topic.

I

Tattoo artist!

I

A glitter tattoo kit provides a structured way for children to interact with friends or relatives who have been educated to use commentary-style talk rather than direct questions (see Chapter 8, page 122). The child either approaches people to ask if they would like a tattoo or sets up a tattoo area for people to visit (eg a rug spread out in a corner of the garden). The child asks each person to choose a stencil, pick two colours and say where they want their tattoo – and goes on to delight everyone with the results!

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APPENDIX A

Quick-fire greetings

E

This activity gives children practice at responding automatically to greetings and other social language expressions. The adult prompts by randomly saying ‘Hello’, ‘Good morning’, ‘Thank you’, ‘Goodbye’, ‘Cheerio’, ‘Here you are’, etc. The child replies as quickly as possible with any socially acceptable response (there will be local variations), such as ‘Hi’, ‘All right?’, ‘You’re welcome’, ‘Don’t mention it’, ‘No worries’, ‘Bye’, ‘Thank you’. Aim to fit in as many prompt–response pairs as possible into a 30-second countdown.

Turn up the volume Extend the ‘Turn up the volume’ activity for Stage 6 by playing games, such as ‘Guess Who?’, ‘Guess what?’, ‘Pot-luck questions’ and ‘Crosswords’, sitting either back-to-back or on opposite sides of the room.

Group turn-taking

7+

Precede sentence-level activities with single-word or reading games. Use a fixed turn-taking sequence initially, then gradually move on to less structured activities. For turn-taking sequences where children talk to the person next to them, rather than the adult, use Stage 7 activities such as ‘Colour sequences’, ‘Yes or No’ questions, ‘Pot-luck questions’, ‘Guess what?’, the ‘Yes! No! Game’ and ‘Instructions’, plus the following.

Rote sequences

7+

Counting drills Take it in turns to count in multiples of one, two, five or ten, saying two or three numbers of the sequence at each turn. Continue the sequence to an agreed number and then repeat in the opposite direction. Repeat with months of the year or letters of the alphabet.

I

All change! Working with rote sequences, such as numbers, months of the year or letters of the alphabet, say two or three items at each turn. Each speaker holds up their right or left hand to indicate who goes next.

Talking grid (from Active Listening for Active Learning, QEd Publications)

I, 7+

Draw a grid on a large piece of paper. Add one row per child, a column for their names and three to four columns for personal information. For example: Name

Who I live with

My pets

My favourite television programme

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My favourite food

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The children write their names in the left-hand column of the grid and, taking one topic at a time, go round the group asking for information from each child. As each child responds, the adult writes or draws their answers on the grid. The completed grid may then be used in several ways, for example:

★ Guessing game – ‘This person likes pizza and has a goldfish. Who is it?’ ★ Memory game – ‘Who can remember Mark’s favourite programme?’ (Cover all squares on the grid with individual pieces of paper initially and remove them one at a time to see if the children are correct.)

★ Questions – ‘Zoë, what’s your favourite food? (Children take it in turns to ask each other questions. The child answering places a counter on the corresponding square. Continue until all of the squares have a counter.)

I went to market

E, 7+

This classic memory game has many variations. In the original version, someone starts off saying, ‘I went to market and bought a pig.’ The next person says, ‘I went to market and bought a pig and some toothpaste’, and so on, until the sequence is too long to remember. We have also heard ‘I went on holiday and packed a swimsuit …’, and ‘I went to a party and ate six pizzas …’. Perhaps the most enterprising version (spotted in a language unit in a secondary school) is the ‘Gossip’ game. Younger children may need picture prompts to stimulate their imagination, but others will enjoy the freedom to say (within reason!) what they like. For example:

★ ‘I heard Mrs Townley crashed her car.’ ★ ‘I heard Mrs Townley crashed her car after robbing a bank …’ ★ ‘I heard Mrs Townley crashed her car after robbing a bank and went to prison …’ Consequences

R, E, 7+

Although much of this activity is spent in silence while the children write, the resulting laughter is worth it. Participants take a blank piece of paper, write the first of the following items at the top, fold the paper over to cover their words, and pass it on to the next person. Then everyone writes the next item, folds the paper over and repeats. By the end of the game, there will be as many stories as there are participants. Finally, each participant reads out a complete story. [Name of a man] met … [Name of a woman]. [enter a place]. He said … [enter a question or comment]. She said … [enter reply]. Then … [enter what happened next]. And the consequence was … [draw the story to a conclusion].

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(fold the paper over and pass it on) (fold the paper over and pass it on) (and so on …)

(make the final fold, and pass the paper on).

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APPENDIX A

Pot the Lobster (Crossbow Education Ltd, age 7 to adult)

R, I, 7+

See Stage 5 ‘Reading aloud’ for details of this card game. When playing at Stage 7, the players call out ‘Pot the lobster!’ when they have a complete sentence.

Happy Families (3–6 players)

, I, SS, 7+

The object of the game is to collect as many families as possible (groups of four cards that belong together) by requesting individual cards. Deal out all of the cards so that every player gets an equal number of cards.* The dealer starts by asking another player for a card needed to complete a family. If the player has the card, it must be handed over. The dealer continues asking for cards until a player does not have that card. The dealer then picks up a spare card and it is now that player’s turn to request cards. They can retake the cards taken in the previous round if they still have part of that family. When a player gathers a family, they must put the four cards face-up on the table in front of them. The player who collects the most sets is the winner. This is good for using each other’s names to get their attention, and for eye contact to ensure that the right person is listening before a card is requested. *Any spare cards are placed face-down in a central pile. When a player’s turn ends, they take one of the cards and this continues until all of the cards have been taken.

, I, SS, 7+

Fish (3–6 players)

This game is similar to the previous activity (Happy Families), the object being to collect as many groups of four cards that belong together as possible. Fish is usually played with a standard pack of playing cards but you can make your own, the object being to collect four of the same cards (matching colours, animals, vehicles, etc). Play as for Happy Families but with the following changes. Deal five cards to each player and put the rest face down in a central pile. Ask individuals for all the cards they have in a particular group, eg ‘Can I have all your threes?’, ‘Have you got any cats?’ If the person asked does not have any of the named cards, they say ‘Go fish!’ The asker must then take the top card of the undealt stock. If that card is the one asked for, the asker shows it and gets another turn. If the taken card is not the one asked for, the asker keeps it, but the turn now passes to the player who said ‘Go fish!’.

Give Us a Clue (Charades)

, I, E, U, 7+

This is a miming game in which players take it in turns to mime the title of a book, song or film while the other players call out to guess it. There are various devices for indicating the number of words or syllables in a word, rhyming words, and so on. You can also play it like PictionaryTM (stage 6) and draw the clues. Reading will be required to know what title to mime or draw, unless it is whispered by an adult.

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Stage 8 Using connected sentences in conversation All of the group games can initially be practised one-to-one.

Storytelling

I, E, SS

Use a prompt such as Rory’s Story Cubes® (available from www.storycubes.com). Roll the dice and make up a story connecting all nine images. Choose from themes such as ‘Batman’ or ‘Doctor Who’, or the original set for general storytelling.

Floor plan

I, E, SS

Show children the convention for marking doors on a floor plan. One person describes the ground floor of their house as if they are entering through their front door and walking from room to room (they might like to draw a floor plan first). The other person listens and creates a matching (they hope!) floor plan, interjecting to seek clarification or ask for repetition as necessary. Swap roles. This can be repeated for upstairs or the garden.

Twenty Questions

I, E, SS

Each player can ask up to 20 questions to identify a hidden word or picture – the other person can only answer ‘Yes’ or ‘No’. The choice can be as wide as you like by making the introductory question, ‘Animal, vegetable or mineral?’, or narrow the choice down to a category such as ‘Famous people’, ‘Television and films’, ‘Natural world’, etc.

Teach me

I, SS

Version 1 The adult and the child play a game in which the adult has ‘forgotten’ how to do a simple task such as brush their teeth or make a sandwich. The child must give them step-by-step instructions to make them carry out the activity correctly. For best effect, the adult should deliberately make mistakes by following instructions literally. Version 2 The child teaches the adult something new, eg how to play a game, set up an online account or use an app.

Talking Grid (from Active Listening for Active Learning, QEd Publications)

I, 8+

Extend the Stage 7 activity by asking each child to relay their information to the group. For example, ‘My name is Mark. I live with my Mum and Dad and baby sister Kirsty. I haven’t got any pets. My favourite TV programme is Dr Who and I love spicy bean burgers.’ The other children are invited to ask questions, for example ‘How old is Kirsty?’

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APPENDIX A

Walking Robot (from Active Listening for Active Learning, QEd Publications) 

I, SS

The child hides an object and you become a robot who needs precise instructions to find it. Put on a blindfold or simply shut your eyes, sit down … and wait! You can prompt if necessary with ‘I can’t move until you tell me to’. When told to move or walk, step your legs up and down until told to stand up. When eventually walking,  continue to walk until you are told to stop … even if this means bumping into furniture or the wall! If the child doesn’t know their left from right, they can tell you to turn slowly until you are facing the right way and then command you (the robot) to stop. When they say, ‘It’s in front of you’, reach out and grab at the air until you are given precise directions to move forward, reach lower down, etc. You may need to take crafty peeks to avoid accidents!

Drawing Robot (from Active Listening for Active Learning, QEd Publications)

I, SS

Draw a large but very simple line drawing in pencil on a sheet of A4-sized paper. This can be a house, robot, frog or car, for example:

Place a marker pen next to the drawing and tell the child you are a robot who needs instructions to draw the picture. They must tell you exactly what to do and you will do exactly what they say. Put on a blindfold or simply shut your eyes … and wait! Prompt the child if necessary with ‘I can’t move until you tell me to pick up the pen’. When told to pick it up, make open and shut movements with your hand until told to move your hand forwards to where the pen is placed. When you eventually pick up the pen, continue to lift it up in the air, high above your head until the child tells you to stop … and to bring it back down again. Don’t take the top off the pen until instructed, and so on, until the picture is completed. You will get some surprisingly good results and have a lot of fun!

Seeking clarification (from Active Listening for Active Learning, QEd Publications)

I, SS

Read out a series of instructions that are deliberately complicated or ambiguous and warn the child that they will need to ask you questions to be sure about what to do. The following example is reproduced with permission from QEd Publications.

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  1 Take a piece of paper and place it in the portrait position on the table, in front of you.   2 Draw an inverted triangle at the bottom of the page. (The child will need to ask for a pen or pencil.)   3 Draw another inverted triangle next to it. Make it the same size.   4 Draw an upright oval above the left triangle.   5 Draw an identical item above the triangle on the right.   6 Draw a line horizontally across each oval.   7 Draw a line vertically through the middle of each oval.   8 Draw a larger circle in the middle of the page, above the ovals.   9 Draw an inverted banana-shape above the big circle. 10 Draw a line down the length of the banana. 11 Ask the child ‘Can you guess what you have drawn?’ If they have no idea, suggest they turn the page upside-down!

Note: see Active Listening for Active Learning (2009) for more individual and group games to develop questioning, directing and seeking clarification.



Stare out contest!

This is a non-verbal activity but we do not introduce it until Stage 8. We prefer to allow individuals to develop eye contact naturally while they relax during turn-taking and talking activities, and only introduce this activity when there are difficulties establishing eye-contact. Set a challenge to maintain eye contact for 30 seconds without looking away – blinking and laughing are allowed! The first 10 seconds often feel intensely uncomfortable for both parties but, suddenly, something lifts and it becomes surprisingly easy. Once the individual can make eye contact, apply the rules in Chapter 10 (page 214) to activities in Stages 6, 7 and 8, as appropriate.

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APPENDIX A

Hedbanz (What Am I?) (Paul Lamond Games, age 7 to adult)

I, SS, 8+

Each player wears a headband which holds a picture that only the other player(s) can see. Taking it in turns, the players then have a minute each to ask as many questions as they can to identify their picture. Make your own version using stretch cotton headbands and pictures for ‘Who Am I? and ‘Where Am I?’ in addition to ‘What Am I?’.

Don’t Say It (Paul Lamond Games, age 6 to adult)

R, I, U, 8+

Can you get your partner or team to say ‘pig’? It’s not as easy as it sounds, when you can’t say the words on the card – in this case, ‘sausage’, ‘sty’ or ‘pork’. Players need to be quick to avoid running out of time. The game contains 200 words at four different levels of difficulty, depending on the age and abilities of the players. This game re-creates many elements of conversation – creativity, spontaneity, interjection, clarification – while retaining the comfort of a familiar structure.

Who’s Who (Ginger Fox, age teen to adult)

R, I, E, U, 8+

This game is similar to ‘Don’t Say It’. The players describe famous names for their partner or team in a series of one-minute rounds, without giving any rhyming clues or saying the name on the card.

Sussed!® All sorts (Games to Get Ltd, age 8 to adult)

R, I, E, U, 8+

The players ‘suss out’ each other’s likes and dislikes. Each player draws a card containing questions with three possible answers, which they read out. They choose the answer they consider to be true and write it down. The rest of the players win points if they write down the same answer. Players may challenge the reader’s answer and the reader may change their mind as a result. This leads to amended points so it is in players’ interests to dispute answers and argue their case!

Sussed!® Emotional Intelligence (Games to Get Ltd, age 10 to adult)

R, I, E, U, 8+

This is played in the same way as the previous game but focuses on the players’ personality traits, emotions and reactions to different situations.

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APPENDIX B

[N] = Name of child or young person [A] = Adult who [N] will be talking to for the first time. These programmes are usually implemented to enable children and young people to speak to an adult for the first time, but the voice message telephone programme may also be useful for speaking to other children. See ‘Small-steps programmes – general principles’ in Chapter 10 (page 187) for length and frequency of sessions.

Appendix B

ESTABLISHING SPEECH USING TELEPHONE, LONE TALKING AND SHAPING PROGRAMMES

The programmes provide a very structured small-steps approach for the most anxious individuals. Younger or less anxious individuals may work through quickly, with little need to repeat targets, or suddenly take off and not need to complete a programme. Be flexible and let the child or young person’s response set the pace. Set targets in a game format for young children wherever possible, using ideas from Appendix A. This provides an extra element of purpose – when you are extremely anxious, the idea of fun is not enough to distract you from your thoughts and feelings, but having an external focus is very beneficial. Older children and young people will understand the rationale of overriding their SM anxiety response through tiny steps and repetition and can take a more directive approach. Tailor targets to individual interests and aspirations, choosing age-appropriate tasks and activities. If at any point the child or young person does more than the stated target, do not delay progress by going slower than is necessary. Go straight to the relevant point in the programme. For example, they might say letter names rather than letter sounds, answer in phrases rather than single words, or make a spontaneous comment. Follow the programmes with generalisation activities involving other people and other settings as appropriate (see Chapters 9 and 10). Change to generalisation activities sooner if face-to-face conversational speech emerges spontaneously during the programme. [A] can facilitate conversation by (a) ensuring that the child or young person understands that talking to [A] will not mean a sudden expectation to talk in other situations; (b) using undemanding ‘commentary-style’ talk in between targets, with the occasional casual question, eg ‘Did you see where I put my pen?’ (See Chapter 8 page 122, and Figure 9.2 on page 153 for the recommended question sequence.)

P

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APPENDIX B

1 Telephone programmes These programmes can be implemented separately or in combination, as shown in Example 8, Appendix C. The first two routes focus on establishing speech with a familiar adult, possibly someone who does not see [N] regularly; while the third route builds confidence in talking to strangers. All routes have the advantage of allowing [N] to work initially from a comfortable setting such as home. The Remote Talking route requires the involvement of a talking partner. It is particularly suitable for children who are comforted by their parent’s presence and ready to be guided by them about the best way to talk to an adult such as their teacher, school key worker, therapist or relative. The Voicemail route may benefit from a parent’s support, but does not require their actual involvement in completing the targets. While equally suitable for young children, this route is therefore a good option for anyone who does not have access to support from a talking partner or is sufficiently motivated and independent to work alone with the identified adult. The Robot route similarly benefits from a parent, mentor or key worker’s support to maintain momentum, but it can be carried out by young people and adults independently. This route has four objectives, so it may be a useful additional component in programmes using other techniques in this manual. 1 To reduce or eliminate anxiety associated with using the telephone (also useful for parents who model avoidance of using or answering the phone). 2 To enable individuals to gain voice control when feeling anxious by practising steady breathing and airflow in a safe environment. 3 To enable individuals to confidently repeat themselves with increased volume and/or clarity when not heard on the first occasion. 4  To enable individuals to approach and speak to strangers.

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Goal

The Remote Talking and Voicemail routes

Reassurance and desensitisation

Explain that it will be easier for [N] to talk if [A] is some distance away and that, initially, all that [N] needs to do is let [A] listen – [N] will not be asked any questions. Stress that things will go very slowly and new targets will only be introduced as [N]’s anxiety reduces. Both routes may optionally be preceded by sharing a voice recording with [A] as described below under ‘Lone talking’ (‘Talking bridge’) and in Chapter 9, ‘Desensitisation using voice recordings’ (page 157).

Goal

The Remote Talking route

Tips

Preparation

[N] is given a short passage to read to their parent and practises this at home. Non-readers or struggling readers can count alternately with their parent instead; parent says ‘one’, [N] says ‘two’, parent says ‘three’, etc, up to 20 or as high as [N] can manage.

Choose text that [N] can manage easily; the technique can be used later to hear children read for assessment purposes if required.

Comfortable toleration of voice being heard when talking to parent

[A] rings [N] at a prearranged time and the parent answers, or vice versa. [N] repeats the reading or counting activity with the handset positioned on the table, but not set to speakerphone or loudspeaker. The parent relays any questions or comments at this stage. When finished, the parent picks up the receiver, tells [A] that [N] did well and passes on [A]’s congratulations.

It does not matter if [A] cannot hear [N]; what is important is that [N] thinks they can and was able to tolerate being listened to. If [N] whispers, move the phone far enough away for [N] to use their voice (however quietly). If [N] cannot manage to get started, the parent reads out the start of each sentence and [N] says the last word. Or they swap to counting: first in unison to 10 and then alternately; parent says ‘one’, [N] says ‘two’, parent says ‘three’, etc, up to 10.

The Selective Mutism Resource Manual © Maggie Johnson & Alison Wintgens, 2016

APPENDIX B

Goal

The Remote Talking route

Tips

Repeat until [N] can comfortably read to their parent, or count aloud in turn with their parent, with the handset on the table. Turn taking may be varied by using other rote sequences [N] knows well, such as the days of the week, months of the year, or letters of the alphabet. Optional extras: Encourage [N] to pick up the phone when [A] rings (it’s OK to hand the receiver straight to the parent). Young children can be encouraged to join in when the parent says ‘Bye’ to [A], eg ‘Shall we say “Bye” together? One, two, three … Bye!’. If [N] does not join in, don’t comment – focus only on the earlier success. Answers questions through the parent; adult’s voice is not audible

As above, but when the activity is completed, [A] asks the parent to relay a question to [N] about the reading passage or rote sequence, eg ‘What was Matilda’s brother called?’; ‘What number comes after seventeen?’ The parent then relays the answer to [A]. Repeat until [N] can comfortably answer two or three questions through their parent without whispering (a quiet voice is fine).

All steps begin with a reading or turn-taking activity to get [N]’s voice ‘flowing’. If [N] whispers, the parent puts their hand over the receiver and says ‘There’s no need to whisper’ and repeats the question. If [N] whispers again, repeat the target at the next session. Start with questions that require a single-word answer and gradually increase to phrases and sentences.

Optional extras When [N] seems confident, other questions are introduced at any point of the programme at [A]’s discretion, starting with factual questions rather than opinions, feelings, reasons or explanations. Answers questions through the parent; adult’s voice is audible through speakerphone

Repeat the above with [N]’s device set to speakerphone or loudspeaker, so that [N] can hear [A] throughout the activity. The questions are relayed through the parent as before, ie ‘Can you ask [N] …?’ with the parent repeating the question to [N].

If the phone does not have the loudspeaker facility, omit this step and the next step.

Answers questions through speakerphone

Repeat the above, but this time [A] directs the questions to [N] rather than the parent, ie ‘OK [N], here are today’s questions …’

If [A] cannot hear [N]’s answer, [A] explains that they couldn’t hear and asks [N] to talk into the handset rather than talk louder.

Uses sentences through handset without parent present

As above but, after the reading or turn-taking activity, [N] is asked to pick up the handset which has the effect of blocking the parent out of the conversation. [N] answers two or three questions, says ‘Bye’ and hangs up.

If necessary, the parent can retreat more slowly, eg sitting away from the table rather than leaving the room immediately. If questions are easy, change to descriptions: [A] explains that they would like to picture [N]’s room. [N] is asked to name at least five objects in the room and then to describe certain ones in more detail. [A] adds comments such as ‘That sounds just like my television!’

If [N] answers without waiting for parent to repeat the question, move on to the next step.

[N] is encouraged by parent to say ‘Bye’ at the end of the call.

Repeat with [N] answering the phone and holding the handset throughout. [N] reads aloud to [A] or counts alternately with [A] rather than their parent, and answers two or three questions and/or descriptions (see ‘Tips’).

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APPENDIX B

Goal

The Remote Talking route

Tips

Repeat, omitting the initial reading or turntaking activity and going straight to questions or descriptions. Repeat with the parent some distance from [N] (‘You don’t need me any more’), preferably out of the room but with a door open to oversee the proceedings. When [N] can comfortably talk to [A] without their parent in the same room, arrange for [A] to meet [N] for the final step. Uses sentences face-to-face without parent present

382

The reading or turn-taking activity is repeated in a familiar environment, followed by questions, with [N] and [A] sitting next to, rather than directly opposite, each other. No one else is present and there is no risk of interruption, eg in [N]’s classroom at lunch-time. Additional steps to make the activity easier if necessary Method 1: [A] sits facing away from [N] and does not turn round until [N] is reading fluently. Method 2: [N] and [A] repeat the previous step using handsets in the same building but different rooms. Once [N] is talking to [A], [A] enters [N]’s room as they continue to talk. Method 3: [N] reads to or counts with parent while [A] observes. [A] asks [N] questions (a) through the parent and (b) directly. The parent pulls away until [N] can talk to [A] without the parent present.

Method 2: [A] can walk in backwards if necessary (!) and only turn round once [N] is talking fluently.

Goal

The Voicemail route

Tips

Preparation

[A]’s phone must have a voicemail facility; this is optional for [N] but useful for younger children. Younger children: [A] rings [N]’s phone and leaves a message for [N], or gives them a question to take home. Older children and young people agree a single word or phrase which they will leave on [A]’s voicemail.

If [N] cannot talk when alone, see ‘Lone talking’ programme Stage 3. [A] assures [N] they will not answer the phone.

Comfortable toleration of one word or short phrase being heard through voicemail

[N] leaves a message on [A]’s phone at an agreed time. This could be the answer to a prearranged message or a question from [A], or an agreed word or phrase such as ‘Hello’, or ‘This is Megan’. Note: this is different from making a voice recording which is saved and sent in your own time. [N] is talking ‘live’ for [A] to hear, albeit at a later time, and may not be able to delete and rerecord the message. Therefore, [N] has less control of the outcome and may be much more anxious as a result. [N] may need to ring and hang up several times before they can finally speak. That is fine and the anxiety will eventually pass.

It may help [N] to ring when [A]’s phone is switched off or when [A] has gone out, or to have several ‘dry runs’ without actually making the call (dial or tap in the number and say the message aloud). See ‘Breathing’ in Chapter 10 (page 216).

The Selective Mutism Resource Manual © Maggie Johnson & Alison Wintgens, 2016

APPENDIX B

Goal

The Voicemail route

Tips

Comfortable toleration of sustained voice or messages being heard through voicemail

Children: repeat exchanging voicemail messages with [A] (eg simple question and answer, or guessing games) until [N] can do this comfortably. Young people: build up to talking for longer (eg reading out a favourite poem or a few paragraphs from a magazine or an instruction manual). The content is not important – the focus is on maintaining steady breathing and voice quality, and remembering to pause and breathe in at full stops. The final target is to make this more personal and leave a message listing three or four items. (For example, [N]’s favourite takeaway meal or things [N] has done that day – anything from cleaning their teeth to going on social media to feeding the cat!)

Comfortable toleration of voice being heard ‘live’

[N] leaves a short message while [A] is listening. The message can be the answer to a texted or an emailed question; or ‘Hi, this is [N]’; or a surprise of [N]’s choice. Method 1: if [A]’s phone allows them to screen calls (ie they don’t need to pick up the phone), [A] agrees a time to be at the phone when [N] calls, and listens while they leave the message. Repeat until [N] can do this comfortably. Then repeat with [A] picking up the phone during [N]’s message and signing off as described in Method 2. Method 2: if [A] cannot screen calls, [A] and [N] agree a time and [A] texts [N] to say they are ready for [N] to call. [A] picks up and listens to [N]’s message, briefly acknowledges it, says goodbye and hangs up. [N] says ‘Bye’ if they can, but that is optional.

Method 2: if five full seconds of silence pass after [A] answers the phone, [A] says ‘Hello [N], do you have a message for me?’ If there is no answer after five more seconds, [A] says, ‘Don’t worry, I’ll message you about trying again later, bye!’ and hangs up. Repeat the previous step and this step until successful – or see if Method 1is possible.

Answer two or three questions during a planned telephone conversation and say ‘Bye’

As above, but [N] will tell [A] something that [A] can ask them a question about (eg something they have done that day or are going to be doing shortly). [A] will let [N] speak and then ask a simple question, ie ‘What’s your dog’s name?’ not ‘What made you decide to walk along the tow-path?’ [N] can answer straightaway or, if that feels difficult, [N] hangs up and redials with the answer when they are ready. [A] now asks another question and [N] answers immediately or rings back. After the second or third answer from [N], [A] terminates the exchange, acknowledging how well [N] has done and says ‘Goodbye’. Again, [N] should say ‘Bye’ if it comes easily. Repeat this sequence until [A] says ‘Hi [N]’ when picking up the phone; [N] answers two or three questions without hanging up in between; [A] terminates the call; and [N] says ‘Bye’.

Ideally, N will make the call at a prearranged time but may need a text prompt. Although it seems as if [N] is initiating, which they may find very difficult in real-life situations, the exchange is planned and [N] has full control. [N] decides when they are ready to make the call, is guaranteed a favourable response from [A] and knows what [A] will do.

See the Robot route below for private practice to achieve relaxed breathing, clarity and acceptable volume.

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Goal

The Voicemail route

Tips

Ask a question during a planned telephone conversation

Repeat above sequence but [N]’s brief is to ask [A] something during the exchange in addition to answering two or three questions. [N] is making the call and introducing the initial topic, so [N] can think about this question in advance. Alternatively, [N] may start the exchange by asking a question they have prepared earlier. Repeat until comfortable. (Note: sometimes N will spontaneously combine this step with the previous one.)

[A] can help [N] to ask a question by making a comment after one of [N]’s answers, rather than asking another question, and waiting for several seconds.

Answer the phone at a prearranged time and have a conversation

[N] now gives more control to [A] who will make the call at a prearranged time to ask a question linked to a prearranged topic. [N] picks up the phone and says ‘Hello’ if they can (this will probably depend on having ‘Caller ID’ displayed on their phone). [A] asks the question, acknowledges [N]’s reply and hangs up. Repeat until [N] can precede the conversation with ‘Hello’, answer two or three questions that have not been prearranged, and demonstrates ability to keep the conversation going, rather than relying on [A] to prompt with questions. This depends on age, eg: Children: link two or three sentences together in response to ‘So tell me about …’ or ‘What happened …?’ Young people: respond to one or more of [A]’s statements, such as ‘I saw Mike yesterday’, with either a conversation filler, eg ‘Did you?’, ‘Really?’; a question, eg ‘How was he?’; a reaction, eg ‘Poor you!’; or new information, eg ‘I stayed in bed’, ‘So did I!’.

If there is silence, [A] asks ‘Is that [N]?’ and waits five seconds for [N] to reply. If [N] says ‘Yes’, [A] repeats the original question. If there is no answer, [A] says, ‘Don’t worry, I’ll message you about trying again later, bye!’ and hangs up. Repeat the previous step and this step until successful. Conversation-maintenance techniques can also be practised through texting or instant messaging. (See Chapter 10, page 229.)

Answer the phone and have a conversation

As above, but the time of the call is not prearranged. [N] and [A] should be having a fairly easy conversation at this point: [N] not only answers questions but also occasionally asks questions or introduces new information.

See Chapter 9, ‘Talking to strangers – using the phone’ (page 164), when ready to generalise to other people.

Have a conversation face-to-face

[N] and [A] now arrange to meet. Method 1: [N] and [A] start a conversation on the phone as they approach each other. Once in the same room, they put their handsets down to continue talking face-to-face. Method 2: [N] and [A] agree a shared activity where [A] can do the talking initially and [N] will join in as they feel ready, eg [N] brings something to show [A], such as photographs, artwork or a project; or they do something together that has an element of problem solving, such as a jigsaw puzzle, cooking, or a construction task. [A] introduces questions as indicated in Figure 9.2 (page 153), ‘Introducing questions to a person who has SM’.

Conversation can be difficult when one person is doing more to keep it going than the other. If this is a concern, avoid situations where there is nothing to do but look at each other or the view! A shared focus on completing a task will naturally generate talking points.

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APPENDIX B

Goal

The Robot route

Tips

Preparation

It is important for [N] to understand the rationale for following the programme, which will vary according to individual circumstances and need, . Select one or more of the following explanations as appropriate.

Look out for telephone enquiry lines which use voice-recognition software. Mentors can help by using the service themselves and writing down the available menu options or scripts that are used. For example, the UK TrainTracker™ on 03457 48 49 50 #1 is an automated service which provides rail journey or ticket information after asking a few questions. [N] must answer by talking, rather than opting to use the telephone keypad!

1 Talking to a robot (speech-recognition software) is an excellent way to get accustomed to using the telephone and to practise voice and breathing techniques that are essential to override the physical ‘freeze’ that prevents speech when in a state of heightened anxiety. 2 Well-programmed software is very realistic and creates the illusion of talking to a real person; individual anxiety can therefore be very high to begin with, but quickly falls with practice. This demonstrates how, by facing fear and pushing through it, the brain rapidly learns when fear is irrational and switches off its automatic anxiety response. 3 The robot can only respond accurately to speech of reasonable volume and clarity; therefore, individuals can be confident that if the robot ‘understands’ them, other people will understand too. 4 It is a fact of life that listeners don’t always hear first time round, and working with the robot develops the habit of repeating yourself effectively, without becoming distressed or giving up. 5 Mastery of talking to strangers is the best preparation for a fresh start in settings where the young person does not know anyone. Talking to strangers by telephone is a step towards face-to-face interaction. 6 Being able to make the first approach is both the hardest and most essential part of coping in any community, whether this is a school, college, workplace or social organisation. Having this ability puts you in control: not only do you have more influence, you will also no longer be on guard in case other people approach you. 7 The world is full of strangers who are willing to provide endless opportunities for talking practice, so although it is possible to find answers to most questions through the internet, take advantage of a stranger! Every talking opportunity is a chance to practise control; making talking easier when it really matters.

The advice in point 7 applies to children as well as adults. Children are often expected to talk to ‘safe’ strangers, eg people who talk to them when they are with their parents. See Chapter 9, page 161 for further guidance.

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APPENDIX B

386

Goal

The Robot route

Tips

Talk comfortably to a robot

[N] calls the robot as often as necessary until they can complete a task without hanging up. (For example, find out what time the next train for London leaves Manchester Piccadilly and how much a ticket costs with a Young Person’s Railcard). Ideally, [N] will complete without having to repeat themselves because this will show they are using good pace and volume. But background noise and a poor signal often interfere with voice quality, so the important point is for [N] to stay calm, and repeat themselves louder and more clearly whenever necessary (eg take a deeper breath, release more air, open their mouth and move their lips more as they speak).

Remind [N] that they have complete control and can hang up without offending anyone! See ‘Breathing’ in Chapter 10 (page 216).

Talk comfortably to a stranger on the phone – ask a question

[N] calls a stranger, either to ask a simple question (eg what time the library opens or whether a certain item is in stock) or runs through the same robot enquiry with a real person. For example, option 2 on UK TrainTracker™ goes to a National Rail customer service agent, or private train operators such as Virgin Telesales will ask very similar questions if [N] says they need to check a ticket price. Repeat with as many different short enquiries as possible, until feeling comfortable and in control.

Even though this is a real person, [N] still has the option to hang up without causing offence! Lines go dead, emergencies happen … service agents are used to it.

Talk comfortably to a stranger on the phone – complete a transaction

[N] now makes a call which they need to see through – if they hang up, the onus is on them to call back to complete or restart the transaction. These calls usually require more talk, but can be a lot more rewarding! Examples are placing an order (eg for pizza, takeaway, shopping channel purchase, insurance, theatre tickets) or making an appointment (eg for a haircut, manicure, gym induction, driving test). Once successful, [N] repeats the challenge while imagining making eye contact with the person as they speak. Repeat until it feels comfortable.

Write down the information you will need in advance, in case your mind goes blank: details of the order, full delivery address, possible dates, etc. Cut out a life-size face from a magazine, stick it on the wall and talk to it!

Talk comfortably to a stranger in the community – ask a question or request an item and end the transaction appropriately

[N] covers the following steps in whichever order they choose – it doesn’t matter if [N] already knows the answer; this is about making anxiety disappear through repetition and practice.

[N] should choose settings where they feel most comfortable initially: some people prefer a noisy background to mask their voice, eg a supermarket or night club; some prefer an empty shop, café or quiet street where they won’t be overheard by other people – particularly people they know. Practise aloud at home first while visualising every detail of the chosen setting.

1 Request an item at a shop, café or ice-cream van (the server is expecting a request and usually initiates the exchange), eg purchase a first-class stamp, burger or drink. 2 Ask a question at a reception desk, information point or ticket office, or approach a shop assistant, eg ask the time of the next train or where the magazines are. (There is a greater need to be clear as this is less predictable than a food order, but it is the person’s job to be helpful.).

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APPENDIX B

Goal

The Robot route

Tips

3 Approach a stranger in the street to ask a question, eg what time it is, directions to the café, small change in exchange for a note. [N] must work out how to get the stranger’s attention and will have to say ‘Excuse me’ or ‘Hi’ and wait for eye contact before speaking. If [N] doesn’t wait for eye contact (the signal that the person is listening), there is a strong chance that [N] will need to repeat their question. ([N] should always be prepared for this, of course!) Simple questions will allow [N] to leave without further discussion. A smile and a nod will do, but add ‘Thank you’ as soon as possible. Gradually tackle venues with more people around and more possibility of being overheard. Talk comfortably to a stranger in the community – complete a longer transaction

As above, but with more complex enquiries that take longer to complete, eg ordering several items of food; asking the times and prices of train tickets; asking how to join the library/ leisure centre/ art class; finding out the difference between two computer games or food brands; booking a holiday; opening a bank account; going for a test-drive; enquiring about work opportunities or becoming a volunteer; asking for help to change a car tyre or move some furniture.

Prove to yourself that you can cope with anything and deliberately do something outlandish! Go into several shops, asking for whatever the shop nextdoor sells¦… Smile at ‘safe’ strangers as you pass them by Ring the pizzeria and order a Chinese meal … It is unlikely that people you know will comment but rehearse a reply just in case. Agreeing with people quickly puts an end to the matter, e.g. ‘Yeah, I never had much to say in those days …’

[N] gradually works towards approaching unsuspecting strangers (people in the street rather than community workers) , talking in front of bystanders and, ultimately, talking in places where they may be observed by people who know them and have never seen them speak before. Move freely in community settings

[N] identifies the reasons they avoid certain places and devises a plan to address specific anxieties. ‘I will always be an anxious person but I control the anxiety, it doesn’t control me.’

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• To use gesture without body tension to communicate with [A]

Stage 3: Non-verbal and written communication

• To establish effective twoway email communication • To understand [A]’s role in helping them overcome their anxiety and participate in a small-steps programme, knowing it will move at their pace

or

Programme goals

Stage of one-toone interaction

Note: if [N] feels they could read aloud to [A], or read aloud in an adjacent room without too much difficulty, try jumping ahead to or and starting the Lone Talking programme at these points – you can always backtrack if necessary.

• Understand that the lone-talking approach involves starting at the point of lowest anxiety and very gradually allowing someone to approach until the physical anxiety reaction is no longer triggered. • When alone, try talking aloud to a toy, pet or baby who will not answer back, or singing along to music. • Practise talking alone, counting to 20 or reading aloud (wherever [N] feels comfortable, ie out of earshot of other people).

As part of rapport building and understanding of SM, [A] and [N] establish that [N] can speak easily when their intense anxiety reaction is not triggered. It will be helpful for [N] to speak aloud when alone and tune into the sensations in their body when their throat, shoulders and breathing are relaxed, allowing their voice to flow. In contrast, when their speech anxiety is triggered, muscular tension freezes their vocal cords and makes it difficult to breathe.

Lone talking programme targets

Intervention plan: select age-appropriate materials and targets

Note: [A] sometimes adds sound (eg mimes whiskers plus ‘meow’ for cat; zig-zag arm motion plus ‘ssss’ for snake) and provides pictures where blowing would be a good clue (eg birthday cake with lit candles; blowing bubbles). Sound is optional for [N] but may come naturally. Move on to the next stage when [N] achieves targets with relaxed posture, movements and facial expression. If [N] spontaneously begins to use sound, bypass the talking bridge and go straight to Stage 5.

• Point to the appropriate picture, object or word, in response to a factual question (eg ‘Which one do you write with?’; ‘Who’s got a beard and a hat?’). • Point to indicate choice (eg the next activity; a friend to work with; preferred drink or snack). • Point to answer a personal question (eg ‘Which of these do you like best?’; ‘Have you got any of these pets?’). • Nod, shake head or shrug to indicate if [A] has labelled or described picture correctly. • Nod, shake head or shrug to answer [A]’s questions in a guessing game (eg ‘Is it a bird?’) • Nod or shake head in quick-fire question routine (eg ‘Do babies cry, do fish swim, do trees laugh?’). • Interpret [A]’s mime or gesture and select a matching picture (eg flapping arms might indicate a bird). • Reverse roles. Give [A] a clue through gesture or mime (eg hand on head might indicate a hat).

Shaping programme targets

2  Lone talking and shaping programmes (smallest steps for the most anxious individuals and most entrenched SM)

APPENDIX B

The Selective Mutism Resource Manual © Maggie Johnson & Alison Wintgens, 2016

Talking bridge: Comfortable toleration of voice being heard

• Allow [A] to hear a voice recording • Speak while [A] listens at a distance, not watching [N]

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Note: [A] moves further away if [N] starts to whisper or feels too inhibited to speak. Repeat until [A] is in the adjacent room and [N] is talking at audible volume and then implement the Sliding-in Technique as follows (if reading aloud has become difficult, swap to counting). No recording is necessary from this point.

• As above, until [N] can count to 10 or read a few sentences aloud with [A] in an adjacent room.

Note: Ensure that [N] is in a private room and won’t be interrupted and keep the task short. [N] can play music near the door if worried other people are going to overhear. It is not essential for [N] to record self if they prefer not to and can talk aloud without this focus, but the playback to [A] provides additional desensitisation.

• Play recording to [A] or email it to them. ([N] may need reassurance that this will be deleted as soon as [A] has listened to it.) • Repeat the recording and playback activities, increasing to counting up to 20, reciting the alphabet or reading a short passage. • Practise counting or reading aloud or reciting sequences such as months of the year or the alphabet in other places when alone (eg in the park, garden, car, when walking the dog). • Repeat the recording activities in the same building as [A], and play them back.

Note: [N] should choose the task they think will be easier. If they can’t decide, go for counting. Can limit this to counting to five or reading one sentence initially. Children may prefer to choose from two or three sentences, rather than think of their own, eg ‘My name is …’; ‘I live in …’; I go to [name of school]’.

• Record yourself counting or reading aloud at home (or wherever [N] feels most comfortable).

Note: Reassure [N] that no one else will hear and, if appropriate, follow this target by listening to the recording together. If [N] professes to hate the sound of their voice, see ‘Desensitisation using voice recordings’ in Chapter 9 (page 157).

• Allow [A] to hear voice by providing them with an existing audio or video recording if you have one.

• Record a sound1 with [A] outside the room (the door is shut). This could be a letter sound or an animal/transport sound, etc. (If this is difficult with [A] outside the room, try it with [A] in another part of the building or do it with a friend.) • Play the sound to [A]. (Exploring audio-visual effects, using Microsoft® Windows Media Player or equivalent, can help to desensitise [N] to the sound of their own voice.). • Repeat the recording and playback activities with different sounds. • Repeat the recording and playback activities with [N]’s choice of sound and [A] must find the matching picture or letter. (This is good for increasing volume if necessary, but note that the distinction between ‘s’ and ‘f’ is very poor on some recording devices.)

For the next two activities, [A] sets up and demonstrates the use of a suitable recording device.2 This could include playing the recorded sound on ‘repeat’ setting using Microsoft® Windows Media Player or equivalent, and showing the choice of visualisations available to [N] for their own recording. [A] leaves the room while [N] records an agreed sound set by [A] or chosen by [N] from a choice of three to five sounds. Agree a signal to let [A] know when done (eg open the door, ring a bell).

• Say matching letter sound (phoneme)1 when parent presents corresponding letter or picture symbol. (Substitute letter sounds with animal sounds1 and pictures if more appropriate, (eg ‘sss’ for snake, ‘eek!’ for mouse). • Say sounds1 as above while parent records the activity at home (one sound is fine to begin with), using a suitable recording device.2 • Play recording to [A] on the understanding that no one else will hear it. ([N] may initially prefer [A] to listen to it without them.) • Repeat the above activities until comfortable playing [A] a recording of several sounds.

Note: If parent can be part of the programme at a distance, the next two activities are done at home. If not, omit the next four steps.

• Listen to [A] saying a letter sound (phoneme) and select the corresponding letter or picture symbol. (Where appropriate, use current school reading scheme whenever possible.)

Recording sounds

APPENDIX B

389

Stage of one-toone interaction

Programme goals

390 Note: It is usually easier if [A] starts and speaks first. If the reading route has been chosen, a poem with traditional rhyming verses will keep the pace going as [A] and [N] alternate lines, but any familiar text will do.)

• Repeat the recording and playback activities, recording a sequence of two and then three sounds (either repeated sounds, eg ‘p – p – p’ or different sounds, eg ‘p – t – s’). • Repeat the recording and playback activities, alternating paired unvoiced and voiced sounds (eg ‘ssss (snake), zzzz (bumble bee)’; ‘t, d, t, d’; ‘k, g, k, g’; ‘p, b, p, b’) and making them sound different.

• Repeat the talking activity with [A] in an adjacent room with the door pulled to but not closed. • Repeat with [A] in an adjacent room and the door slightly open. • Repeat with the door slightly more open. • (Now [A] joins in, speaking from outside the room.) Take it in turns to count, name days of the week, months of the year, letters of the alphabet or read sentences from a chosen text.

• Repeat the recording and playback activities using letter names rather than sounds, eg M (‘em’) rather than ‘mm’; T (‘tee’) rather than ‘t’. • Work out which letter names sound like words and record these again, knowing they are words (eg pea, tea, bee, sea). • Work out and record more rhyming words (eg me, knee, we, she). • Listen to a single word clue (e.g. desk) and find a hidden object. • Reverse roles. Record the name of a clue or a hiding place with [A] outside the room, and play it back to [A]. (A range of suitable clues can be agreed beforehand to reduce indecision, eg book, chair, bag, red, clock.) • Record a single-word answer to a question and play it back. For example, [A] sets a question ‘What is under the blue cushion?’ and leaves the room while [N] records the answer; [N] answers a factual question on a Talking Postcard or Language Master® card. • Record counting up to five and play it to [A].

Recording words

Go to Stage 5 ‘Shaping targets’.

• Record a sound with [A] present but sitting at a different table with their back turned. Play it back to [A] at [N]’s table. • Repeat with different individual sounds and sequences of two to three sounds until comfortable recording both whispered and voiced sounds with [A] on the other side of the room with back turned.

Recording sounds as [A] listens

Note: it may be better to omit the next group of activities and start recording words before [A] joins [N]. However, if [N] is reporting low anxiety, it can help for [A] to join [N] sooner with the next group of activities and, from there, move quickly to Stages 5 and 6.

Shaping programme targets

Lone talking programme targets

Intervention plan: select age-appropriate materials and targets

APPENDIX B

The Selective Mutism Resource Manual © Maggie Johnson & Alison Wintgens, 2016

Stage 5: Using voice with [A] (but not communicating)

The Selective Mutism Resource Manual © Maggie Johnson & Alison Wintgens, 2016

• Read familiar material aloud • Recite rote sequences

Lone talking

• Make unvoiced speech sounds (eg ‘s’, ‘f’, ‘p’) • Make voiced sounds (eg humming, ‘m’, ‘g’)

Shaping

•  Read a short passage aloud. • Read a short passage, a play script, poem or magazine article, etc, alternating dialogue, lines or sentences with [A].

It is important that [N] speaks at audible volume (not necessarily their normal volume) throughout. If [N] whispers, backtrack until audible volume is restored and continue in smaller steps (see Sliding-in Technique on Handout 16 for examples). Only do the next two activities if [N] has chosen the reading route and/ or is a proficient reader.

• Repeat the above target and continue speaking at audible volume as [A] walks in through the open door and sits just inside the room. • Repeat with a longer sequence (eg count to 30 or do the whole alphabet) and continue speaking at audible volume as [A] walks in through the open door and joins [N]. • As above, but after [A] sits with [N], continue immediately with a different sequence or reading passage.

• The target is to blow audibly. Play a game that requires blowing, such as ‘blow-football’; blow out 10 candles as quickly as possible; blow a bigger bubble or more bubbles than [A]; or blow bits of tissue off the table. • Produce sound by tapping (triangle, chime bar), blowing (recorder, whistle), sucking (mouth organ) and humming (kazoo). (Humming is the difficult one for individuals with SM but may come naturally if the kazoo is introduced with other instruments.) • Listen to [A] make a sound1 (eg ‘sh!’, ‘sssss’), and select the matching picture or object (eg sleeping baby, snake). • Swap roles, select a picture or an object and make a sound1 that will enable [A] to identify the correct match. • Repeat with two and then three turns or sounds each. • Record sounds on computer microphone and have fun playing them back on repeat setting using Microsoft® Windows Media Player or equivalent for amazing visualisation effects.

For individuals bypassing the talking bridge stage

Bypass Stage 5 and go to Stage 6.

•  Repeat with different words until comfortable recording words with audible voice with [A] on the other side of the room, back turned. •  Repeat counting ‘1, 2’; ‘1, 2, 3’; and finally ‘1, 2, 3, 4, 5’.

[A] goes outside again and pulls the door to but does not close it. [N] records word with the door not quite shut. Next time, [A] leaves the door open a fraction more when going outside, and so on, until they can overhear the recording being made. Finally, [A] enters as [N] makes the recording.

If [N] finds it hard to maintain voice with [A] in the room, swap to the Lone Talking programme, talking bridge, 7th target (look for symbol), or continue with single words, using the Sliding-in Technique as follows.

• Record a word with [A] present but sitting at a different table with their back turned. Play it back to [A] at [N]’s table.

Recording words as [A] listens

APPENDIX B

391

392

Stage 6: Communication using single words

Stage of one-toone interaction

• Use audible single words with appropriate eye contact in a structured situation • Be sufficiently comfortable to make fleeting eye contact while speaking

Programme goals

• Listen to [A] saying a letter sound (phoneme)1 and select the corresponding letter or picture symbol. (Use current school reading scheme whenever possible.) • Say matching letter sound (phoneme)1 when [A] presents corresponding letter or picture symbol. • Repeat the above activities using letter names rather than sounds, ie M (‘em’) rather than ‘mm’; T (‘tee’) rather than ‘t’. • Work out which letter names sound like words and say them again, knowing they are words (eg pea, tea, bee, sea). Name pictures or read words aloud.

For all individuals

The Selective Mutism Resource Manual © Maggie Johnson & Alison Wintgens, 2016

• Count to 10, taking it in turns with [A]. ([A] starts and finishes, so [N] says the even numbers.) • Repeat, alternating days of the week, months of the year and letters of the alphabet as appropriate. •  Complete one or more low risk single-word activities.3 • Complete one or more medium risk single-word activities3 then go to Stage 7. After Stage 7 medium high risk activities have been completed, return to Stage 6 for the next target. • Complete one or more high risk single-word activities.3

For all individuals, including those progressing from the Lone Talking targets (see Handout 18, ‘The reading route’, for more detail)

• Now stop recording. Count to five, taking it in turns with [A]. [(A] starts and finishes, so [N] says numbers 2 and 4.) • Repeat, counting to 10 alternately with [A]. • Repeat, counting to 10 alternately with [A] as [A] approaches and sits at [N]’s table.

For individuals progressing from the talking bridge word targets

• Take each word and agree a longer word with [A]. Say the longer word after [A] prompts with the short word (eg ‘pea, piece’; ‘tea, team’; ‘bee, beak’; ‘sea, seat’). • Swap to counting. Say the next number when [A] gives a number prompt (eg ‘1, 2’; ‘4, 5’; ‘9, 10’) and do this three to five times. •  Count to five, taking it in turns with [A]. ([A] starts and finishes, so [N] says numbers 2 and 4.)

For individuals progressing from the Stage 5 shaping targets

For individuals progressing from the Talking bridge sound targets: Move from recording the sounds to saying them directly to [A].

Go to Stage 6 where the emphasis is on two-way communication rather than simply saying words. [N] should quickly pass through Stage 6 to Stage 7.

• Say sounds with [A] on the other side of the room, back turned. • Repeat as [A] approaches and sits at the same table.

Shaping programme targets

Lone talking programme targets

Intervention plan: select age-appropriate materials and targets

APPENDIX B

Stage 7 Communication using phrases and sentences

See Table 10.6 in Chapter 10 and Appendix A for appropriate activities at different risk levels.

Suitable recording devices include a Talking Tin, Talking Postcard, Language Master®, MP3 player, smartphone, laptop or tablet (see Appendix F, ‘Talking resources’).

2

3

See Appendix A, Stage 5, for the best order to introduce sounds in the Shaping programme (unvoiced before voiced sounds).

Note: Extra targets may be needed for eye contact – see Appendix A.

• Complete one or more low risk sentence activities.3 • Complete one or more medium low risk sentence activities.3 •  Repeat low risk activities with other people and in other settings (generalisation) and • Continue with higher risk single-word and sentence activities on a one-to-one basis.3

1

Notes

• Use audible sentences with appropriate eye contact in a structured situation

APPENDIX B

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APPENDIX C

1 Examples of target setting for children requiring a structured small-steps approach to intervention Example 1: Establishing speech using the Sliding-in Technique – a visual approach Child

Robbie (aged 6) with early onset SM associated with high-functioning autism. Session held at multi-agency centre which he had attended several weeks running. He had spoken to his parents in the waiting room and whispered to them during assessment.

Objective

To establish speech with the speech and language therapist [M] and psychologist [J] for the first time.

Timescale

A 60-minute session; 30 minutes for rapport building and the Pep Talk, and 30 minutes for targets.

Recording system

Targets drawn as a series of cartoons to aid Robbie’s very literal comprehension and need for concrete examples. As each was achieved, he selected a gold or silver star to stick on the cartoon.

Comments

Robbie helped to agree the sequence below where asterisked, by choosing from two pictures to indicate who should approach the room first. Robbie stuck rigidly to the targets and did no more than was required each time. At the next session (at home), the parents slid out and Robbie answered [M]’s questions about his toys. At the third session (at school), he joined in with his mother’s conversation, and spoke spontaneously to [M] for the first time.

1

M

APPENDIX C

EXAMPLES OF PROGRAMME TARGETS, RECORDING SYSTEMS AND INDIVIDUAL EDUCATION PLANS

J

Play picturematching game with Mum and Dad. [J] and [M] upstairs

P

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APPENDIX C

2

M

J Picture-matching game, [J] and [M] in next room.

3*

J

M Change to rote counting, taking it in turns. [J] go up to door.

4

J

M Rote counting, taking it in turns, door will open slightly.

5

J

M Rote counting, taking it in turns, door will open a bit wider

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6

J

M Rote counting, taking it in turns, door will open fully.

7

J

M Rote counting, [J] will enter and sit at table.

8

J

M Rote counting, [J] will enter, sit at table and join in counting.

9

J M

Rote counting, [M] will enter, sit at table and join in counting.

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10

All seated at table, taking it in turns to

M

J

count to 10, say days of the week, and months of the year.

11 Take it in turns to answer a ‘Yes/No’ question, read out by [M] (communicating with single words: respond). 12 Take it in turns to name a picture for the next person to find the pair (communicating with single words: initiate). 13 Take it in turns to read ‘Yes/No’ questions (reading sentences). 14 Take it in turns to say what a picture is used for; the next person finds the pair (communicating with sentences: initiate).

Example 2: Establishing speech using a shaping programme with voice recordings (Stages 4 and 6) Child

A boy, Harvey (aged 8 years 6 months), with long-standing SM, attending a small residential school.

Objective

To establish speech at normal volume, with good eye contact.

Timescale

Four 10-minute sessions.

Recording system

Targets written on individual cards and stored in a cardex box. Star stuck on a space-rocket picture as each was achieved. Certain cards allowed Harvey to choose the next activity.

Comments

KW = keyworker Harvey had not yet spoken in the presence of KW, and rarely made direct eye contact at this stage; targets therefore progressed in tiny steps. Using a Language Master® was very successful in achieving acceptable volume because Harvey wanted to hear his answers! Each day, the last successful target was repeated before going on to a new one. Once spontaneous speech occurred, targets were more ambitious, and the generalisation phase progressed at a much faster pace.

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Target

Place

Date achieved

  1  Record last word of four sentences on Language Master® alone and play to KW.

Withdrawal room

17/3

  2  Record last word of four sentences on Language Master® with KW present.

Withdrawal room

17/3

  3  Record answers to four questions on Language Master® alone and play to KW.

Withdrawal room

17/3

  4  Record answers to four questions on Language Master® with KW present.

Withdrawal room

18/3

  5 Select the next activity by recording choice on Language Master® alone and play to KW.

Withdrawal room

18/3

  6  Name five hidden pictures while KW gives clues and looks down.

Withdrawal room

18/3

  7  Record names of five pictures on Language Master® with KW present.

Withdrawal room

18/3

  8  Name five hidden pictures, facing KW (can look at table), while KW gives clues.

Withdrawal room

19/3

  9  Select a sweet (naming colour) while KW looks away.

Withdrawal room

19/3

10  Name five pictures, taking it in turns with KW, with KW looking down at table.

Withdrawal room

19/3

11  Answer five questions, ‘Yes’ or ‘No’ while KW looks down at paper.

Withdrawal room

19/3

12  Pick a sweet (naming colour) while facing KW (can look at table).

Withdrawal room

19/3

13 Name five pictures, taking it in turns with KW, face-to-face, looking at KW while KW speaks.

Withdrawal room

22/3

14  Select the next activity by recording choice on Language Master® with KW present.

Withdrawal room

22/3

15 Find out secret password (a picture hidden in the next room). Return and tell KW, making eye contact either before or after speaking.

Withdrawal room

22/3

16  Answer five questions ‘Yes’ or ‘No’, face-to-face, and making eye contact.

Withdrawal room

22/3

17  Name five pictures held up by KW, face-to-face, looking at KW between each one.

Withdrawal room

22/3

18  Select the next activity by speaking directly to KW and making eye contact.

Withdrawal room

22/3

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Example 3: Building confidence after speaking for the first time (Stages 6 and 7) Child

A girl, Ruth, aged 6 years 6 months. Speech recently established with class teacher [T] using the Sliding-in Technique with clinic keyworker as Ruth’s talking partner.

Objective

For [T] to become the school-based keyworker, and build Ruth’s confidence in talking on an individual basis, before phasing in other class members.

Timescale

Five 10-minute sessions.

Recording system

Targets were written on a checklist and ticked off each time they were achieved. They were all activities Ruth had done with the previous keyworker and they could be done in any order. Each day, one or two successful targets were repeated, and then Ruth chose, or [T] decided on, a new target or targets. The parents agreed that Ruth could have the new pencil case she wanted when all of the targets were completed.

Comments

Sessions were held after school in the empty classroom, before Ruth was collected by her mother. This programme was devised from the anxiety hierarchy in Table 10.4 in Chapter 10. Examples of the activities are included in Appendix A, Stages 6 and 7.

Target

400

Achieved (P)

 1

Counting together

 2

Counting in turn:

 3

Reading together

 4

Reading in turn:

one word each one line each one sentence each one paragraph each one page each two pages each

 5

‘Yes/No’ questions:

answer five answer ten

 6

Name five objects Miss T points to

 7

Choose five objects to name

 8

Choose ten objects to name

 9

Easy questions (one-word answer):

answer five answer ten

10

Complete a sentence:

five one-word answers five phrases ten phrases

11

Favourites:

complete five complete ten

one number each two numbers each five numbers each

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Example 4: Generalising to a new person and a different setting Child

A boy, Robbie (aged 6), with early onset SM associated with high-functioning autism. Session held in school.

Objective

To establish speech with class teacher [T], transfer to empty classroom setting, and slide out mother and therapist [M]. [T] to take over as keyworker.

Timescale

A 30-minute session (including time taken to transfer rooms).

Recording system

Targets drawn as a series of cartoons to aid Robbie’s very literal comprehension and need for concrete examples. After each achievement he stuck a gold or silver star on the cartoon. Some cartoons were worth more than one star.

Comments

This is the fourth session with the child in Example 1. The game ‘Guess Who?’ was chosen as a sentencelevel activity because Robbie often played it with his parents at home. After this session, Robbie was happy to spend five minutes on talking activities with his teacher in the classroom at lunch-times and, in the second week, new children took it in turns to join in.

1

Withdrawal room

Counting circle with Mum and [M]. [T] waits

M

T

outside and comes in, a few seconds after [M] opens the door. [T] slowly walks over and joins in.

2

Withdrawal room

M

T

Days of the week, and months of the year. Yes/No questions.

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3

Classroom

Repeat counting to 12, days of the week, and months of the year in the classroom.

M

T

Then [R] and Mum play Guess Who? against [M] and [T].

4

Classroom

T

M

[R] plays Guess Who? against [T]. [M] and Mum watch, then wait by the door.

5

Classroom

T

M [R] plays Picture Pairs with [T]. [M] watches and Mum waits outside.

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Classroom

T

M

[R] plays Picture Pairs with [T]. [M] and Mum wait outside.

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Example 5: Generalising to a range of people, using a talking circle Child

A girl, Kelly (aged 13), with long-standing SM, attending a large high school.

Objective

To talk to more teachers.

Timescale

A 20-minute session, held in the school lunch-hour in the interview room.

Recording system

Targets presented as a checklist (see below) and ticked off by Kelly.

Comments:

Speech had already been established with the speech and language therapist [M] and a favourite teacher [A] using the Sliding-in Technique. Session was facilitated by [M], who was acting on an advisory basis and had not seen Kelly for several months. On this occasion, three new teachers were introduced to Kelly, but larger groups are possible. The second target (asterisked) was included as a gentle introduction but, if sessions were held more regularly, it could be omitted. Different people can start off each activity, but often it is useful if the facilitator starts, to demonstrate the activity.

Target

404

Place

Talking circle (counting) with [M] and [A] and other teachers outside.

Interview room

*Talking circle (counting) with [M] and [A]. First teacher enters and joins in.

Interview room

Talking circle (counting) with [M], [A] and new teacher. Remaining teachers enter one at a time and join in.

Interview room

Talking circle (days of the week) with [M], [A] and new teachers.

Interview room

Talking circle (months of the year) with [M], [A] and new teachers.

Interview room

‘Yes/No’ questions using silly or sensible questions (see Appendix A). Answer ‘Yes’ or ‘No’ to each adult.

Interview room

Reading aloud around the circle. Ask the person on your left a ‘Yes/No’ question.

Interview room

Reverse direction. Reading aloud around the circle. Ask the person on your right a ‘Yes/No’ question.

Interview room

Thinking up a question – select a card, and ask a question that will make the person on your left answer with the word on the card. Then reverse direction.

Interview room

Thinking up a question – ask a round of questions that will make each person answer using the word on selected cards.

Interview room

Name throwing. If you are pointed to with the left hand, say the name of the person on your left. If you are pointed to with the right hand, say name of person on your right. Then it’s your turn to point. Can we do 30 seconds at top speed without a mistake?!

Interview room

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Example 6: Generalising to a range of people, in a larger group Child

A girl, Sian (aged 7), with early onset SM in a class of 35 students.

Objective

To talk with teacher and other children in a larger group and, ultimately, to contribute to class discussions.

Timescale

Daily 10-minute sessions, for two weeks.

Recording system

Targets were written on individual cards, and a star was added to each as the target was completed.

Comments:

A classroom assistant is the keyworker (KW). The teacher is keen to be involved as soon as possible to avoid Sian getting too used to speaking to only one adult. If Sian had seemed anxious at any step, it would have been repeated once before moving on. Some sessions were held during morning assembly, when most of the children were in the main hall, so that Sian could work in the empty classroom.

Target

Place

Date achieved

  1 Play ‘Where’s the Spider?’ (preposition cards) with KW.

Resource room

9/10

  2 Play ‘Where’s the Spider?’ with KW and teacher comes in to listen.

Resource room

9/10

  3 Play ‘Guess Who?’ (enquiry and elimination) with KW.

Empty classroom

10/10

  4 Play ‘Guess Who?’ with KW and teacher.

Empty classroom

10/10

  5 Play ‘Where’s the Spider?’ with KW and one child (you can choose who).

Empty classroom

11/10

  6 Play phonics game with KW, teacher and same child.

Empty classroom

11/10

  7 Play ‘Where’s the Spider?’ with KW and three children (you can choose who).

Empty classroom

14/10

  8 Play reading game with KW and the same three children.

Empty classroom

14/10

  9 Play ‘Happy Families’ with KW and three children (one new child).

Empty classroom

15/10

10 Play ‘Happy Families’ with KW and all four children.

Empty classroom

16/10

11 Play ‘Where’s the Spider?’ with KW and the same four children in the library corner, while others are getting on with their work.

Classroom

17/10

12 Play phonics game with four children (pick one new one) and KW while others are getting on with their work. Your teacher joins in.

Classroom

18/10

13 Play phonics game with four children (pick one new one) and KW while others are getting on with their work.

Classroom

21/10

14 Read to your teacher at her desk while others are getting on with their work.

Classroom

21/10

General

22/10

15 Find five things beginning with ‘s’ as you walk around the school with KW and familiar children. (Each child has their own letter.)

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Example 7: Generalising to a new person in a more public setting, using a telephone programme Child

A boy, Harvey, 8 years 9 months old, with early onset SM, attending a small residential school.

Objective

To talk to other members of staff around the school.

Timescale

Four 5- to 10-minute sessions.

Recording system

Targets are written on graph paper, and a square is coloured in when the target is achieved. Harvey can choose a trick from the joke shop when all of the squares are filled in.

Comments:

KW = keyworker. This is a later session with the child in Example 2 By now, he talked freely and spontaneously to KW, and to his teacher and classmates in structured situations. Sessions were rarely held in the withdrawal room. He remained very self-conscious about being overheard by people who had not been formally introduced to his talking circle. The secretary was primed for targets 4–8 below.

Target

406

Place

Date achieved

1 Answer three questions (which can be answered with a single word) when phoned by KW.

Top landing

9/6

2 As above, plus say ‘Hello’ and ‘Goodbye’ to KW on the phone.

Top landing

9/6

3 Phone KW at home that evening, give name in response to ‘Who’s speaking?’, answer a question and say ‘Goodbye’.

Top landing

9/6

4 Collect a message from the school secretary and pass it on to KW.

Main office

9/6

5 Phone the school secretary with KW, give name in response to ‘Who’s speaking?’, answer a question and say ‘Goodbye’.

Deputy head’s office

11/6

6 Phone the school secretary without KW, give name in response to ‘Who’s speaking?’, pass on a message from KW and say ‘Goodbye’.

Deputy head’s office

12/6

7 Knock on the door, give a note to the school secretary, say who it is from in response to a question, and say ‘Goodbye’. KW waits outside the office.

Main office

12/6

8 Go to the office, show good work to the school secretary, answer two or three questions about it, and say whether you would like a gold or silver star. KW waits in the classroom.

Main office

15/6

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Example 8: Speaking to a familiar adult for the first time using the ‘Voicemail’ and ‘Robot’ telephone programme Adult

An adult female, Becky (aged 32), who has long-standing (only recently diagnosed) SM.

Objective

To talk to therapist [M], having met on three previous occasions when Beckycommunicated by smartphone or iPad text and gesture.

Timescale

Intermittent email contact over a two month period to establish phone conversation.

Recording system

Email dialogue.

Comments:

After the programme and one more phone conversation with [M], Becky was able to talk to [M] faceto-face when they met 10 months later. In the interim period, Becky created an abridged version of her telephone targets to talk to other adults face-to-face for the first time. Becky reported that she had benefited from: (a) extra work on breathing and breath control, to help her relax and allow her voice to flow; (b) adopting a behavioural small-steps approach (she had previously viewed her difficulty speaking as a purely emotional issue, dependent on how people treated her); (c) being prepared for the need to repeat herself when people didn’t hear her clearly the first time.

Target

Mode

Date achieved

1 Leave a single-word voicemail message (‘Hi’ or ‘Hello’) on [M]’s phone, and repeat until anxiety is significantly reduced. [M] is not listening.

Voicemail

23/3

2 As above, building up to a sentence spoken in one breath.

Voicemail

29/3

3 As above, read aloud for 30 seconds (until [M]’s phone beeps!), concentrating on breathing, voice flow and pace, rather than content.

Voicemail

10/4

4 As above, leave a message of several sentences about daily activities, with same pace and breath control as when reading aloud.

Voicemail

19/4

5 Phone Train Tracker™ and complete a ticket enquiry to get used to being heard ‘live’, maintaining good volume and pace, and repeating self when necessary.

Talk ‘live’ to robot

10/5

6 Leave a voicemail message for [M], knowing that [M] could be listening. ([M] goes into the office on hearing the phone.)

Talk ‘live’ as [M] listens

14/5

7 Leave a voice message at a prearranged time, knowing that [M] will pick up at the end of the message and ask a question. Becky may answer or respond later if preferred. (Outcome: Becky answered [M] and went on to both ask and answer several more questions.)

Phone conversation

15/5

Face-to-face conversation

29/3

Break in target setting as no opportunity to meet 8 Show [M] photos and answer questions face-to-face. (Outcome: Becky able to have a natural conversation with [M], despite having only one more telephone conversation with [M] in the interim period.)

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2 Examples of children’s recording systems Example 1: Jade, aged 5 years, working with her mother and a therapist. Jade added a sticker after each completed target.

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Example 2: Siblings, aged 8, 12 and 14 years, all with SM After each target was completed with Mum and the therapist, Douglas (14), Caitlin (12) and Rose (8) rated their talking anxiety level from 0 (no anxiety) to 5 (panic stations). They took it in turns to go first when entering their rating.

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Example 3: Kelly, aged 13 years Targets were written on index cards in a box kept by the keyworker, ticked off by Kelly and dated on completion. The aim was for Kelly to tolerate being overheard by other people in the school.

3 Examples of individual education plans, targets and reviews Example 1: Transition phase This example is in the printed manual. See Box 11.2 in Chapter 11 for an example of a plan to support the transition of a girl aged 11 to secondary (high) school.

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Example 2: Generalisation phase Jodie, aged 7     Review of speech/social targets     2nd November 2015 Presenting difficulty Jodie talks easily to other children but rarely if adults are present. Jodie’s teacher is her keyworker so small-group work is only possible in the classroom. Previous targets and progress made • Jodie made a smooth transition to Year 2 in September and is able to read to her new class teacher (Mrs Kane), both individually and as part of a small group. Her reading targets were therefore extended at the end of September, to encourage spoken responses in the classroom. • Each week Jodie knows she will be asked four prearranged questions, and that these will be at different times during the school day. • At first, Mrs Kane was careful to ask Jodie a question when no other classmates were near but recently she has been able to ask a question when Jodie is in close proximity with other children. • Jodie has responded every time with a single word, and has also been able to raise the volume when Mrs Kane says ‘Pardon’. • Mrs Kane has related the questions to classroom topics, meaning that Jodie can respond during a relevant activity, rather than speaking only in designated reading sessions. This represents a significant step forward. New targets (to be introduced at Mrs Kane’s discretion) • For Jodie to try to use sufficient voice to avoid Mrs Kane saying ‘Pardon?’ • For Jodie to answer questions that require a short phrase response rather than a single word. Where? When? and, eventually, How? and Why? questions are good for this. • To continue to build questions into classroom activities and small-group work until Jodie is comfortable with any situation. • To include one question each week which will be a ‘surprise’. • To make one question the answer to her name at registration. • To stand near Jodie initially at registration and gradually move away as Jodie responds with greater confidence. Next review January 2016 cc: Parents, SENCo, Class Teacher, Speech and Language Therapist

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412 Date of next review meeting: 4th November 2015 TA: VG Parents present: both____

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Visit Y4 with Mrs G, work in the Y4 area on ‘fun’ tasks. Meet new Y4 teacher and new TA before end of term. Mrs G and H to make a Yr 4 photo book. Mrs G to arrange a handover session with H and new TA in September. Coloured visual timetable on wall – H to have her own copy in tray. Practise using timetable with TA so can show/say what is coming up next. Parents to monitor anxiety and feedback using home/school liaison book. All adults to be aware of H’s anxiety and need for explicit linstructions or explanations. TA/teacher to reinforce use of traffic light system and reward/encourage spontaneous communication. All children encouraged to support each other and offer help/friendship as and when needed. Introduce three or four girls one at a time (H’s choice) into language group – at least one session in classroom per week. SLT to advise on activities and H to practise first on her own with TA. Parents to invite girls home to play/have tea, and mediate play sessions initially.

I will manage the change from Y3 to Y4 with Mrs G’s help, so I don’t need to worry too much about coming back to school after the holidays.

I will know the Y4 routine and numeracy sets and feel ready for the next activity.

I will ask for help using traffic lights on my desk (green = I’m OK, amber = not sure, red = help please). I will use the friendship bench if I feel lonely or upset and to be a good friend.

I will be able to talk and play with some of the girls in my class.

Talking to four girls in structured language activities. Talking to one girl spontaneously at home but gets upset if Amy talks to other girls at school. Try friendship bench and social story.

H loves the traffic lights and can accept help with other children when she’s not the only one showing red. Added JKL to her lights for clarity. Friendship bench still not ready.

TA is telling H what to expect, rather than helping H to use her timetable. H is anxious when TA is absent.

H shared her photo book with relatives over the summer and returned to school with only slight anxiety (lots of ‘checking’ questions).

Outcomes/comments

H talks freely to parents about school experience and knows her views will be taken into consideration. Mrs G will involve H in the targets.

Student involvement:

Strategy (how it will be achieved)

Targets (‘I will be able to …’)

H wants to have friends to play with and do good work at school.

Aims of intervention:

TA support in class. Small group support with TA for developing social communication/confidence/language (verbal reasoning skills).

Support:

Rigidity of thought, leading to poor inference & reasoning. Anxiety associated with change, poor grasp of expectations and unfamiliar adults. Selective mutism – H answers teacher/teaching assistant (TA) in a quiet voice in response to direct questions but no spontaneous speech in the classroom (confident and outgoing at home). No interaction with other children at school and no socialisation outside school.

Brief outline of identified difficulty:

PERSONAL EDUCATION PLAN Date of meeting: 12.6.15 Name: HB Class: 3B Teacher: DH

Example 3: Generalisation phase and support for child with SM and autism spectrum disorder

APPENDIX C

APPENDIX D

1 Legal support Introduction In most countries, children with special educational needs, backed up by a diagnosis, have certain legal rights to compensate for the difficulties that put them at a disadvantage to other children during course work or exams; and to protect them from other forms of discrimination. Most schools understand this and act accordingly, but not always. You may be reading this appendix because you need information about the rights of a child who has SM and/or organisations which can help to get these rights recognised.

Appendix D

LEGAL, PROFESSIONAL AND EDUCATIONAL SUPPORT

Legal and educational Acts The UK has the following important documents and ways to access them:

★ Children and Families Act 2014 (www.legislation.gov.uk/ukpga/2014/6/contents/ enacted)

★ The Equality Act 2010 (www.gov.uk/equality-act-2010-guidance) ★ SEND Code of Practice 0-25 (www.gov.uk/government/publications/send-code-ofpractice-0-to-25).

How to describe the special educational needs of a child who has SM The type of learning difficulty that a child with SM has spans two areas of special educational need: 1 Communicating and interacting – difficulty communicating effectively with other people. 2 Social, emotional and mental health difficulties – difficulty managing relationships with other people, including: problems initiating, reciprocating and maintaining friendships or learning partnerships; withdrawal and isolation; feelings of anxiety, frustration, loneliness or being unfairly treated. These affect their mental health and sense of wellbeing.

Evidence that SM is a special educational need Schools which are unfamiliar with SM may not accept the diagnosis or recognise it as a special educational need (SEN). Here are some suggestions for how to find evidence.

P

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★ Download ‘Special educational needs and disability: a guide for parents and carers’ (Department of Education, 2014, Ref: DFE-00547-2014. Available at www.gov.uk/government/publications/send-guidefor-parents-and-carers.

★ On your local county council’s or education authority’s website, look for ‘Children and Education, ‘Special educational needs and disability (SEND)’, ‘Support and Advice’ or search the website for ‘Parent Partnership Service’ and/or ‘Independent Advice for Schools’. There you will find out how to get help and a contact number for someone to speak to.

★ Download ‘Communicating Phonics’ from www.thecommunicationtrust.org.uk/resources/resources/ resources-for-practitioners/communicating-phonics. Pages 55–59 in the SLCN section are devoted to selective mutism and describe simple modifications to enable children who have SM to participate in an early phonics assessment. These adjustments can be usefully applied to other aspects of literacy and in other classroom activities. Always put your concerns in writing to the head of your child’s school. If your child’s needs are not recognised, be prepared to write to the Director of Children’s Services or the Special Needs Officer at your local educational authority needs department. Use factual statements rather than emotive language and quote from section 36 (1) of the Children and Families Act 2014 and/or the 0-25 SEND Code of Practice (see the references above). The IPSEA website provides letter templates for this purpose: www.ipsea.org.uk/ what-you-need-to-know/model-letters.

Public examinations Here is a summary of information about access arrangements for public examinations in the UK.

★ All exam boards must provide special access arrangements for candidates with a history of SEN, so that they are not at a disadvantage during the exam.

★ Each state school acts as a registered exam centre and must appoint an exam officer (not necessarily the SENCo) who has a coordinating and regulatory role in exam administration.

★ Whichever systems are routinely used in class to enable students to participate, and documented in the child’s personal file, must also be permissible in their exams.

Possible adjustments for a student with SM Possible pre-exam access arrangements should be considered by the student, parents and key staff or practitioners well in advance of the actual exams. This is because any adjustments or extra time allowance must reflect normal classroom practice; that is, systems that are put in place to enable the student to do as well as possible in assessments, tests, written and spoken activities on an everyday basis. For example:

★ If the student is hesitant when answering oral questions, do they benefit from having more time to answer?

★ Do they answer oral questions by writing?

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★ Do they record presentations or answers to oral questions when alone at school, or at home? ★ Do they present to a small group or one or two individuals, rather than the whole class? ★ Do they speak only to their teacher, and risk discrimination if the oral is conducted by an unfamiliar examiner?

★ Does their performance anxiety, fear of making mistakes, or difficulty writing when under pressure, mean that they need extra time to do themselves justice in test or timed situations?

★ Has the student demonstrated that they use adjustments such as extra time effectively? These needs should be discussed with the SENCo or Exam Officer who will need to write to the Exam Board on the student’s behalf, with examples of how the student’s needs have been met, and requesting pre-examination adjustments. In the UK, for further information, download the Joint Council for Qualifications publication ‘Adjustments for candidates with disabilities and learning difficulties’ at www.jcq.org.uk/exams-office/access-arrangements-and-special-consideration. There is a sample letter in Box A1.

Organisations to support parents of children who have SEN If no support is offered by the Special Needs department in your child’s school, or the young person’s college, in the UK there are several organisations for supporting families.

★ IPSEA (Independent Panel for Special Education Advice): www.ipsea.org.uk ★ Afasic (Association for all Speech Impaired Children): www.afasic.org.uk ★ Parent Partnership Network: www.iassnetwork.org.uk ★ The Joint Council for Qualifications (JCQ): www.jcq.org.uk/exams-office/access-arrangements-andspecial-consideration.

Further reading There are details of the legal and educational acts, and some information on international conventions and the criminal justice system, in the chapter ‘Legal issues in selective mutism’ by Denise Lanes and Rae Smith in Tackling Selective Mutism, edited by Smith & Sluckin (2015).

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Box A1: Sample letter to secondary school SENCo about a student aged 14 Dear ___________ I am writing to give you a brief update on ______’s progress and request some reasonable adjustments for her forthcoming GCSEs. ______ has a diagnosis of selective mutism. She has continued to progress well in terms of confidence and self-esteem and is actively participating at school. She is now able to answer questions in lessons but needs support to initiate requests or comments. ______’s parents report that she is generally well supported at school and greatly value the progress she has made. However, fear of making mistakes and drawing attention to her shortcomings are still an issue for her. It is a cause of concern that ______’s performance in exams still does not match the level of attainment she achieves in both class work and homework. I understand from Mr and Mrs _______ that some members of staff raised this issue again at the last parent consultation evening. While all students will benefit from diligent preparation and good revision techniques, individuals like ______ are particularly susceptible to the high significance, intense focus and time pressure related to exams, and they experience much higher levels of anxiety than the general population at these times. It is well known that we cannot perform or concentrate as well when we are anxious. Research has demonstrated the detrimental effect that anxiety has on speed of response, recall of facts and working memory (the memory required for holding and processing information). Working memory is a particularly vital component in mathematical problem-solving which has been a particular issue in terms of ______’s test performance. Moreover, anxiety results in excessive attention to perceived threats such as failure. I understand that, during the recent parent consultation evening, one science teacher asked ______ if a private room would help; however, this has proved counterproductive in the past, and ______reports that she feels more comfortable and less obtrusive in the presence of her peers. I consider that a better way of tackling the issue of exam anxiety would be to apply for extra time to answer questions. This was allowed when ______ was taking music grading aural exams, and she has now passed Grade 8. To summarise, given her long-standing history of anxiety and diagnosis of selective mutism, I believe that ______ qualifies for extra time in exams which require: •

mathematical problem-solving

•

a methodical approach to sift through, select and plan a response to questions

•

multiple-choice questions (it takes a long time for ______ to commit when she is unsure of the answer)

•

a speaking component.

I understand that extra time has been applied informally in the classroom to enable ______ to finish her work and would recommend that this is formally documented to ensure that she is not at a disadvantage in her public exams. I also believe that ______ would benefit from study-skills support to help her use the extra time as productively as possible. I am most grateful to you for considering the above recommendations and taking appropriate action. Please contact me if you would like to discuss any aspect in more detail. Yours sincerely [Add signature and job title]

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2 Professional support Endorsement from professional bodies The Royal College of Speech and Language Therapists (RCSLT) followed the lead of the American Speech–Language–Hearing Association (ASHA) and included SM within the professional remit of speech and language therapists (Communicating Quality 3, 2006). The clinical page on SM on the RCSLT website states that the role of the SLT is:

★ to support effective early identification and intervention ★ to contribute to better outcomes by enhancing the knowledge and skills of the early years and school-aged workforce

★ to ensure that children or young people with selective mutism have access to individualised interventions which are carried out in the setting(s) where the mutism occurs. It continues:

★ The SLT will generally have an advisory role which will involve regular multi-agency review meetings, and email and phone contact, to monitor and review targets and address issues arising in the work.

★ In some instances, the SLT will be directly involved with the client, particularly if he or she has additional SLCN.

Clinical Excellence Networks In 2015, a National Selective Mutism Clinical Excellence Network (CEN) was set up through RCSLT in the UK, followed by regional SM CENs. See www.rcslt.org.uk for further information. The aims and objectives are:

★ to share good practice in relation to the identification and management of selective mutism ★ to share and contribute to research in this clinical area ★ to raise awareness of selective mutism and our professional role(s) with this client group ★ to contribute to members’ continuing professional and personal development ★ to explore policies and contribute to policy development in SM ★ to disseminate good practice within the services we work ★ to liaise with SMIRA and other regional support groups ★ to develop links with universities and professional bodies and to liaise with RCSLT advisers.

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Membership To reflect the range of professionals who may be involved in identifying and supporting children and adults who have selective mutism (SM), membership will be open to professionals from health, education and social care across the UK.

Local interest groups Teachers, teaching assistants and professionals such as SLTs and psychologists meet on a local or county basis in certain parts of the UK to share good practice, develop local provision, discuss and problem-solve case management and provide ongoing support.

Selective mutism training courses for practitioners and parents Details of courses lasting one and two days are available from:

★ SMIRA (www.smira.org.uk) ★ iSpeak (www.ispeak.org.uk) ★ University College, London (CPD@PALS department, [email protected], www.ucl.ac.ukpals). 3 Educational support There are different forms of education for different purposes. Here some possible formats are outlined that professionals might like to use. First there is a short general introduction to SM before details of training sessions for people involved with a child who has SM. Ideally, this should include families and school staff together, either in a general workshop or adapted for a meeting in the school around an individual child. Areas to cover and suitable relevant materials are suggested. All resources are detailed in Appendix F. Certain perhaps more practical or general handouts can be distributed at first – and others introduced later as needed as part of individual case management.

General awareness and introduction to SM Duration 30–60 minutes Introduction – SM is a phobia

★ Play the opening two minutes of the Silent Children DVD to illustrate: – intense irrational fear – but only when triggered – consistent, predictable pattern – psychosomatic illness and avoidance as coping strategies

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Definition of SM and classification as an anxiety disorder

★ Misinterpretation as shyness, rudeness, refusal to speak, oppositional behaviour, ASD, emotional trauma.

★ Risks associated with lack of identification, mismanagement and long-standing SM. Treatment principles

★ Early intervention. ★ Open communication with child or young person to explain SM. ★ United approach to guarantee general anxiety reduction.

In school settings, watch and discuss Lucy Nathanson’s YouTube video ‘The Dos and Don’ts When Interacting with a Child with Selective Mutism’ (start at time 01:30 and finish at 07:44).

★ Behavioural programme to establish and generalise speech across a range of people and settings

starting with informal strategies (gradually face fear at own pace). Refer to the model of confident talking (Figure 2.5 in Chapter 2) and, if appropriate, the progressions of confident talking (Tables 5.1 and 7.1 in Chapters 5 and 7 and Figure 9.2 in Chapter 9). These are reproduced here on Handouts D1 to D4.

Where to get further information

★ SMIRA contact details. ★ SMIRA or local advice leaflets. ★ Details of national or local training sessions.

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Handout D1 A multidimensional model of confident talking (Johnson & Wintgens, 2016) Sustained conversation

Family, friends, regular contacts and strangers

Range of

Talking

people

in public

Being watched and overheard by others

places Sustained conversation

Sustained conversation

Moving from one-to-one conversations to a larger audience

Group

Social

participation

functioning

Spontaneous, conversation to meet academic, social and emotional needs

Sustained conversation

1 Do you know a child who talks confidently to some people but not others? 2 Using the four quadrants of the circle, think about the people and situations in your setting where the child does not talk. (Source: The Selective Mutism Resource Manual, second edition, 2016, Speechmark Publishing)

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Handout D2 The progressions of confident talking (Johnson & Wintgens, 2016) One-to-one interaction Moving towards relaxed, sustained conversation with each individual

GENERALISATION Note: all aspects are tackled together in a coordinated manner, but at a different rate for each progression

0 Absent 1 Frozen 2 Participation without communication

increasing demand

3 Non-verbal and written communication

4 Talking via another person 5 Using voice

6 Single words

7 Phrases and sentences

Range of people People the child can talk to on a one-to-one basis Family and friends Immediate and extended family and close friends. This group is most likely to include the people with whom the child talks freely

Regular Contacts Familiar people with whom the child is in regular contact, eg teacher, classmates, neighbours, friends’ parents, babysitter Strangers People the child is unlikely to see again or sees only fleetingly, eg shop assistants, librarian, school visitors, school crossing patrol, dentist increasing demand

Talking in public places Presence and proximity of bystanders and possibility that talking will be disclosed to other settings No chance of being overheard

May be overheard by one person outside comfort zone

May be overheard by a few people outside comfort zone

increasing demand Group participation Group size includes the child and a facilitating adult, if appropriate 3–7 eg group work, sleepover, family meal

17+ eg class, party, stage performance

8–16 eg tutor group, football team increasing demand

Social functioning Moving towards spontaneous conversation to meet the child’s needs Planned

8 Sustained conversation

May be overheard by many people outside comfort zone

Unplanned

Adult-initiated

Child-initiated

Adult-initiated

Child-initiated

Structured

Unstructured

Structured

Unstructured

Factual content

Emotive content

Factual content

Emotive content

(Source: The Selective Mutism Resource Manual, second edition, 2016, Speechmark Publishing)

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Handout D3 Confident talking – the stages of one-to-one interaction Stage

Child’s presentation

Example of behaviour

0

Absent

Child or young person stays in the bedroom, hides behind a chair or observes activity from a distance.

1

Frozen

Child sits passively or accepts help without moving (eg does not take a ball that is offered; stands motionless while coat is buttoned up).

2

Participates without communication

Child participates silently in activities such as board games or jigsaw puzzles; takes items that are offered (eg a biscuit or crayons); and complies with requests which do not require an answer (eg deals out cards or draws a picture).

3

Uses non-verbal and written communication

Child responds to questions and may even initiate contact through: pointing; nodding or shaking head; tapping; gesture; drawing or writing. Child is relaxed and responds to the adult with a variety of facial expressions.

Talking bridge

Tolerates voice being heard by a bystander

Child talks to or laughs with parent without hiding their mouth in a visitor’s or the therapist’s presence; talks to other children in the same room as their teacher; talks to family member using a telephone in a public area. Voice may be quiet but is audible rather than whispered.

4

Talks through another person

Child answers when the parent repeats the therapist’s question; asks the parent if a person present can play a game with them; talks in a structured activity with an adult but looks at their friend or parent when they speak. Voice may be quiet but is audible rather than whispered.

5

Uses voice

Child vocalises an audible rather than a whispered sound to express emotion, accompany shared play, participate in an activity or directly communicate (eg laughter, humming, sound of police siren, animal noises, letter sounds, ‘mmm’ for ‘yes’). Child reads familiar material aloud on request (reading is a vocal exercise for proficient readers, rather than communication).

6

Communicates with single words

Child says a single word in response to questions or choices or in structured activities such as games. Voice may be very quiet but is audible rather than whispered.

7

Communicates with sentences

Child uses sentences in response to questions or in structured activities such as games or play readings. Child may: • occasionally offer a spontaneous comment • only ask questions during structured activities. Voice may be very quiet but is audible rather than whispered.

8

Conversation

Child has an adult-led, two-way conversation, provided no one else is perceived to be listening. Child: • volunteers spontaneous comments but questions may be limited • may not initiate contact or seek help outside planned sessions.

Note

Whispering is not included in this progression because it is an avoidance of using voice. For the purposes of keeping records, whispering can be regarded as stage 3+.



When the child is completely comfortable, 8+ may be observed, for example: unplanned conversation on most topics; child-initiated questions and requests; social language and conversation-fillers (words and phrases that add no meaning but feature in relaxed, uninhibited conversation).

(Source: The Selective Mutism Resource Manual, second edition, 2016, Speechmark Publishing)

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Handout D4 Informal ways to support the development of confident talking 1 Gradually introduce questions on a one-to-one basis at the child or young person’s pace. Question sequence only move on when they participate and respond

Chatty comments with rhetorical questions that need no answer (eg ‘This is fun, isn’t it!’, ’I wonder what this is?) ‘Show me’/’Which one?’ requests that can be answered by pointing ‘Yes/no’ questions that can be answered by nodding or shaking the head ‘X or Y?’ questions that can be answered with one word Simple questions that can be answered with one word Factual questions that can be answered with a phrase Leave open-ended and non-factual questions until later (eg ‘How’s it going?’, ‘Why did you do that?’, ‘What do you think?)

pull back if they freeze

Note: comments always outweigh questions! 2 Talk through a parent or friend • Use parents or friends as ‘go-betweens’ to prepare the child for talking to you directly. • Provide space for them to talk together, eg ‘Why don’t you two go into the book corner to discuss your plan?’ (Keep your distance and/or pretend to be occupied.) • Ask questions through the friend or parent, eg ‘Could you ask Pria where she put her lunchbox?’, ‘I expect you’ve got a favourite character – Mum, do you know Joe’s favourite one?’ (Prime parents to redirect questions rather than answer for the child.) • Ask the child to communicate through their friend or parent, eg ‘Tell Ben whose table you want to be on and we’ll get it sorted.’ (Move away or turn away initially, so that the conversation is private and gradually get closer until the child talks to their parent or friend in your presence.) 3 Parents can help their child to answer unexpected questions • Give the child five seconds to respond, then repeat or rephrase the question if necessary. • If there is no response after another five seconds, casually move on or change the subject, eg ‘We’ll let you know later’, ‘Have you got this style in size three?’ Don’t answer for the child! (Source: The Selective Mutism Resource Manual, second edition, 2016, Speechmark Publishing)

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Early Years Workshops – for parents and early years staff and carers.

Duration: 2–3 hours

Introduction – SM is a phobia

★ Silent Children DVD

Play the opening two minutes to introduce the topic (see the previous training format) and emphasise the importance of early identification and intervention to avoid long-standing SM.

Prevention

★ Reduce anxiety around speaking for all early years children. ★ Remove pressure to speak while helping children to participate at their own pace. Handout 9 ‘Helping young children to speak at school’ Understanding the nature of SM

★ Differentiating between SM, shyness, the ‘silent’ period’ in second language learning and mutism as a reaction to witnessing or experiencing threatening or abusive behaviour.

★ Key principles of anxiety/phobia management. Handout 2 ‘What is selective mutism?’ Handout 3 ‘Quiet child or selective mutism?’ Handout 5 ‘Selective mutism is a phobia’ Talking to and managing a child who has SM

★ Use commentary-style talking rather than direct questions. ★ Set up the expectation that the child will talk when they are ready. ★ General confidence building and anxiety management. Handout 1 ‘Talking to the child’ Handout 4 ‘What to say when ...’ Handout 6 ‘Firm foundations: building confidence, courage and self-esteem

★ Informal techniques: shaping a verbal response at the child’s pace; talking through parents and friends. Refer to Table 5.1 and Figure 9.2 in Chapters 5 and 9 which are reproduced on Handouts D3 and D4. Handout 12 ‘Do I answer for my child?’ (for parents in attendance) Handout 15 ‘The informal Sliding-in Technique’

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Useful books and resources (details are in Appendix F)

★ Can I Tell You About Selective Mutism? ★ My Friend Daniel Doesn’t Talk ★ Supporting Quiet Children: Exciting ideas to help reluctant talkers become confident talkers ★ Talking Tins and Talking Photo Albums Where to get further information

★ SMIRA contact details Make SMIRA leaflets and/or locally produced advice leaflets available if possible.

School-aged training sessions – for parents and school-based staff

Duration: 2–2½ hours

Parents of school-aged children and relevant staff could attend the Early Years Workshop and, maybe after lunch, learn about additional areas that are relevant for this age group. General classroom management

★ Maintaining minimum levels of anxiety within the classroom (alternative means of communication equate to ‘participation’ rather than ‘avoidance’), in order to support a small-steps programme which may start outside the classroom. Handout 10a ‘Creating an anxiety-free environment for children who have selective mutism’ Handout 10b ‘Creating an anxiety-free environment for young people who have selective mutism’ Establishing and generalising speech through small-steps programmes

★ The principles of graded exposure. ★ The concept of the child’s comfort zone. ★ The model of confident talking to consider the child’s speaking habits, and emphasise the importance of generalising to: a range of people; talking in public places; group participation; and social functioning. Handouts D1 - D3 in this appendix

★ The concept of working from low-risk to high-risk activities. ★ Specific techniques: sliding-in; reading route. Handout 16 ‘The Sliding-in Technique’ Handout 18 ‘The reading route’

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Progress Chart 4 ‘Talking to a new person using the Sliding-in Technique’ Progress Chart 5 ‘Generalising speech from one-to-one interactions to the classroom’ Talking to peers about SM

★ Be ready to deal with individual comments as they occur. ★ Consider the need to raise the subject with the whole class. ★ Watch the YouTube extract from BBC1 documentary ‘My Child Won’t Speak’, showing a discussion with Megan’s classmates.

★ Refer to the ‘My Story’ script from Chapter 10. Transition to new class or secondary school – additional considerations These may need longer or separate sessions.

★ Rapport building by email. ★ Specific techniques: students may prefer techniques with minimal parental involvement, eg Sliding-in Technique in one sitting, the reading route, or sliding-in by telephone. Handout 17 The Sliding-in Technique using telephone handsets

★ Access to public exams (see section 1, Legal support). ★ Fresh start at college or new sixth-form setting. Booklet for teenagers and adults with SM ‘When the words won’t come out’ Form 15 ‘Talking to strangers’

Follow-up parent group meetings (ideally 3–6 families)

Duration 2 hours

Sharing good news / successful strategies / progress

★ Each person is invited to contribute one item. Sharing difficulties and questions

★ Each person is invited to contribute one item to go on the board or flipchart. Problem solving

★ All ideas are welcome!

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Handouts to address specific issues Handout 4 ‘What to say when ...’ Handout 7 ‘Helping children to cope with anxiety’ Handout 8 ‘Mistaeks happen!’ Handout 12 ‘Do I answer for my child?’ Handout 13 ‘Easing in friends and relatives’ Handout 14 ‘Talking in public places’ Note: allow parents some time to talk to each other without the facilitator, during a coffee break and after the meeting. Share contact details, with their consent, so that they have the option to contact each other between meetings.

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Early identification and intervention are central to SM management It is universally acknowledged that early identification and intervention are crucial for the most effective management of SM.1 This can be seen from the good results of early intervention and the detrimental effects when SM is ignored, misdiagnosed or inappropriately treated.

Appendix E

EVIDENCE BASE AND REFERENCESFOR THE SELECTIVE MUTISM RESOURCE MANUAL (SECOND EDITION)

Rationale ★ Early identification and ‘light touch’ management strategies in settings where SM occurs prevent the development of later intractable problems requiring more complex, aggressive management.17, 19, 35, 42, 61

★ Prognosis is better for children with SM who receive early intervention.4, 30, 46, 86 Delay in diagnosis denies these children immediate intervention and, in some cases, creates functional impairment.70

★ In a randomised controlled trial involving 24 children with SM, aged 3–9, 12 remained in a waiting or control group while 12 received home- and school-based intervention over a three-month period. Only the intervention group made significant progress and there was no change in the control group. Progress was greater in younger children, emphasising the need for early detection and intervention.64

★ The cooperation of parents and school personnel during treatment is crucial for positive outcomes, and early intervention can minimise the long-term psychological effects.32, 50, 70, 74

★ In an audit of SM cases in East Kent Hospitals University NHS Foundation Trust (EKHUFT), 13 out of 15 children referred to SLT as preschoolers had overcome their difficulties by five years old.37

★ Selective mutism significantly impairs the individual’s level of functioning. This is because the individual is unable to complete the required educational, social and family tasks, and the emotional distress engendered in situations requiring the person to speak can result in them refusing to attend school.41

P

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★ While there is evidence to suggest that SM may resolve spontaneously11 and symptoms of SM may become less severe over time,6, 86 longer-term rates for complete remission are concerning (eg 39–58 per cent).46, 67, 77

★ When SM is ignored or treated inappropriately, it can lead to intractable problems requiring more complex, aggressive management.17, 19, 35, 42, 61

★ Prognosis is poorer when SM persists into adolescence.46, 72 A full multidisciplinary assessment is not necessary routinely but further assessment is important when there are indicators of other concerns Many children need only a screening assessment carried out with parents and teachers to see if they meet the criteria for SM set out in DSM–5 (APA, 2013)1 and then, with information and advice, go on to resolve their difficulties with appropriate support from school and family.37 Meeting strangers is always stressful for children who have SM and the very nature of SM means they will usually be too anxious to demonstrate their full potential at a formal assessment. Even when assessed by their parents, they are probably less forthcoming in a strange environment than at home. Direct assessment should therefore be avoided unless absolutely necessary. Speech and language delays are to be expected within the SM population, given the significantly reduced interaction with peers and adults, and many of these delays can be expected to resolve over time with natural maturation. However, the incidence of speech or language disorders is higher among children who have SM and the possible need for full SLT assessment should always be considered. The need for this, and/or involvement of other agencies to investigate and manage other concerns, can be picked up from the screening assessment.

Rationale ★ Children who have SM do not initiate or reciprocally respond when spoken to by other people outside their comfort zone,1 reducing the reliability of assessment results.

★ When 33 children with SM aged 5–12 were tested in an office environment, they performed better with their parents than with professionals. However, even with their parents, children performed less well on tests requiring sentences than single-word answers. The authors noted that the children might have remained anxious and would have performed better in a more familiar environment.45

★ Children who have SM find single words more manageable than sentences, as reflected in graded programmes to overcome SM.19, 35, 61

★ There is high co-morbidity between SM and developmental disorders and anxiety disorders.48, 76 ★ The extent of additional speech or language difficulties within the SM population is difficult to gauge and varies considerably in the literature from 19 to 50 per cent.24, 27, 48, 71, 76, 86 However, the

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higher figures come from relatively small clinical samples which are less representative than general population samples, and include both delayed and disordered speech and language development. In the largest study of this type, which surveyed 135 children and 18 adults with SM, 19 per cent had speech and language problems and 34.6 per cent had worked once with a speech and language clinician.27 All that can be said with any certainty is that children who have SM are more likely to have a resolved or current difficulty than members of the general population; and at least half do not.

Universal and targeted training (education about SM) is a key part of intervention and prevention To minimise the gap between onset and treatment, a comprehensive training programme should be offered which is open to everyone and not restricted to parents and staff members working with children who are known or suspected to have SM. All educationalists and early years workers who are given basic training should be able to recognise SM and to put appropriate strategies in place to reduce anxiety and facilitate talking in young children.12, 42 Education must include the importance of home–school liaison and team work12, 32 and address popular misunderstandings; for example, that children who have SM are oppositional and choose not to talk.35, 36, 73

Rationale ★ Universal training will promote early identification and intervention. ★ Early years staff members have a key role in prevention and management.12 SM is typically evident from a very young age, the mean age of onset ranging from 2.7 to 4.1 years.72, 82 Often, however, there is a long delay between onset and treatment.72, 82 Studies suggest that the average age when a child is formally referred for an assessment may range from 6.5 to 9 years51, 75, 86; for example, in a sample of 41 referrals, the children’s SM had been evident at 3–4 years old but they were not referred for treatment until 5–12 years old (8½ years of age on average).67

★ SM is currently underdiagnosed and often confused with shyness.20, 56, 70, 72 This is partly because of low-profile SM where children talk with less frequency, volume and spontaneity than usual27 or avoid anxiety by whispering or altering their voice.4

★ SM is not as rare as previously thought – most nurseries and primary schools will have one or more children who have SM on roll.59

★ Recent prevalence rates range from 0.71 per cent (one in 143 children) to 1.9 per cent (1 in 50) in young school-aged populations6, 50, 51, 82 with 0.76 per cent (1 in 132) affected in preschool settings.25 Prevalence decreases with age to about one in 550 for older children.37, 47

★ SM is no longer regarded as an oppositional disorder. The oppositional behaviours exhibited by children who have SM are believed to be linked to their fear of speaking, reflecting their compulsion to avoid situations requiring them to speak. Indeed, in a study of 52 children with SM matched to 52 controls, the SM group members were less oppositional in school than the controls.20, 21, 48, 73

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★ The efforts teachers make in helping new children settle into school can actually maintain and reinforce SM.16

★ Failing to recognise SM within school settings can lead to labels such as ‘autistic’, ‘language delayed’, ‘defiant’ or ‘learning disabled’, together with inappropriate or ineffective interventions. Simply waiting for the child to ‘outgrow’ this disorder, and failing to provide proper treatment, can lead to lifelong psychological problems.74

★ Training for staff in education settings is often absent or inadequate: for example, an online survey of education settings found that two-thirds would like to feel more confident about supporting children who have SM, and would make more of accessible resources if given additional support and guidance.26

★ Feedback from training days indicates that staff and parents in early years and school settings feel empowered to manage young children’s intervention programmes with minimal speech and language therapy support.37

Bilingualism must be managed carefully because of the higher risk of SM Since immigrant and minority language children are at a higher risk of SM than indigenous populations, their reluctance to speak must be respected to avoid them being made to feel uncomfortable about speaking. At the same time, their silence should not be routinely accepted without questioning the possibility of SM because delayed diagnosis and intervention can lead to more entrenched mutism.32, 35, 82 Therefore, adults working with immigrant and minority language children need to be aware of the difference between SM and the ‘silent period’ (a common stage in second language learning), in order to assess, monitor and support these children appropriately.

Rationale ★ In a study in Israel, SM prevalence in the general child population was 7.6 per 1,000. However, this represented 4.7 per 1,000 indigenous children compared with 22 per 1,000 children who had migrant backgrounds. Therefore, SM was 4.5 times more likely in children with immigrant backgrounds.25

★ In a large survey in Canada, SM prevalence, although relatively low, was 10 to 13 times higher in immigrant children than non-immigrant children (5.5–7.8 versus 0.5–0.7 per 1,000).9

★ Immigrant background among children who have SM is relatively common. In a clinical sample of 100 children in Switzerland and Germany, 28 were immigrants.76

★ Children are commonly non-verbal in the initial stages of acquiring a second language. However, this should not exclude them from a diagnosis of SM.80

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Small-steps intervention programmes should be based on behavioural approaches In both editions of The Selective Mutism Resource Manual, the intervention approach and small-steps programmes are based on sound psychological principles of learning theory and a behavioural approach. The manual has been a key resource in several studies, as detailed below.

Rationale ★ Behavioural techniques of stimulus fading (graded exposure), shaping, positive reinforcement of any communication and systematic desensitisation are the most efficacious interventions in treating SM.8, 17, 74, 82

★ In a survey of 30 young people aged 10 to18, programmes involving graded exposure were the most commonly and successfully used method of treatment: 63 per cent of children were exposed to this method of treatment with positive outcomes in 89 per cent of cases (17 out of 19).68

★ In a small-scale, school-based study (N = 5), only the children whose teachers implemented a programme of graded exposure overcame their SM.63

★ In a short-term study with alternating treatments design (child-focused, graded exposure and parent-focused contingency management), eight out of nine children with SM increased their speech by 600 per cent. Graded exposure was more effective than contingency management.81

★ In a randomised controlled trial involving 24 children with SM, aged 3–9 years, 12 remained in a waiting or control group while 12 received 21 sessions over a three-month period of ‘defocused communication’ techniques and behavioural intervention from The Selective Mutism Resource Manual.35 Frequency of talking, as rated by a teacher questionnaire, increased significantly in the intervention group with no change in the control group.64 Progress was maintained one year post-treatment: 78 per cent of the children aged 3–5 years did not have SM, compared with 33 per cent of children aged 6–9 years.63

★ In a randomised controlled trial, 21 children with SM aged 4–8 years were assigned to a 12-week waiting or control period or 24 weeks of exposure therapy. The children receiving exposure therapy made a significant gain in functional speaking which was retained three months post-treatment; no significant gains were made by the control group.5

★ In a survey of 123 cases of SM treated by an SLT service, using behavioural techniques taken from The Selective Mutism Resource Manual,35 the techniques were effective in 91 per cent of cases, rising to over 96 per cent if both the SLT and the child’s parent and/or school had attended a training day around programme planning and home–school liaison.36

Small-steps intervention programmes must be delivered in the context of an overall approach to anxiety management SM is an anxiety disorder and failure to talk is the main behavioural symptom.1, 85 Treating this symptom with behavioural interventions can completely overcome communication difficulties, particularly if they are

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implemented at an early age.35 However, individuals with SM are likely to have a genetically determined predisposition or vulnerability towards developing fears and anxiety disorders in general. Therefore, a broader approach to management is indicated, including:

★ coping strategies for general anxiety management in later life ★ an understanding of the physiology of anxiety and the role of the amygdala in phobia development and management, which can help older children and adults with SM to externalise the problem and gain control of their anxiety

★ support for anxious parents who may share the same disposition ★ recognition that parents who have an identifiable anxiety disorder could also benefit from mental health, counselling or general well-being services.

Rationale ★ The aetiology of selective mutism lie in a complex interaction of individual and environmental factors, namely genetics, temperament, developmental milestones and social factors.18, 82 Temperament is usually seen as a set of genetically based predispositions that, in conjunction with the influence of environmental factors, contribute to later personality, with particular implications for anxiety symptoms and coping strategies.28, 29, 52

★ Jerome Kagan and his colleagues did the first research on infants and young children who appeared sensitive and fearful. They described the children’s shared temperamental trait as ‘behavioural inhibition’.31 The temperament of children who have SM is consistent with this personality trait, ie difficulty adapting to change and new situations, presenting as withdrawal.16, 27, 82, 55, 57 Kagan et al listed inhibited vocalisation to strangers as a common feature of behavioural inhibition in very young children. They went on to report that stopping talking in the company of strangers was the most sensitive indicator of behavioural inhibition in five year olds.39

★ Behavioural inhibition is a good predictor of anxiety disorders.33, 77 ★ Children who have SM often have parents who meet the criteria for an anxiety disorder. For example, in a sample of 30 children with SM, a family history of social phobia or SM was present in 70 per cent and 37 per cent of first-degree relatives, respectively.7

★ In a sample of 50 children, 38.9 per cent of mothers and 31.4 per cent of fathers of children with SM reported shyness and/or social anxiety, compared with 3.7 per cent of control mothers and 0.9 per cent of control fathers. Parents of children with SM also reported more avoidant behaviours and features of schizoid personality than the control group. This study confirmed SM and social anxiety as a familial phenomenon, recommending that assessment and treatment planning should take this into account.49

★ Similarly, another study of family psychopathology found that the parents of children with SM had higher rates of lifetime generalised social phobia and avoidant personality disorder than controls

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(37.0 versus 14.1 per cent and 17.5 versus 4.7 per cent, respectively).15 Despite its limitations, this data is important because it supports a clear connection between familial social anxiety and SM in children.82

★ SM appears to be a strong indicator of future phobic disorders. For example, in a clinical sample of 33 children, 48 per cent had developed a different phobic or anxiety disorder when they were followed up as adults.77

★ In a large school-based population in England, researchers found that one or more parents described themselves as shy for 51 per cent of children with SM, compared with 7 per cent of children without SM.11 In a more recent school-based population in the Republic of Ireland, 50 per cent of the children with SM had a parent who had been treated for SM or social phobia, and all of the children with SM had at least one parent who was portrayed as ‘very shy’.71 This is a typical finding for clinicians in the field, with parents often describing themselves as quiet or socially anxious at school.69

★ The major conclusion from studies of fear is that the part of the brain responsible for triggering the fear reflex (the fight–flight–freeze response), and other emotions such as anxiety, is the amygdala.23, 53, 54, 66

★ The response of the amygdala to phobia fear triggers is immediate, automatic and not under people’s conscious control.14

★ ‘Externalising’ anxiety is an important part of gaining control over it: ‘the person is not the problem, the problem is the problem’.79, 82

★ Externalisation is achieved in SM management by understanding it as a phobic reaction which can be overcome.36

An effective intervention programme must address the parental role and include appropriate care-giving strategies The role of parents in working collaboratively with clinicians and teachers of children who have SM is frequently acknowledged in the literature.2, 5, 32, 50, 64, 70, 74, 84, 86 Parents are not only in the best position to influence the communication environment for their children at home and in the community; they can also provide much more consistent daily support than schools or therapy services, without the inevitable gaps in service delivery.36 However, SM is associated with high anxiety in both children and their parents, not least because SM creates anxiety for carers who do not know how to deal with it. This anxiety will, in turn, affect parenting style. Therefore, it is important for clinicians to be aware of the impact of various parenting styles on children’s behaviour and to help parents support their child’s intervention programme as effectively as possible.

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Rationale ★ Care-giving strategies may help in reducing the stability of behavioural inhibition. A care-giving style that encourages children to develop independence and confidence may help children reduce their distress in new social environments. Care-givers can give children opportunities to engage and excel in social activities.28

★ When care-givers are overly responsive and provide assistance when a child does not need it, this may reinforce the child’s anxiety in new situations as it sends them the message that their anxiety was warranted. Research suggests that the best way to encourage children to feel independent and less afraid in social environments is to help them to feel as though they don’t need to depend on care-givers in new situations.28

★ Research suggests that parenting practices determine the extent to which inhibited infants become fearful of unfamiliar people and events later in childhood. Using firm expectations and limits that teach inhibited children how to cope with stress reduces their risk of later anxiety. In contrast, caring but overprotective parents, who shield their child from stressful events, inadvertently encourage a continuation of timidity by preventing the child from confronting fears and, by doing so, eliminating them.40, 60 In a long-term study of hundreds of infants, none of the highly reactive children who had limits imposed on their behaviour ended up fearful at the age of two. Conversely, at the same age, the infants who had been shielded from stress remained behaviourally inhibited and displayed avoidance and distress when faced with unfamiliar people, objects and events.38 The latter parenting style is common and understandable because it is a direct response to the child’s behaviour and natural instinct to look to their parents for comfort.60, 83 Children’s fearful reactions and care-givers’ protective behaviours therefore reinforce each other over time.22, 60, 84

★ An unusually high proportion of adolescents and adults who experience panic attacks report having had overprotective parenting in childhood.58

★ In one study, 93 two year olds were observed across six novel contexts designed to elicit distress, in the presence of their mothers. Saliva samples were taken at the beginning and end of the procedure to measure the levels of cortisol, the steroid hormone released when people are stressed. The study confirmed that care-giver protective behaviour, which functions to prevent a child from interacting with a novel stimulus, exacerbated the children’s distress.34

★ Other studies show that the link between protective behaviour and increased distress or anxiety is strongest when the threat is low rather than high. In other words, when the care-giver’s behaviour is overprotective, rather than protective, and when the care-giver is adept at anticipating fear and taking avoidant action.43

★ A three year study of 214 mothers and their children aged 8–10 years showed that different personality traits in the children reacted differently to different parenting styles. Children with significant selfcontrol were more likely to be anxious when parented by a controlling mother and fared better when

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their mothers gave them more independence. In contrast, reactive sensitive children, who were less able to self-regulate emotions and behaviours, became more anxious when their mothers exhibited a ‘hands-off’ parenting style. Ultimately, when the mothers’ parenting approach complemented their children’s inherent need for either structure or more autonomy, the youngsters experienced half as many anxiety symptoms.44

★ Instances of family members ‘speaking for’ the child who has SM positively reinforce not speaking, which may also be self-reinforcing, because the child does not have to separate from them.59, 87 The acceptance of non-speaking does not cause SM (mothers of children with SM and socially anxious children without SM are equally accepting87) but maintains it.

Medication may be recommended as a last resort intervention for older children There is insufficient evidence for the routine use of medication to treat children who have SM. However, it may be considered for those who are older in certain circumstances.

Rationale ★ Pharmacological interventions should not be offered routinely to treat anxiety disorders in children and young people.62

★ Pharmacological treatments such as SSRIs do not contribute to the development of appropriate social skills or adaptive behaviours that can relieve symptoms or related distress.3

★ Medication should only be considered, by a multidisciplinary team, for older children and adolescents, where recognised intervention measures for SM are not working because of severe anxiety, and when additional anxiety-reducing techniques, such as relaxation and cognitive behavioural therapy, are also unsuccessful.10

★ Studies of the benefits and need for pharmacological interventions are inconclusive. There is a need for further double-blind group studies with children across a broader age range, and in combination with other interventions.10, 16

There are strong indicators that speech and language therapy is the best discipline to take the lead in diagnosing and coordinating support for SM in children and young people Although the management of SM and the coordination of individual services are not the sole prerogative of one discipline, there does need to be agreement on who will take the lead in diagnosing and advising on SM otherwise children will be overlooked.42 In the UK, it is appropriate for speech and language therapists (SLTs) to take this role.

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However, some cases are complicated by factors needing further investigation and a more holistic approach to support, for example:

★ additional language, learning or developmental difficulties ★ additional mental health concerns ★ issues with family dynamics or parental mental health ★ cultural issues ★ domestic concerns. When SM is complicated by factors beyond their remit, the SLT needs to refer to, or work alongside, other specialist services, for example paediatricians, educational psychologists, Child and Adolescent Mental Health Services (CAMHS) and social services. Collaboration with mental health services is particularly important while young people transition into the adult care sector.

Rationale ★ SM is an anxiety disorder resulting in situational communication difficulties.1, 13, 85 It is the SLT’s remit to treat a wide range of communication difficulties, including those with a psychological cause or component (eg psychogenic voice disorder, puberphonia, dysfluency); so SLTs are well equipped to manage SM.

★ Co-morbidity between SM and speech or language disorders is well documented.24, 48, 76 ★ The differential diagnosis of SM involves the skill to both consider and eliminate other communication pathology.1 The clinician needs to determine: – whether a specific communication disorder is the primary reason for a child’s lack of speech – whether it exists alongside SM – the extent to which it may be a contributing factor – the best way to manage the two conditions should they occur together.

★ Advising parents, relatives and staff members on the appropriate interaction style is fundamental to SM intervention and central to the work of SLTs.

★ SLTs have the clinical skills to engage individuals and take a full case history.

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References  1 American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders, 5th edn DSM-5 American Psychiatric Publishing, Washington, DC.  2 Barrett PM, Dadds MR & Rapee RM (1996) ‘Family treatment of childhood anxiety: a controlled trial’, Journal of Consulting and Clinical Psychology, 64, pp333–42.  3 Beidel DC, Turner SM, Sallee FR, Ammerman RT, Crosby LA & Pathak S (2007) ‘SET-C versus fluoxetine in the treatment of childhood social phobia’, Journal of the American Academy of Child & Adolescent Psychiatry, 46, pp1622–32.  4 Bergman RL & Hunt L (2008) ‘Selective mutism’, Paradigm, winter issue, pp12–14.  5 Bergman RL, Gonzalez A, Piacentini J & Keller ML (2013) ‘Integrated behavior therapy for selective mutism: a randomized controlled pilot study’, Behaviour Research and Therapy, 51 (10), pp680–9.  6 Bergman RL, Piacentini J & McCracken JT (2002) ‘Prevalence and description of selective mutism in a school-based sample’, Journal of the American Academy of Child & Adolescent Psychiatry, 41 (8), pp938–46.  7 Black B & Uhde TW (1995) ‘Psychiatric characteristics of children with selective mutism: a pilot study’, Journal of the American Academy of Child & Adolescent Psychiatry, 34 (7), pp847–56.  8 Bögels SM, Alden L, Beidel DC, Clark LA, Pine DS, Stein MB & Voncken M (2010) ‘Social anxiety disorder: questions and answers for the DSM-V’, Depression & Anxiety, 27, pp168-89.  9 Bradley S & Sloman L (1975) ‘Elective mutism in immigrant families’, Journal of the American Academy of Child Psychiatry, 14, pp510–4. 10 Bramble D (2015) ‘Is medication helpful in selective mutism?’, Sluckin A & Smith BR (eds), Tackling Selective Mutism: A Guide for Professionals and Parents, Jessica Kingsley Publishers, London and Philadelphia. 11 Brown BJ & Lloyd H (1975) ‘A controlled study of children not speaking at school’, Journal of the Association of Workers with Maladjusted Children, 3, pp49–63. 12 Busse RT & Downey J (2011) ‘Selective mutism: a three-tiered approach to prevention and intervention’, Contemporary School Psychology, 15, pp53–63. 13 Carbone D, Schmidt LA, Cunningham CC, McHolm AE, Edison S, St Pierre J & Boyle MH (2010) ‘Behavioral and socio-emotional functioning in children with selective mutism: a comparison with anxious and typically developing children across multiple informants’, Journal of Abnormal Child Psychology, 38 (8), pp1057–67. 14 Carlsson K, Petersson KM, Lundqvist D, Karlsson A, Ingvar M & Öhman A (2004) ‘Fear and the amygdala: manipulation of awareness generates differential cerebral responses to phobic and fear-relevant (but nonfeared) stimuli’, Emotion, 4 (4), pp340–53. 15 Chavira DA, Shipon-Blum E, Hitchcock C, Cohan S & Stein MB (2007) ‘Selective mutism and social anxiety disorder: all in the family?’, Journal of the American Academy of Child & Adolescent Psychiatry, 46, pp1464–72. 16 Cline T & Baldwin S (2004) Selective Mutism in Children, Whurr, London.

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17 Cohan SL, Chavira DA & Stein MB (2006) ‘Practitioner review: psychosocial interventions for children with selective mutism: a critical evaluation of the literature from 1990–2005’, Journal of Child Psychology and Psychiatry, 47, pp1085–97. 18 Cohan SL, Price JM & Stein MB (2006) ‘Suffering in silence: why a developmental psychopathology perspective on selective mutism is needed’, Journal of Developmental & Behavioral Pediatrics, 27, pp341–55. 19 Cunningham CE (2001) ‘COPEing with selective mutism: a collaborative school-based approach’, Consultant’s Manual produced by the Selective Mutism Service, COPE Program, McMaster Children’s Hospital, Hamilton, ON, Canada L8N 3Z5. 20 Cunningham CE, McHolm AE & Boyle MH (2006) ‘Social phobia, anxiety, oppositional behavior, social skills, and self-concept in children with specific selective mutism, generalized selective mutism, and community controls’, European Child & Adolescent Psychiatry, 15, pp245−55. 21 Cunningham CE, McHolm A, Boyle MH & Patel S (2004) ‘Behavioral and emotional adjustment, family functioning, academic performance, and social relationships in children with selective mutism’, Journal of Child Psychology and Psychiatry, 45 (8), pp1363–72. 22 Dadds MR & Roth JH (2001) ‘Family processes in the development of anxiety problems’, Vasey MW & Dadds MR (eds), The Developmental Psychopathology of Anxiety, Oxford University Press, New York. 23 Davis M (1992) ‘The role of the amygdala in fear and anxiety’, Annual Review of Neuroscience, 15, pp353–75. 24 Dummit ES, Klein RG, Tancer NK, Asche B, Martin J & Fairbanks JA (1997) ‘Systematic assessment of 50 children with selective mutism’, Journal of the American Academy of Child & Adolescent Psychiatry, 36 (5), pp653–60. 25 Elizur Y & Perednik R (2003) ‘Prevalence and description of selective mutism in immigrant and native families: a controlled study’, Journal of the American Academy of Child & Adolescent Psychiatry, 42 (12), pp1451–9. 26 Essex SMIG (Selective Mutism Information Group) (2014) Selective Mutism: Education Settings Survey, online, www.essexlocaloffer.org.uk/content/service-feedback-selective-mutism (accessed March 2016). 27 Ford MA, Sladeczek IE, Carlson J & Kratochwill TR (1998) ‘Selective mutism: phenomenological characteristics’, School Psychology Quarterly, 13 (3), pp192–227. 28 Fox NA, Henderson HA, Marshall PJ, Nichols KE & Ghera MM (2005) ‘Behavioral inhibition: linking biology and behavior within a developmental framework’, Annual Review of Psychology, 56, pp235–62. 29 Fox NA, Nichols KE, Henderson HA, Rubin K, Schmidt L, Hamer D, Ernst M & Pine DS (2005) ‘Evidence for a gene–environment interaction in predicting behavioral inhibition in middle childhood’, Psychological Science, 16 (12), pp921–6. 30 Freeman JB, Garcia AM, Miller LM, Dow SP & Leonard HL (2004) ‘Selective mutism’, Morris TL & March JS (eds), Anxiety Disorders in Children and Adolescents 2nd edn, Guilford Press, New York. 31 Garcia-Coll C, Kagan J & Reznick J (1984) ‘Behavioural inhibition in young children’, Child Development, 55, pp1005–19.

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32 Giddan JJ, Ross GJ, Sechler LL & Becker BR (1997) ‘Selective mutism in elementary school: multidisciplinary interventions’, Language, Speech, and Hearing Services in Schools, 28, pp127–33. 33 Hirshfeld DR, Rosenbaum JF, Biederman J, Bolduc EA, Faraone SV, Snidman N, Reznick JS & Kagan J (1992) ‘Stable behavioral inhibition and its association with anxiety disorder’, Journal of the American Academy of Child & Adolescent Psychiatry, 31 (1), pp103–11. 34 Hutt RL, Buss KA & Kiel EJ (2013) ‘Caregiver protective behavior, toddler fear and sadness, and toddler cortisol reactivity in novel contexts’, Infancy, 18, pp708–28. 35 Johnson M & Wintgens A (2001) The Selective Mutism Resource Manual, 1st edn, Speechmark Publishing, Brackley. 36 Johnson M & Wintgens A (2015) ‘Viewing selective mutism as a phobia of talking: the importance of accurate conceptualisation for effective clinical and parental management’, Essau CA & Allen JL (eds), ‘Making parenting work for children’s mental health’ (Chapter 7), ACAMH Occasional Papers No. 33, Association for Child and Adolescent Mental Health, London. 37 Johnson M, Jemmett M & Firth C (2015) ‘Effective care pathways for selective mutism’, Sluckin A & Smith BR (eds), Tackling Selective Mutism: A Guide for Professionals and Parents, Jessica Kingsley Publishers, London and Philadelphia. 38 Kagan J & Arcus D (1994) ‘The neurodevelopmental origins of behavioral inhibition’, Symposium paper presented at the Annual Meeting of the American Psychiatric Association, Philadelphia, PA. 39 Kagan J, Reznick JS & Snidman N (1987) ‘The physiology and psychology of behavioral inhibition in children’, Child Development, 58, pp1459–73. 40 Kagan J, Snidman N & Arcus DM (1992) ‘Initial reactions to unfamiliarity’, Current Directions in Psychological Science, 1 (6), pp171–4. 41 Kearney CA & Albano AM (2004) ‘The functional profiles of school refusal behaviour. Diagnostic aspects’, Behaviour Modification, 28 (1), pp147–61. 42 Keen DV, Fonseca S & Wintgens A (2008) ‘Selective mutism: a consensus based care pathway of good practice’, Archives of Disease in Childhood, 93 (10), pp838–44. 43 Kiel EJ & Buss KA (2012) ‘Associations among context-specific maternal protective behavior, toddler fearful temperament, and maternal accuracy and goals’, Social Development, 21 (4), pp742–60. 44 Kiff CJ, Lengua LJ & Bush NR (2011) ‘Temperament variation in sensitivity to parenting: predicting changes in depression and anxiety’, Journal of Abnormal Child Psychology, 39 (8), pp1199–212. 45 Klein ER, Armstrong SL & Shipon-Blum E (2012) ‘Assessing spoken language competence in children with selective mutism: using parents as test presenters’, Communication Disorders Quarterly, 20 (10), pp1–12. 46 Kolvin I & Fundudis T (1981) ‘Elective mute children: psychological development and background factors’, Journal of Child Psychology and Psychiatry, 22 (3), pp219–32.

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47 Kopp S & Gillberg C (1997) ‘Selective mutism: a population-based study: a research note’, Journal of Child Psychology and Psychiatry, 38, pp257–62. 48 Kristensen H (2000) ‘Selective mutism and comorbidity with developmental disorder/delay, anxiety disorder, and elimination disorder’, Journal of the American Academy of Child & Adolescent Psychiatry, 39, pp249–56. 49 Kristensen H & Torgersen S (2001) ‘MCMI-II personality traits and symptom traits in parents of children with selective mutism: a case-control study’, Journal of Abnormal Psychology, 110, pp648–52. 50 Kumpulainen K (2002) ‘Phenomenology and treatment of selective mutism’, CNS Drugs, 16 (3), pp175–80. 51 Kumpulainen K, Rasanen E, Raaska H & Somppi V (1998) ‘Selective mutism among second-graders in elementary school’, European Child & Adolescent Psychiatry, 7 (1), pp24–9. 52 Lau JY, Gregory AM, Goldwin MA, Pine DS & Eley TC (2007) ‘Assessing gene–environment interactions on anxiety symptom subtypes across childhood and adolescence’, Developmental Psychopathology, 19 (4), pp1129–46. 53 LeDoux J (1997) ‘Emotion, memory and the brain’, Scientific American, pp68–75. 54 LeDoux J (2003) ‘The emotional brain, fear, and the amygdala’, Cellular and Molecular Neurobiology, 23 (4–5), pp727–38. 55 Leonard H & Topol D (1993) ‘Elective mutism’, Child and Adolescent Psychiatry Clinics of North America, 2, pp695–707. 56 Lescano CM (2008) ‘Silent children: assessment and treatment of selective mutism’, The Brown University Child and Adolescent Behavior Letter, 24 (1), pp6–7. 57 Lesser-Katz M (1986) ‘Stranger reaction and elective mutism in young children’, American Journal of Orthopsychiatry, 56, pp458–69. 58 Liebowitz MR (1994) ‘Treatment of the anxiety spectrum of disorders’, Symposium paper presented at the Annual Meeting of the American Psychiatric Association, Philadelphia, PA. 59 Manassis K (2009) ‘Silent suffering: understanding and treating children with selective mutism’, Expert Review Neurotherapeutics, 9 (2), pp235–43. 60 Manassis K & Bradley S (1994) ‘The development of childhood anxiety disorders: toward an integrated model’, Journal of Applied Developmental Psychology, 15, pp345–66. 61 McHolm A, Cunningham C & Vanier M (2005) Helping Your Child with Selective Mutism: Practical Steps to Overcome a Fear of Speaking, New Harbinger Publications, Oakland, CA. 62 NICE (National Institute for Health and Care Excellence) (2016) Guidelines for social anxiety disorder, online, www.nice.org.uk (accessed May 2016). 63 Oerbeck B, Stein MB, Pripp AH & Kristensen H (2015) ‘Selective mutism: follow-up study 1 year after end of treatment’, European Child and Adolescent Psychiatry, 24 (7), pp757–66.

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64 Oerbeck B, Stein MB, Wentzel-Larsen T, Langsrud Ø & Kristensen H (2014) ‘A randomized controlled trial of a home and school-based intervention for selective mutism – defocused communication and behavioural techniques’, Child and Adolescent Mental Health, 19 (3), pp192–8. 65 Omdal H & Galloway D (2008) ‘Including children with selective mutism in mainstream schools and kindergartens: problems and possibilities’, International Journal of Inclusive Education, 12 (3), pp301–15. 66 Rauch SL, Shin LM & Wright CI (2003) ‘Neuroimaging studies of amygdala function in anxiety disorders’, Annals of the New York Academy of Sciences, 985, pp389–410. 67 Remschmidt H, Poller M, Herpertz-Dahlmann B, Hennighausen K & Gutenbrunner C (2001) ‘A follow-up study of 45 patients with elective mutism’, European Archives of Psychiatry and Clinical Neuroscience, 251, pp284–96. 68 Roe V (2011) ‘Silent voices: listening to young people with selective mutism’, British Education Index, online, www.leeds.ac.uk/educol/documents/203095.pdf (accessed May 2016). 69 Schum R (2006) ‘Clinical perspectives on the treatment of selective mutism’, Journal of Speech-Language Pathology and Applied Behavioral Analysis, 1 (2), pp149-63. 70 Schwartz RH, Freedy AS & Sheridan MJ (2006) ‘Selective mutism: are primary care physicians missing the silence?’, Clinical Pediatrics, 45, pp43−8. 71 Sharkey L & McNicholas F (2012) ‘Selective mutism: a prevalence study of primary school children in the Republic of Ireland’, Irish Journal of Psychological Medicine, 29 (1), pp36-40. 72 Sharkey L, McNicholas F, Barry E, Begley M & Ahern S (2008) ‘Group therapy for selective mutism: a parents’ and children’s treatment group’, Journal of Behavior Therapy and Experimental Psychiatry, 39, pp538-45. 73 Sharp WG, Sherman C & Gross AM (2007) ‘Selective mutism and anxiety: a review of the current conceptualization of the disorder’, Journal of Anxiety Disorders, 21 (4), pp568–79. 74 Shipon-Blum E (2007) When the words just won’t come out: Understanding selective mutism, online, www.selectivemutism.org/resources/library (accessed May 2016). 75 Standart S & Le Couteur A (2003) ‘The quiet child: a literature review of selective mutism’, Child and Adolescent Mental Health, 8, pp154–60. 76 Steinhausen H & Juzi C (1996) ‘Elective mutism: an analysis of 100 cases’, Journal of the American Academy of Child & Adolescent Psychiatry, 35, pp606–14. 77 Steinhausen HC, Waachter M, Laimbock K & Metzke CW (2006) ‘A long-term outcome study of selective mutism in childhood’, Child Psychology and Psychiatry, 47 (7), pp751–6. 78 Svihra M & Katzman MA (2004) ‘Behavioural inhibition: a predictor of anxiety’, Paediatrics & Child Health, 9 (8), pp547–50. 79 Thomas L (2002) ‘Poststructuralism and therapy – what’s it all about?’, International Journal of Narrative Therapy and Community Work, 2, pp85–9.

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80 Toppelberg CO, Tabors P, Coggins A, Lum K & Burger C (2005) ‘Differential diagnosis of selective mutism in bilingual children’, Journal of the American Academy of Child & Adolescent Psychiatry, 44 (6), pp592–5. 81 Vecchio J & Kearney C (2009) ‘Treating youths with selective mutism with an alternating design of exposure-based practice and contingency management’, Behavior Therapy, 40 (4), pp380–92. 82 Viana AG, Beidel DC & Rabian B (2009) ‘Selective mutism: a review and integration of the last 15 years’, Clinical Psychology Review, 29 (1), pp57–67. 83 White M (2007) Maps of Narrative Practice, Norton & Company, New York. 84 Wong P (2010) ‘Selective mutism: a review of etiology, comorbidities, and treatment’, Psychiatry (Edgmont), 7 (3), pp23–31. 85 World Health Organization (2015) International Classification of Diseases, 11th edn, Beta draft, online, http://apps.who.int/classifications/icd11/browse/f/en# (ICD-11 is due for publication in 2017), World Health Organization, Geneva. 86 Wright HL (1968) ‘A clinical study of children who refuse to talk in school’, Journal of the American Academy of Child Psychiatry, 7, pp603–17. 87 Yeganeh R, Beidel DC & Turner S (2006) ‘Selective mutism: more than social anxiety?’, Depression and Anxiety, 23, pp117–23.

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Organisations The non-profit-making organisations listed below by country offer support and advice when someone has SM. Please note that most organisations also have an active Facebook Group.

UK

Germany

The Selective Mutism Information and Research Association (SMIRA) C⁄ 5 Keyham Close, Leicester LE5 1FW O Website: www.smira.org.uk Email: [email protected] Telephone: 0800 228 9765

Mutismus Selbsthilfe Deutschland e.V Website: www.mutismus.de

USA The Selective Mutism Foundation Website: www.selectivemutismfoundation​ .org Selective Mutism Group – Child Anxiety Network Website: www.selectivemutism.org

New Zealand Selective Mutism Parent Support Group Email: [email protected]

South Africa Selective Mutism Support Group – South Africa (SMSG-SA) Website: www.selectivemutism.co.za

Belgium Selectief mutisme Vlaanderen Website: www.selectiefmutisme.be

Denmark Selektiv mutisme Website: www.selektiv-mutisme.dk

France Ouvrir la Voix Website: www.ouvrirlavoix.sitego.fr

Appendix F

RESOURCES AND USEFUL CONTACTS

Italy Associazione Italiana Mutismo Selettivo (AIMuSe) Website: www.aimuse.it

Japan Kanmoku Net Website: www.kanmoku.org

Norway Mutisme.no – Foreningen selektiv mutism Website: www.selektivmutisme.no

Poland Mutyzm Wybiórczy Website: www.mutyzm.org.pl

Sweden Föreningen selektiv mutism Website: www.selektivmutism.se

Switzerland Mutismus Schweiz Website: www.mutismus.ch

Worldwide Selective mutism EU Website: www.selective-mutism.eu

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Other websites and support for selective mutism Finding Our Voices

SM Space Cafe

Provides a free quarterly online magazine, and a Facebook page, for young people and adults with SM. www.findingourvoices.co.uk

A Facebook page, for young people and adults who have SM and the people who want to support them. www.facebook.com/groups/1462678917293033

iSpeak

Face-to-face support group for adults in East Kent who have, or are recovering from, SM www.mind.org.uk/information-support/guides​ -to-support-and-services/peer-support/find-peer​ -support-in-the-south email: [email protected]

Information for young people and adults with SM. www.ispeak.org.uk

NHS Choices – Selective Mutism www.nhs.uk/conditions/selective-mutism

TalkingCircles

SM

Websites for general anxiety Anxiety UK

Rethink Mental Illness

www.anxietyuk.org.uk

https://www.rethink.org

Fear Fighter

The Association for Behavioural and Cognitive Therapies (ABCT)

www.fearfighter.com

www.abct.org

Mind – The National Association for Mental Health Together www.mind.org.uk

www.together-uk.org

Books Support for selective mutism ★ Can I Tell You about Selective Mutism? (2012) by Maggie Johnson and Alison Wintgens, Jessica Kingsley, London (a guide for friends, family and professionals).

★ Selective Mutism in Our Own Words: Experiences in Childhood and Adulthood (2015), written and edited by Carl Sutton and Cheryl Forrester, Jessica Kingsley, London.

★ Tackling Selective Mutism (2015), edited by Benita Rae Smith and Alice Sluckin, Jessica Kingsley, London.

★ Supporting Quiet Children: Exciting Ideas and Activities to Help ‘Reluctant Talkers’ Become ‘Confident Talkers’ (2012), by Maggie Johnson and Michael Jones, Lawrence Educational, Cambridge (for children aged 2 to 6 years).

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Story books and novels featuring selective mutism ★ Can’t Talk, Want to Talk! (2014) by Jo Levett, Speechmark Publishing, Milton Keynes. (A little girl with SM starts school and finds a friend in Lily.)

★ My Friend Daniel Doesn’t Talk (2006) by Sharon L Longo, Speechmark Publishing, Milton Keynes. (Another charming story of friendship which will help teachers explain SM to the whole class; ages 4–8).

★ Medina Hill (2009) by Trilby Kent, Tundra Books/Random House, London. (An adventure set in 1935 featuring an 11-year-old boy with selective mutism; ages 10–14).

★ Persona Medusa: An Embodied Tale of Anxiety (2015) by D.J. Sharry, CreateSpace Independent Publishing Platform. (This survival story is an adult’s personal account of facing and making peace with SM.)

★ The Voice of the Xenolith (2015) by Cynthia Pelman ,Grosvenor House Publishing, Guildford. (A detective story about a girl aged 13 who had SM aged five, has her own specific interests and prefers to spend time on her own, thinking and researching.)

★ Slipping In and Out of My Two Worlds (2011) by Jessica Thorpe, Lulu online publishing at www.lulu.com. (A 19 year old’s coming of age story about living with and eventually overcoming SM.)

Other children’s books ★ Penguin (2007) by Polly Dunbar, Walker Books, London. (An amusing book which beautifully illustrates what will not help children to speak! Ages 3–5 but adults love it too!)

★ Lamb Says Boo! (2012) by Katherine Sully, Greenbrier Publishing, Marlborough, USA. (A book about being brave and how being quiet can have its advantages too! Ages 3–5.)

★ Little by Little (2008) by Amber Stewart, Oxford University Press. (Scramble the otter can’t swim but, by taking one tiny step at a time, he succeeds. Ages 3–6).

★ Me Too! (2001) by Mercer Mayer, Random House, New York. (A book with repeating lines). ★ Oh No! (2012) by Candace Fleming, Schwartz & Wade, New York. (A book with repeating lines.) ★ Jump, Frog, Jump (1989) by Robert Kalan, Greenwillow Books, New York. (A book with repeating lines.)

★ Pierre: A Cautionary Tale in Five Chapters and a Prologue (2007) by Maurice Sendak, HarperCollins Publishers Inc., London. (A book with repeating lines.)

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Tackling anxiety ★ The Huge Bag of Worries (2011) by Virginia Ironside, Hodder Children’s Books, London (ages 3–9). ★ What to Do When You Worry Too Much: A Kid’s Guide to Overcoming Anxiety (2006) by Dawn Heubner, Magination Press, Washington, DC (ages 6–12).

★ Anxious Kids, Anxious Parents (2013) by Reid Wilson and Lynn Lyons, Health Communications, Inc., Florida (ages 8–18).

★ Playing with Anxiety: Casey’s Guide for Teens and Kids (2013) by Reid Wilson and Lynn Lyons, online, http://playingwithanxiety.com (ebook for ages 8–18).

★ Think Good – Feel Good: A Cognitive Behaviour Therapy Workbook for Children and Young People (2002) by Paul Stallard, John Wiley & Sons, Chichester.

★ A Clinicians’ Guide to Think Good – Feel Good: Using CBT with Children and Young People (2005) by P. Stallard, John Wiley & Sons, Chichester.

★ Children and Young People with Anxiety: A Guide for Parents and Carers / Young Person’s Guide, Anxiety UK, Manchester. Available online at www.anxietyuk.org.uk.

★ First Steps Out Of Anxiety (2010) by Dr Kate Middleton, Lion Books, Oxford. ★ Overcoming Your Child’s Fears and Worries: A Self-help Guide Using Cognitive Behavioral Techniques (2007) by Cathy Creswell & Lucy Willetts, Robinson, London.

★ Helping Your Anxious Child: A Step-by-step Guide for Parents, second edition (2008) by Ronald M. Rapee, Ann Wignall, Susan H. Spence, Vanessa Cobham and Heidi Lyneham, New Harbinger Publications, Oakland, CA.

Tackling fear of making mistakes ★ The Girl Who Never Made Mistakes (2011) by Mark Pett, Sourcebooks Jabberwocky, Illinois (ages 4–8). ★ Mistakes That Worked: 40 Familiar Inventions and How They Came to Be (2013) by Charlotte Foltz Jones, Doubleday Books for Young Readers, Toronto (ages 8–12).

★ Helping Your Child Overcome Perfectionism, Anxiety BC resources, online, www.anxietybc.com/sites​ /default/files/OvercomingPerfectionism.pdf.

★ Beautiful Oops! (2010) by Barney Saltzberg, Workman Publishing Company, NewYork (age 3–adult). ★ Mindset: The New Psychology of Success (2006) by Carol Dweck, Random House, New York. Sensory processing difficulties ★ The Highly Sensitive Child: Helping Our Children Thrive When the World Overwhelms Them (2003) by Elaine N. Aron, Thorsons, London.

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★ The Highly Sensitive Person: How to Thrive When the World Overwhelms You (1999) by Elaine N. Aron, Thorsons, London.

★ The Out of Sync Child: Recognising and Coping with Sensory-processing Disorder (2005 revised edition), by Carol Stock Kranowitz, Perigee, New York.

★ Too Loud, Too Bright, Too Fast, Too Tight: What to Do If You Are Sensory Defensive in an Overstimulating World (2004 reprint edition) by Sharon Heller, HarperCollins, London.

Talking resources Voice-activated toys ★ Talking Toucan or Repeating Parrot: www.nauticalia.com. ★ ‘Nintendogs’ game for Nintendo DS console: talk to dog to make it perform up to 14 different commands; www.nintendo.co.uk.

★ Lucy The Dog: Lucy obeys 12 commands such as ‘sit’, ‘search’, ‘on your head’ and ‘give me a kiss’; www.toysrus.co.uk, www.argos.co.uk.

Voice-recording devices ★ Language Master® System, Drake Educational Associates: www.drakeed.com. ★ Mini Me Voice Recorder, Talking Tins, Talking Photo Albums, Talking Keyrings, Talking Labels, Talking Greeting Cards and Talking Treasure Hunt Game: Talking Products Ltd, www.talkingproducts.co.uk.

★ Talking Postcards and Talking Photo Album: Special Direct, www.specialdirect.com ★ Talking Teddy: make a bear to your own specification and include a recorded message from Build-A-Bear Workshop UK (www.buildabear.co.uk).

Other support for communication ★ Talking Tubes: Asco Educational Supplies Ltd (www.ascoeducational.co.uk) and Taskmaster Ltd (www.taskmasteronline.co.uk).

★ Proloquo2go® ‘A voice for those who cannot speak’: symbol-supported communication app useful for participating in class or meetings as voice (optional) can be heard by whole group; Assistiveware (Netherlands) at www.assistiveware.com and www.itunes.apple.com.

★ Emergency Chat by Leonard Elezi: ‘the app can be used in any situation where speech is impossible but communication is still necessary’. This phone app provides an explanation and text support when talking is difficult; it is available at www.leonardelezi.com/emergencychat.

★ SM awareness cards (the size of business cards) by Lizzie Helps: SM Space Café, smspacecafe@gmail​ .com, www.facebook.com/groups/1462678917293033.

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Audio-visual resources ★ Silent Children DVD explaining about SM and showing helpful strategies. Available from SMIRA, [email protected].

★ ‘My Child Won’t Speak’ BBC documentary available on YouTube (www.youtube.com​ /watch?v=fm1SOoY57cE).

★ Saki Galaxidis talks about overcoming selective mutism on YouTube (www.youtube.com​ /watch?v=VyatBNFI9u4).

★ ‘Educating Yorkshire’, Channel 4 documentary: see the extract ‘Mushy Finds His Voice’ on YouTube (www.youtube.com/watch?v=CFXl27z5sIE).

★ The Dos and Don’ts When Interacting with a Child with Selective Mutism is a short film by Lucy Nathansan, based on the Johnson–Wintgens teaching approach. Available on YouTube (www.youtube.com/watch?v=WzlhqoLZwNw).

Clinical resources ★ Autism Diagnostic Observation Schedule (2000) by C. Lord, M. Rutter, P.C. DiLavore and S. Risi, Western Psychological Services, Los Angeles.

★ More Than Miracles: The State of the Art of Solution-focused Brief Therapy (2007) by S. de Shazer, Y.M. Dolan and H.N.Y Korman, Haworth Press, Philadelphia.

★ The Wellbeing Toolkit: a skills-based training programme in therapeutic tools to foster social and emotional development in children and young people (2015) by Tina Rae, Nurture Group Network, London.

Therapy resources ★ Active Listening for Active Learning (Resources for Guessing, Good Thinking, Giving and Seeking Clarification) (2009) by Maggie Johnson and Carolyn Player, QEd Publications, Stafford. Available online at www.qed.uk.com.

★ Social Skills Posters including Facing Fears and Good Explaining, by Maggie Johnson. Available online at www.specialdirect.com.

★ Worry Wheels (2015) by Lesley Burton, SenseToys Limited, www.sensetoys.com. ★ Stories for Talking (2008) by R. Bergman, QEd Publications, Stafford. Available online at www.qed.uk.com.

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★ Big Mouth Crocodile, Special Direct, www.specialdirect.com. ★ I Say! (2001) by Margaret Valery, Stass Publications, Cornwall. Fifty short, easy-to-read dialogues for two people. Available online at www.stasspublications.co.uk.

Educational resources ★ Leaflets produced by Kent Community Health NHS Foundation Trust (KCHFT) at www.kentcht.nhs​.uk (search for selective mutism). Contact KCHFT Communications Team at [email protected] for permission to use the leaflets.

★ Special educational needs and disability: a guide for parents and carers (2014) Department of Education, Ref: DFE-00547-2014. Available at www.gov.uk/government/publications/send-guide​ -for-parents-and-carers.

★ Adjustments for candidates with disabilities and learning difficulties (2017) The Joint Council for Qualifications. Available at www.jcq.org.uk/exams-office/access-arrangements-and-special​ -consideration.

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TALKING TO THE CHILD ABOUT SPEECH ANXIETY – ‘THE PEP TALK’ Acknowledge the child’s fear of speaking.

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Let them know that you understand their difficulty and the feelings they experience when they try to speak. You know they want to and have tried to speak, but they feel so worried about talking that they tighten up and feel frozen – the words seem to get stuck in their throat. The language you use and the detail you give will depend on their age, but even very young children benefit from having their problem acknowledged rather than ignored, ‘hushed-up’ or misinterpreted. Let the child know they are not alone.

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Younger children need to know that there are plenty of other lovely children who find talking hard at first. For older children (just as for adults) it can be especially reassuring to be told that their condition has a name (selective mutism) and that other children their age have got through it. A calm, informed approach will inspire confidence!

Take the pressure off talking so that the child can relax, participate, enjoy and learn in all settings. Emphasise that there are lots of other ways to join in and have fun. Impress on the child that the most important thing is for them to be happy and relaxed. Tell the child that there is no rush and they can speak when they feel ready. Let them know that they have a friend in you to turn to, if they are feeling upset. Explain that talking will get easier.

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It is essential that the child sees themselves as a person who will talk at some time in the future and knows that you have confidence in them. Tell them you know they are not ready to talk yet but it will not always be like this; it will get easier and they will get braver. Emphasise that they only have to do things they can manage; and that by starting with things they find easy, they will gradually be able to do more and more until, one day, talking is really easy too. Even children as young as three years old can see the logic of this approach.

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Advice sheet for staff and parents of children who have selective mutism

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WHAT IS SELECTIVE MUTISM?

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An information sheet for parents and professionals

WHAT IS SELECTIVE MUTISM? Selective mutism is a term used when children who are able to talk comfortably to some people, usually family members and close friends, are silent or unable to talk freely when other people are present. Often the problem is not apparent until the child goes to playgroup, nursery or school. Children who have not spoken in certain situations for over a month – not including the first month which is often a settling-in period – can be described as having selective mutism. ‘Selective mutism’ used to be known as ‘elective mutism’ but it is now understood that the child’s mutism is not a choice. This is not normal shyness, nor obstinacy; it is a psychological problem where children have developed a phobia of talking to anyone outside their limited comfort zone. Their panic reaction is so extreme and frightening that they either freeze and become unable to speak or do all they can to avoid the need to talk.

A few facts ★ Selective mutism is more common than previously thought. Studies suggest that up to seven children per thousand are affected – that is one or more children in most primary schools.

★ Selective mutism affects children of a sensitive disposition. ★ It is usually present from the time that children move outside the family circle but people often do not seek help until the child is between the ages of four and six.

★ It occasionally develops in older children and can persist into adulthood if untreated. ★ Girls are affected at least as frequently as boys, if not more. ★ Children who have selective mutism are more likely to have other speech and language difficulties.

★ Children who come from bilingual or migrant backgrounds are more likely to have selective mutism.

★ Children who have selective mutism are more likely to have other family members who are shy or anxious or have difficulty with social relationships.

★ The pattern of speaking and silence is different for every child but it is consistent and predictable.

★ Children who have selective mutism are no more likely to have been abused than any other child.

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In younger children, and when the mutism is less entrenched, there are ways of creating an environment in school and at home that alone may result in considerable progress. These include:

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★ Understanding the nature of selective mutism and that it is neither stubbornness nor ★ Openly acknowledging the child’s difficulties in an accepting and relaxed way, while reassuring the child that the situation is only temporary.

★ Encouraging general participation in a relaxed atmosphere, with no pressure on the child to speak until they are ready.

★ Acknowledging and rewarding independence, initiative, communication and participation in activities.

★ Accepting the child’s spontaneous efforts to communicate non-verbally. ★ Letting the child talk to parents and friends, allowing enough time for them to become comfortable, before gradually approaching and joining in. If the child is older, the mutism is longstanding, or there are any other concerns about the child, in addition to the above modifications, a referral should be made to a professional such as a speech and language therapist, educational psychologist or clinical psychologist, according to local referral guidelines. If it is difficult to find a professional with an interest or experience in selective mutism, local authorities can ensure that staff members receive appropriate training from specialists in the field. An assessment may include a parental interview, information from school, and an evaluation of the child’s speaking habits (a picture of the locations and conditions where speaking is comfortable). It may also include the assessment of speech and language and cognitive skills. Treatment is likely to take the form of a behavioural programme designed to reduce the child’s anxiety about speaking. This will involve parents and school staff with regular meetings to review and update treatment targets. Ongoing support and advice to the school and family are crucial. Training in social skills or assertiveness is often beneficial. In a few situations, or at some stage of treatment, alternative therapies or medication may help.

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WHAT IS SELECTIVE MUTISM?

deliberate.

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Progress is best when the child’s problem is identified early and steps are taken to understand and manage the problem before it gets firmly established.

Suggestions for further reading The Selective Mutism Resource Manual, 2nd edition, by Maggie Johnson and Alison Wintgens (2016), Speechmark Publishing Ltd. Can I Tell You About Selective Mutism? by Maggie Johnson and Alison Wintgens (2012), Jessica Kingsley Publishers.

Resources for children My Friend Daniel Doesn’t Talk by Sharon Longo (2006), Speechmark Publishing Ltd. Can’t Talk, Want to Talk! by Jo Levett (2015), Speechmark Publishing Ltd.

Helpful organisations ★ SMIRA (Selective Mutism Information and Research Association): www.smira.org.uk ★ The Selective Mutism Foundation, Inc.: www.selectivemutismfoundation.org ★ NHS Choices: www.nhs.uk/conditions/selective-mutism

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QUIET CHILD or SELECTIVE MUTISM?

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An information sheet for parents and professionals

QUIET CHILD or SELECTIVE MUTISM? Some children are naturally quiet and present a similar personality at home and in school. They do not venture a lot of information but can become quite animated with a familiar topic that captures their imagination. Provided they are coping academically, have a good friend or two and are not being bullied, quiet children move easily between their home and school environments without anxiety. Their relaxed body language and facial expressions show that they are happy to listen, without necessarily feeling the need to talk as much as their noisier peers.

Not all quiet children are comfortable with silence For some quiet children and young people, however, it’s a very different picture. They may have an anxiety disorder called selective mutism (SM) – a phobia of speaking in specific situations. These individuals do not want to be quiet. They may have plenty to say but are unable to speak freely – just the thought of speaking to certain people fills them with dread and can trigger a panic or ‘freeze’ reaction. Typically, they feel a blockage in the throat as their muscles tense, and they cannot produce sound to talk, laugh, cough or cry out loud.

When is it selective mutism? Although no two children who have SM are exactly the same, they all have:

★ the ability to talk freely to certain people and not others (often described as ‘two personalities’)

★ a consistent pattern of situations where speech is possible and not possible ★ avoidance or reluctance to attend events where they will be expected to speak ★ high levels of distress when their difficulty speaking freely is not understood. Some children who have SM are recognised more easily than others …

High-profile selective mutism These children and young people do not speak at all to certain people. They are therefore quite easily recognised by the observable contrasts in their speaking patterns. They may speak to children in their educational setting, for example, but not adults. They may speak freely to their friends in the playground but not in the classroom where they will be overheard by other people. They may speak to relatives they see on a regular basis, but not those they see infrequently. And, typically, they speak to parents as soon as they move out of earshot of other people.

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Once recognised, there is generally a willingness to accept that these children have an anxiety-related communication difficulty.

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Children with low-profile SM speak when prompted, so adults usually regard them as shy, quiet or rude and don’t realise that speaking provokes the same intense anxiety as highprofile SM. These children manage to say a few words because of their strong desire to be compliant. In effect, their fear of the consequences of not speaking outweighs their fear of speaking, but this fine balance only operates when they are fairly confident about the subject matter. So, in school, they may answer the register or read aloud on request, and can answer simple questions, albeit with a much quieter voice and less eye contact than they would use at other times. They may occasionally initiate an essential request, such as using the toilet, or pass on a short message when instructed. In contrast, they do not enter into reciprocal two-way conversation or initiate conversations, except with close friends and family. ‘Nonessential’ language such as ‘please’ and ‘thank you’ is very difficult for them.

QUIET CHILD or SELECTIVE MUTISM?

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Low-profile selective mutism

Until it is recognised that they are unable to report bullying or illness, seek help, ask permission or explain themselves, these young people are at risk. Their difficulties may go unnoticed and they may be reprimanded, rather than supported, when they don’t speak up for themselves. Repeated encouragement to speak louder and make more of a contribution only heightens their discomfort. If their difficulties continue to be mismanaged, they are likely to speak less and less with an increase in school absence and a decrease in self-esteem. When children with high-profile SM receive the right support, they initially resemble a lowprofile child because they answer questions but rarely initiate interaction.

Supporting children and young people who have selective mutism Children with low-profile and high-profile SM need the same help to achieve anxiety-free communication and participation. Steps must be taken to remove all pressure to speak, followed by a gradual step-by-step approach to face their fear of talking, at their own pace. Importantly, the children need an explanation to recognise that SM is not part of their personality. It is something that can be overcome, like other fears they worked through when they were younger; for example, a fear of darkness, fireworks or letting go at the top of a water chute.

★ Appoint a member of staff to make a special relationship with the child or young person on a one-to-one basis.

★ Actively support the development of friendships and inclusion in pastoral activities. ★ Be patient and don’t pressurise the child or young person to speak; focus on discovering and acknowledging their many strengths and attributes.

★ Continue to support and monitor progress until the child speaks freely and independently. Seek advice or information on providing appropriate help from websites and organisations such as:

NHS Choices www.nhs.uk/conditions/selective-mutism Selective Mutism Information and Research Association (SMIRA) www.smira.org.uk

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WHAT TO SAY WHEN …

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An advice sheet for parents, teachers and carers of children who have selective mutism

WHAT TO SAY WHEN … ... other people need a quick explanation (do this in private) “Selective mutism is an anxiety disorder – if we do nothing or treat it like a behaviour problem, the anxiety will get worse.” “No, it’s not shyness, more like stage fright. She literally freezes up and can’t get a word out at times.” “Selective mutism is a phobia of talking to anyone outside your comfort zone. It’s the same as a phobia of cats or eating certain foods – even though there’s nothing to be scared of, you just get this awful feeling of panic.” ... people make unhelpful comments in front of the child Step in quickly and play down unhelpful comments and questions as in the following examples. Show that you are not concerned and quickly move on to another topic. If appropriate, arrange to speak to the individuals concerned later, to explain how they can help the child or young person in future. ... adults put pressure on the child to speak If adults make comments such as: “Are you going to speak to me today?” “Has the cat got your tongue?” “What’s the matter – is something wrong?” Say something like: “You’ll have to wait and see, won’t you?!” (To [N], referring to the comment) “That’s a funny thing to say, isn’t it?!” “[N]’s doing really well. We’re all very happy with how she’s doing.” “Nothing’s wrong. [N]’s enjoying listening, aren’t you?” ... other children ask why the child who has selective mutism doesn’t talk “[N] will talk as soon as she feels ready, won’t you [N]?” “[N] hasn’t found his voice in school yet but, when he does, we won’t make a fuss. We’ll talk to him as if he’s always spoken.” “Some of us find it hard to speak when there are lots of people around. It’ll be easier when just the two of you work or play together.”

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“[N]’s working on it. You can be a good friend and just wait for it to happen.”

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[N] is the name of the child or young person who has selective mutism

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... other children tell you the child can’t talk

“[N] talks lots at home, and he’s working hard on talking here too” “If you’re lucky you might be the first person [N] talks to at school. But it won’t be you if you keep saying that!” “Of course she can, but right now you prefer to listen and think, don’t you [N]?” … other children speak for the child If children pass on a message from the child openly accept this to gradually enable [N] to speak to friend(s) in front of you. “Thank you, I’ll check with [N] that I’ve got the message right.” “Is that right, [N]?” ([N] confirms by nodding or shaking their head.) (Use friend as a go-between) “Can you ask [N] who he’d like to sit with?” If children answer for the child, make it clear that you were not talking to them! “It’s OK, [N] knows how to answer. He can point/show me/nod/shake his head.” … the child puts up their hand in class to answer or is asked a question Smile and wait five seconds. If no answer comes, calmly move the conversation on:

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“[N] is really good at talking at home and if we all help by being patient, she’ll be able to talk here too, isn’t that right [N]?”

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“Well done, I can see you know the answer! Who else wants to have a go?” “That’s OK, jot it down/show me later/tell Danny what you were going to say.” “Let [N] have a think about that.” (Explain privately that [N]’s not ready for direct questions.) … the child speaks for the first time and/or other children comment on this Respond to what [N] says as if they have always spoken (ie no direct praise): “Great idea”; “That sounds fun”; “Yes let’s do that”; “Good answer!” “We always knew [N] would feel like talking one day.” “That’s great – and what have you managed to do today? … you cannot hear what the child says If you are alone with [N], say you’re sorry you didn’t hear, rather than ask [N] to repeat or speak up. But don’t draw attention to this in public. Thank [N] for the contribution and, if necessary, seek clarification later on a one-to-one basis. … people expect the child to say ‘Hello’, ‘Goodbye’, ‘Please’ or ‘Thank you’ Smile and calmly move the conversation on. Social conventions are the hardest thing for children who have SM to accomplish and are not a priority. If appropriate, explain later in private that the child was not being rude. Note: these are just examples which can be adapted for individual children, depending on their age and different situations – you will be able to think of more! The last example in each group is generally more suitable for older children.

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SELECTIVE MUTISM IS A PHOBIA

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An information sheet for parents and professionals

SELECTIVE MUTISM IS A PHOBIA Selective mutism is a phobia of talking to certain people in certain situations. This understanding is central to successful treatment. As with all phobias: 1 Phobias can be overcome So relax and let children who have selective mutism know you have complete confidence that they will conquer their fear of talking. 2 Phobias are common and nothing to be ashamed of It helps when people talk openly and non-judgementally about fear and we know what we’re dealing with – it’s not ‘just the way we are’. 3 Applying pressure makes phobias worse Phobic individuals can’t be rushed, and any use of force, disapproval, unrealistic targets or bribery will simply raise their anxiety levels even higher. 4 Facing fears is the key to success The most successful way to overcome a phobia is to gradually face the fear at your own pace. So, after initially removing all pressure to talk, we help children gradually participate in conversations, one small step at a time. It’s like leaving the light on when a child is afraid of the dark, and gradually darkening the room, using a dimmer switch. 5 Avoidance is not an option The longer you put off facing your fear, the stronger it becomes and the better avoidance feels. So we must find ways to make difficult situations more manageable, rather than avoiding them altogether. 6 Confidence has a ripple effect Nurture a positive self-image, anxiety-coping strategies and courage!

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An advice sheet for staff and parents of children who have selective mutism

★ Focus on what children can do rather than can’t. Foster their individual skills, talents and interests so that they have plenty to feel good about. Ask children to show you and others how to play an instrument, care for their pets, use technology, contribute to a magazine – anything that shows you value them as a whole person and that there’s more to life than talking.

★ Physical exercise is good for mind, body and soul and helps to keep anxiety at bay. Start each day with a plan that includes physical activity – whether this is letting off steam after school for younger children, or sweeping up leaves, Tai Chi or walking the dog for older children. Build family outings and school trips around physical challenges which can do so much to boost children’s confidence while proving that it is possible to conquer fears through sheer determination.

★ It’s achievement that builds confidence rather than praise; confidence then enables us to accept praise. Under-confident children are therefore often uncomfortable with praise, but need frequent acknowledgement that they are doing well to build self-esteem, persistence and motivation. So ensure success by setting realistic targets and structuring or adapting tasks to the child’s capabilities; then smile and describe what the child has achieved. You thought really hard about that and chose carefully

Wow, even though you were really nervous you joined in!

Look at you – you walked straight in and found your place really quickly!

Thank you for helping Marie today – you made it really clear for her

★ Children with SM become acutely aware that they are different to other children and do not want this emphasised, so unless children are very young, acknowledge their achievements around talking and being brave in private, rather than in public. In contrast, make sure they receive plenty of praise in public for behaviour that is encouraged and valued in all children.

★ Recognise courage or bravery when children do something they initially resist, and reward appropriately with a hug, sticker, special treat, congratulations or verbal acknowledgement. There is a danger of ignoring or dismissing bravery if it seems that the child was being ridiculous to worry in the first place, especially if the situation leaves adults feeling irritated or guilty rather than sympathetic. However, it is important to replace the child’s panic, resentment, exhaustion or residual anxiety with pleasant feelings as soon as possible. This is how children learn the name for courage and become less resistant next time; they have a right to feel proud of themselves when they are brave.

FIRM FOUNDATIONS: BUILDING CONFIDENCE

FIRM FOUNDATIONS: BUILDING CONFIDENCE, COURAGE & SELF-ESTEEM

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★ Resist the urge to do things for children when they look anxious or hesitant, e.g. stepping in to take something that has been offered to your child. If it’s only anxiety that’s stopping them, this anxiety will not subside if you allow them to rely on you. Give a clear message that they are capable in the form of permission, e.g. “It’s OK to take the present from Robert”, rather than a direct command, e.g. “Go on, take the present”. Then smile and wait (at least 5 seconds). If this does not work, make the task easier, “Tell you what, hold your hands out and see if you can catch it!”, “I’ll help you hold your hands out and then Robert can give it to you”. Do not step in unless you do it with the child, “Let’s take the present from Robert together, are you ready, 1-2-3…!”. Be ready to say “You did well!” as soon as they take up the challenge.

★ Check your behaviour to see if stepping in has become a habit. If you don’t know how to make a task more manageable, give yourself some thinking time by gently moving on rather than doing the task yourself. “Come back to Jess later and she can try again”; “That’s OK, leave it for now”. The less you do, the more children will see you believe in them, and the braver they’ll become.

★ Stick to your word so children know they can trust you to move at their pace – and be ready to be lead by them as they gain confidence and want to do more!

We’ll just give Charlie his present and stay for 15 minutes while it’s quiet

I’m just popping to the school office, I’ll be back in 10 minutes and then we can go home

★ It’s important for children to view difficult tasks as challenges to work towards, rather than insurmountable obstacles. Convert ‘can’t’ to ‘can’t yet’ and assure children they will succeed with more practice / as they get braver / when it’s broken down into tiny steps.

★ Children will only take risks and push the boundaries if they are not afraid to make mistakes. Acknowledge and reward effort rather than perfection and view mistakes as proof of endeavour and learning, rather than opportunities for adults to correct or children to give up.

★ Show children how to laugh, relax and have fun. It is important for everyone to enjoy mealtimes, gardening, craftwork and play without worrying excessively about germs or mess, so put away the wet-wipes until the end of the activity! Fears of getting dirty or putting something in the wrong place make it hard to settle in unfamiliar environments, mix with other children and take the initiative.

★ If children are worrying about their parents, they cannot focus on their own well-being. If a child has good reason to be concerned about a parent’s behaviour or lifestyle, it is time to reflect on changes the adult would like to make, before investigating local resources or talking to a friend or GP about accessing parental support.

★ Most children who have SM are unable to initiate contact with other children so actively cultivate friendships by pairing them up with other children for play activities and project work.

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★ Ensure inclusion in all activities and welcome participation at any level while the child

★ Often it is anxiety about only one component that creates avoidance, e.g. opting out of a school trip because you don’t know if there’ll be a toilet-stop en route; being afraid to use school toilets because of the sound of the hand-dryer; not going abroad because you don’t know how to get a passport. Show children how to be a positive problem-solver by visualising big intangible worries as smaller components on post-it notes, a mind-map or list. It’s then much easier to see which part is causing most anxiety and how it can be addressed.

★ Show by your own example how you don’t let anxiety stop you doing things that at first seem frightening or overwhelming. Tell children about times you felt worried and considered backing out, but faced your fear and gave it a go or found a solution.

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works towards talking, e.g. gesture, writing, drawing, making choices, scoring, recording information, checking and handling equipment.

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An advice sheet for parents, teachers and carers

HELPING CHILDREN TO COPE WITH ANXIETY How to make anxious children more anxious … 1 Tell them there’s nothing to worry about. 2 Sort out their problems. 3 Don’t allow them to become distressed. 4 Rush to comfort them. 5 Let them decide what they can cope with. 6 Ask if they are going to be OK. 7 Answer all of their questions. 8 Spring the dreaded event on them at the last minute so there’s less time to worry. Did that list surprise you? No one wants to see their child in distress. So, of course, you want to take away your child’s anxiety. However, anxiety is normal and it is good for us – it keeps us safe! Anxiety makes sure that we look out for danger and are prepared to meet life’s challenges. When children are shown that the only way to cope with anxiety is to eliminate it, they become increasingly intolerant of anxiety. They only have to feel the tiniest bit anxious and it’s unbearable – they feel compelled to run (FLIGHT) or resist (FIGHT) and may seize up or go into denial (FREEZE). There is another way. Parents can help children FACE their anxiety, understand it, work with it and overcome it!

Things to do differently to make anxious children less anxious 1 Anxious children can’t help worrying. Telling them there’s nothing to worry about makes the worry more confusing, elusive and overwhelming. Children need help to understand that it is worry (a product of their excellent imagination!) that is making their body produce the sensations of panic, rather than the situation they fear: “You feel worried because you’ve never done this on your own before”, “You’re not sure what will happen when I go downstairs”, “It feels scary right now but, after a while, you’ll see that nothing bad happens, and your worry will go away and stop bothering you”. By labelling and recognising ‘Worry’, children learn that it’s a normal response that they can talk to and control; it’s not a stop sign that has to be obeyed. So, rather than dismissing

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worries, let children know how amazing they are every time Worry appears and they are brave enough to ride it out. They’ll be surprised how quickly it gives up and goes away!

3 If we allow children to avoid everything they’re afraid of, they will never learn the difference between a real threat and an imagined threat. Acknowledge how brave children are being and help them face that fear, one tiny step at a time. Maybe they only need to attend the party for the first ten minutes or watch you having your dental examination, but not going to the party or to the dentist’s should never be an option. 4 We comfort young children when they are in pain and convey the message ‘Stinging nettles, broken glass and fights are bad things that you need to avoid if you want to save yourself further pain; meanwhile, I will make you feel better’. If we cuddle and soothe children when they are afraid of insects, dogs or fireworks, for example, the message is the same: ‘These are BAD things to be avoided and you should run to me for comfort’. So, ACKNOWLEDGE their anxiety; REASSURE; FACE the fear and PRAISE them. “Of course you’re worried, you weren’t expecting that but it can’t hurt you. Let’s stand further back until you get used to it”. Save the cuddles for when you congratulate them for being so brave!

DANGER!

5 Anxious children will be convinced they cannot face certain events. By agreeing to their terms – no parties, no visits, no falling asleep alone in their own bed – we deprive them of the opportunity to discover that anxiety can be managed and things are not as difficult as they expect. Consequently, all new challenges will be scary and they will make increasing demands to avoid any anxiety-provoking situation. It is frightening for children to have this much control; they need adults to make the big decisions about what is a real threat and what is safe. Adults should, in turn, be guided by the child regarding how much they can face at a time, steering them towards gradual mastery of feared situations. By making activities simpler or shorter, providing a distraction or phasing out support, realistic expectations can be set and children can be assured that all they need is the courage to have a go. It may also take courage for their parent to step back and let it happen. 6 “Will you be OK now?” Asking children this question before leaving them tells the child they are right to worry – after all, even you, the adult, are not sure that they’ll be OK! Tell children they will be OK, let them know when you will be back, and do your very best

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2 When children are tiny, of course they need their carers to fix any problems so that they are safe, well and happy. But even two year olds are actively problem solving throughout the day as they discover how to stop food falling off their spoon and retrieve objects that are out of reach. Independence develops through experimenting, finding your own solutions and enjoying the knowledge that you can be self-reliant. It thrives on a flexible approach to life where there are many ways to do the same thing; there is no need to be perfect; and you can take pride in effort as well as achievement. When parents do all of the fixing for anxious children by providing comfort, removing sources of stress or doing things for them to prevent failure, the children become more dependent, less willing to take risks and increasingly passive in their parent’s presence. Just recognising that you have fallen into any of these patterns of behaviour, and knowing that it was in response to your child’s anxiety, not the cause of it, is the most important step towards turning things around.

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not to be late. When you return, stay a while to share an activity and, on your way home, talk about the fun you had, rather than the terrible time they had without you.

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7 Anxious children try to eliminate uncertainty by asking their parents endless questions about upcoming events. Answering each one conveys the message that the only way to deal with anxiety is to have a completely accurate forecast for the future – an impossible task. Having no idea of what’s coming up is horribly unsettling at best and utterly terrifying at worst. So children certainly need a broad outline of their daily schedule and important events in their calendar. They need explanations or role play of routine procedures to know what to expect. But beyond that, as long as children have a clear understanding of what is required from them to complete specific assignments, they need to discover that the finer detail can wait and, more importantly, that they can cope with not knowing. Differentiate between need-to-know questions that require an answer and ‘worry’ questions. Try to answer ‘worry’ questions with another question, so children can explore the reasons for their anxiety and test how they would cope in each situation.

For example:



“I’m not sure how many people will be there. Why would you like to know? How many do you think you could cope with? So what could you do if there are more than that? What would make it easier?”



“She might have a dog. What worries you most about dogs? How can we tell if it’s safe to go near a dog? What do you think dogs want when they jump up? What would make you feel better if a dog was around? So what should we ask Auntie Sue to do?”



Above all, show children by your own example that it’s natural to worry about new situations but you can be brave and give it a go anyway. You can show Worry who’s in charge!

8 After seeing anxiety, repetitive questioning and resistance grow on the approach to dreaded events, it is completely understandable to forgo advance warning to save children getting themselves into a state. On the surface, this seems to be a good strategy because children often appear to cope reasonably well when there is no way out of a situation. However, this ‘success’ is usually a feat of endurance, spurred on by sheer adrenalin, rather than an enjoyable experience. The child is left, not with a sense of achievement, but with feelings of resentment, dread and insecurity. They become increasingly wary and suspicious, knowing that the next surprise could be just around the corner. Working through anticipatory anxiety to prepare for a specific event takes a lot more energy and resolve, but provides the foundation for general anxiety-coping strategies. Children learn that anxiety is normal; it can be spoken to with calming and rational thoughts, and overcome with familiarisation, a back-up plan and courage!

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Heubner (2005), Magination Press (age 6–12).

★ Anxious Kids, Anxious Parents by Reid Wilson and Lynn Lyons (2013), Health Communications, Inc. (age 8–18).

★ First Steps Out Of Anxiety by Dr Kate Middleton (2010), Lion Books, Oxford (young people and adults).

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Further reading ★ The Huge Bag of Worries by Virginia Ironside (2011), Hodder Children’s Books (age 3–9). ★ What to Do When You Worry Too Much: A Kid’s Guide to Overcoming Anxiety by Dawn

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An advice sheet for parents, carers and teachers of children who worry

MISTAEKS HAPPEN …! Being afraid to make mistakes can hold us back in all walks of life. It’s particularly hard on anxious children and young people who are desperate to get it right first time. The following tips may help them learn that mistakes are an inevitable and important part of life – they can even be fun!

Create a culture where mistakes are expected rather than penalised ★ Talk positively about mistakes when they occur. They show that children are having a go, trying hard and giving themselves and others the opportunity to learn. The only way you find out what works is to rule out the things that don’t work, and the only way you get better at anything is to practise. Mistakes are the most important thing that happen in any classroom, leisure or sporting activity, because they tell you where to focus that practice.

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★ When children are reluctant to write because they fear their work will be returned with any mistakes marked in red pen. – Add comments on sticky notes which can be studied, moved around and removed later. – Try the ‘two stars and a wish’ approach for group, self and individual evaluation. Say two things you like about the piece of work and one thing that could be improved to make it even better.

★ Introduce correction policies (simple written rules) for perfectionist children who can’t bear to make mistakes. So it’s not ‘If you make a mistake …’ but ‘When you make a mistake, you need to …’. This gives children something definite to do, rather than simply telling them not to throw their work in the bin or give up.

★ Do an internet search for someone your child admires for their accomplishments; for example, a footballer, a musician, an author or a game designer. The chances are that you will find something about how it took them a long time to get it right! Or look for inspiring quotes like this one, which is attributed to Thomas Edison, who invented the light bulb and much more: ‘I have not failed. I’ve just found ten thousand ways that won’t work.’

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Be a role model ★ Be good-humoured about your own mistakes – the kind that cause no harm – and show that they are nothing to feel bad about. You simply put things right, keep trying or leave things until later to sort out.

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★ Always state what you have learned from your

★ Resist the temptation to swoop in and fix children’s handiwork to make it perfect – celebrate their efforts, creativity and personal achievements. Once you change a child’s masterpiece, it’s yours not theirs and they may be less willing to share with you next time.

★ Demonstrate that it’s fine to say ‘I don’t know’ or ‘I’m not sure’ – it’s OK not to know the answer, and cool to try to find it.

MISTAKES ARE PROOF THAT YOU ARE TRYING

★ Get children you know well laughing with this game. Take it in turns to pick an activity out of a hat (eg ‘Clean your teeth’, ‘Go upstairs’) and do it in the most daft, silly way possible – you can mime, but doing it for real is funnier!

A different attitude to guessing ★ Encourage children to guess by stressing that all of their guesses are acceptable. Guesses demonstrate good thinking; it’s not about ‘right’ and ‘wrong’ answers.

★ Practise guessing in the safe structure of guessing games such as Guess Who? (which can be adapted using the children’s names), Twenty Questions, Hangman, I-Spy and What Am I? Children are usually more inclined to guess if they are given so many ‘lives’ to use up.

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mistakes, eg ‘At least I know to put the lid on firmly next time!’; ‘I’m definitely getting better at this’.

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★ Teach the process of good guessing for when you don’t know the answer – this is vital for multiple-choice questions. First, eliminate the answers that are definitely wrong. If one of the remaining answers seems more likely than the others, or you just get a feeling about it, choose that one. But think about it for only ten seconds. If nothing is obvious, decide a rule beforehand and make that choice as quickly as possible; for example, always go for ‘the third option’ or ‘the longest answer’. Done!

Further reading ★ Beautiful Oops! by Barney Saltzberg (2010), Workman Publishing Company (ages 3– adult).

★ The Girl Who Never Made Mistakes by Mark Pett (2011), Sourcebooks Jabberwocky (ages 4–8).

★ Mistakes That Worked: 40 Familiar Inventions and How They Came to Be by Charlotte Foltz ones (2013), Doubleday Books for Young Readers (ages 8–12).

★ Helping Your Child Overcome Perfectionism, Anxiety BC resources, online, www. anxietybc.com/sites/default/files/OvercomingPerfectionism.pdf.

★ Active Listening for Active Learning (Good Thinking) by Maggie Johnson and Carolyn Player (2009), QEd Publications.

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An advice sheet for early years practitioners and carers working with quiet children

HELPING YOUNG CHILDREN TO SPEAK AT SCHOOL

! ?

Early years staff members have seen an increase in the number of children who talk happily and noisily to close family but say much less outside the home. Children need to be eased into new settings gently, so that initial reluctance to speak does not become an intense fear of speaking.

Why is this happening? While family life gets busier, children are going

into school younger and may not be ready to separate from parents and talk confidently to strangers. Some children are particularly sensitive to change and anything new. Well-meaning attempts to encourage speech can actually make them more anxious about talking.

Turn this worrying trend around now! By expecting less while supporting more, children are allowed to succeed and develop the confidence to take small steps forward.

Be positive and reassuring ✣ As soon as it becomes clear that children are remaining silent in response to questions, have a private chat to reassure them. Say you know they want to talk but are finding it difficult at the moment. Tell them not to worry because talking will get easier and they don’t have to talk straightaway. Ask them to concentrate on having fun and then it will be easier to be brave and have a go. ✣ Make sure that no adult applies pressure to talk using bribery, persuasion or negative comments. Never force children to say ‘Hello’, ‘Please’, ‘Thank you’, etc. Social conventions are extremely difficult for anxious children.

Build confidence ✣ Look out for children who are stiff or frozen in their facial expression or body movements. This is usually caused by extreme anxiety. Focus on physical activity, laughter and general noise making to help them relax. ✣ Include plenty of activities which involve children moving, singing or talking in unison. ✣ Adopt a self-registration system, or repeat ‘Is _______ here?’, so that the whole class gets to know each other as they answer in unison each time.

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✣ Welcome parents as volunteer helpers for the whole group, not just their child. ✣ Encourage non-English-speaking parents to learn and use English at school, to show their child that it’s OK to have a go and make mistakes. ✣ Organise playground activities and make sure each quiet child has a friend at playtime. Encourage parents to invite the same children home to play. ✣ Give extra smiles and attention when children try anything new. Do things with children or make things easier, rather than doing things for them. ✣ Ensure that children can access the toilet, drinking water and first aid without asking.

Gradually facilitate speech, being guided by the child’s response ✣ Encourage all children to record messages for each other at home to add to their photographs on a computer or to share with recording devices such as Talking Tins®. ✣ Assign an adult to befriend and play with quiet children for short periods of time. ✣ Don’t ask direct questions while building rapport. Instead, chat in the style of a running commentary, with pauses so that children can join in when they feel ready: “Wow, look how tall you made your tower!”; “I wonder if that’s a horse … or maybe it’s a dog …”; “This is fun, isn’t it?”. Be prepared to do all the talking for a while! ✣ When the child gestures (eg nods or points), talk back as if they spoke to you. ✣ When children are relaxed enough to laugh, smile, nod and shake their heads, help them answer questions by providing a choice: “What’s this on your tree – are they apples or cherries?” Smile and allow a full five seconds for them to answer. If they don’t reply, move on the conversation in a positive way: “They look very tasty!” If children struggle to answer near other people, only use the choice technique one-to-one. If they tense up, even on a one-to-one basis, return to commentary-style chat until they relax again. ✣ When children speak, praise their ideas or the way they joined in, rather than the fact that they spoke: “Hey, you chose your book really quickly today!” ✣ Once children have begun to talk, turn gestures into speech by seeking clarification: “I can see you nodding. Does that mean you want milk or juice?”; “You’re pointing over there, are you showing me Tommy or Max?”; “You’re shaking your head, does that mean you want to play outside or stay here?”

Do some investigation ✣ Ask parents which language is spoken at home, how much the child speaks with family and friends, and whether they have any concerns about their child’s pronunciation or ability to understand or speak in sentences. ✣ Share the above advice on facilitating speech if the child is quiet with family or friends.

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✣ Parents can reduce the anxiety of separation by giving children something of theirs to look after before they leave. Arrange an early return so that parents can join in and make the last part of the session a positive experience.

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✣ Let parents know that you are very pleased with how their child is settling in and that you are working on building their confidence, so that they can do as well with you as they do at home. ✣ Make sure that parents are not putting pressure on the child by telling them they must speak at school or with relatives because this will increase separation anxiety and stop the child looking forward to school and social events. ✣ Seek advice about bilingualism if appropriate. ✣ Ask for advice from the local speech and language therapy service if language development appears to be delayed. ✣ If the above advice has been followed for six weeks, and the child is speaking much more at home than at school, the child could have a condition called selective mutism (SM). Continue this advice while seeking information about SM for home and school.

Suitable children’s books Penguin by Polly Dunbar (2007), Walker Books. Little by Little by Amber Stewart (2008), Oxford University Press. Lamb Says Boo! by Katherine Sully (2010), Alligator Books Ltd.

Additional resources Talking Tins®, Talking Products Ltd, www.talkingproducts.co.uk. Supporting Quiet Children: Exciting Ideas and Activities to Help ‘Reluctant Talkers’ Become ‘Confident Talkers’ by Maggie Johnson and Michael Jones (2012), Lawrence Educational. The Selective Mutism Resource Manual, 2nd edition, by Maggie Johnson and Alison Wintgens (2016), Speechmark Publishing Ltd.

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ENSURING AN ANXIETY-FREE ENVIRONMENTFOR CHILDREN WHO HAVE SELECTIVE MUTISM PLEASE DO: ★ Recognise that selective mutism is an anxiety disorder; a phobia of talking which can only be overcome by allowing children to take small steps forward, in a controlled way, at their own pace. By removing speech anxiety in everyday situations, you will enable them to benefit fully from an intervention programme.

★ Remember that this is a genuine difficulty and any pressure to speak will make things worse. Have patience and let the child speak when they are ready.

★ Engage the child through physical activity, craftwork, creative projects and fun. ★ Talk to the child about what you are doing without expecting an answer. Make comments rather than asking direct questions, eg ‘This looks like your dog, I can’t remember his name though’, rather than ‘What’s the name of your dog?’

★ Provide the opportunity to speak rather than making demands, eg ‘Hmm, I wonder where this one goes?’ (pause); ‘Oh dear, I can’t find any round ones’ (pause).

★ Warmly respond to the child’s attempts to communicate through gesture or whispering, by talking back in a natural way as if they had spoken.

★ Ask the child questions through other adults or children they talk to, keeping a comfortable distance until the child can talk easily in front of you.

★ Reassure the child in private that you won’t single them out in class to answer a question, read aloud or demonstrate an activity unless they let you know that they want to be chosen. Say that they can start talking as soon as they feel ready but, until then, just have a good time! It’s OK to laugh and it’s OK to sing – whatever they feel they can manage.

★ Invite the child to let you know if anything is upsetting them, or if they have news they want to share, through a two-way liaison book with home.

★ Assist transitions between home and other settings: eg parents participate with the

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An advice sheet for parents, carers and teachers

child in other settings; staff or friends visit the child’s home.

★ Try to find time at school for periods of unpressured one-to-one interaction. ★ Encourage the child to sit, work or play with friends they talk to in other settings. ★ Organise activities in which children move, sing or talk in unison, and activities and games which do not require speech, making this clear before you start.

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PLEASE DO: ★ Include the child in other activities by offering alternative forms of communication as a temporary stepping-stone while the child is having difficulty speaking; for example, pointing, holding up a picture, writing, or recording their news at home.

★ Provide opportunities to talk in situations that are less threatening to the child. For example: ‘Can you take [new child] to the pegs and show her where to put her bag?’; ‘Take Mummy to the hall and show her what we’ve been making for assembly’; ‘Please help [less able child] tidy up. He’s not sure what he’s got to do.’

★ Actively support friendships with other children, making sure that peers don’t pressurise the child to speak and understand that they will speak in their own time.

★ Use puppets, masks, voice-activated toys, recorded messages, talking tubes and walkietalkies, which may be easier for the child than direct talking.

★ Ensure that the child can access the toilet, meals, drinks, help and first aid without speaking. Agree a procedure to follow when they feel ill or upset.

★ Let children sit at the back or side of the classroom so that they have a good vantage point.

★ At registration, allow hands-up, involve the whole class in a social activity, or ask ‘Is [each child’s name] here?’, so that the class members look around and answer in unison.

★ Let the child know how well they are doing by noticing them being helpful, kind, thoughtful, hard-working, good-humoured, brave and creative.

★ Encourage independence and ensure success. Rather than doing things for the child, do things with them initially and then withdraw, or make things easier.

★ Have the same expectations for good behaviour as for any other child. PLEASE DO NOT: ★ Be hurt or offended when the child remains silent. ★ Confuse a fixed facial expression with glaring, defiance, being uninterested or smirking. ★ Beg, bribe, persuade or challenge the child to speak, or make it your mission to get them to talk.

★ Make the child say ‘Hello’, ‘Please’, ‘Thank you, etc. They are not being rude. ★ Ask direct questions which put the child on the spot, especially when other people are watching and waiting for an answer.

★ Look directly at the child when you are hoping that they might say something. ★ Penalise the child for not talking or tell them that they are talking too quietly. ★ React when the child finally talks. Simply carry on as if they have always spoken, responding positively to what they say, rather than the fact that they spoke. Later you can remark on how much fun you had, how good they are at reading, etc.

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at all!). Do say in private, ‘Sorry, I don’t understand’, or ‘That was a great try but I’m sorry, I didn’t hear’, or ‘Did you say X or Y?’.

★ Tell the child off in public – have a quiet word in private about your expectations. ★ Treat the child too delicately – they enjoy banter the same as anyone else! ★ Follow opting out with special treatment or privileges because this can delay gradual participation.

★ Anticipate the child’s every need. Instead, hold back, give permission (‘It’s OK to …’) and create opportunities for them to start taking the lead.

★ Object if the child talks to you through their friends – they could be valuable allies in the child’s intervention programme. But do make sure that the child is comfortable enough to communicate with you non-verbally when needed. For example, they could confirm you heard their friend correctly by nodding or shaking their head.

★ Be afraid to say ‘Hey, please can you keep the noise down!’ as necessary. ★ Be surprised if the child looks confused, does the wrong thing or does nothing. Anxious children are often too tense to process information quickly or accurately, so repeat your instructions quietly and calmly.

★ Spring surprises on the child; instead, prepare them for changes and transitions with photographs, visits and pictorial timetables.

★ Allow the child to become isolated. Actively foster friendships with peers, both in and outside school through games, shared projects, interests and activities.

★ Dwell on what the child can’t do. Discover their interests and talents and let them shine. J

Other useful handouts Handout 4 ‘What to say when …’ Handout 5 ‘Selective mutism is a phobia’

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PLEASE DO NOT: ★ Make the child repeat themselves in public if you don’t hear (it’s great that they are talking

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An advice sheet for parents, carers and teachers

ENSURING AN ANXIETY-FREE ENVIRONMENTFOR YOUNG PEOPLE WHO HAVE SELECTIVE MUTISM PLEASE DO: ★ Recognise that selective mutism is an anxiety disorder; a phobia of talking which young people can only overcome by taking small steps forward in a controlled way at their own pace. By removing speech anxiety in everyday situations, you will enable young people to benefit fully from an agreed intervention programme.

★ Remember that this is a genuine difficulty and it will get worse if the young person feels any pressure to speak or has a sense of being made into a public spectacle. Have patience and let them speak when they are ready.

★ Engage the young person through their interests and talents, their sense of humour and by asking for their help. Tell them what a good job they did.

★ Include the young person by talking to them in a chatty, friendly way without expecting an answer. Make comments, rather than asking direct questions; for example, ‘I’d love to know where this came from, it’s gorgeous’, rather than ‘Where did you get that?’

★ Provide the opportunity to speak, rather than making demands; for example, ‘I love this colour. I wonder what you used to mix it?’, rather than ‘How did you make this?’

★ Warmly respond to the young person’s attempts to communicate through gesture or whispering, by talking back in a natural way as if they had spoken.

★ Reassure the young person in private that you won’t single them out in a group to answer a question, read aloud or demonstrate an activity unless they let you know that they want to be chosen. Say that they can start talking as soon as they feel ready but, until then, there are plenty of other ways to get the best out of school, college or work life or their chosen activity. It’s OK to laugh or join in when the group speaks in unison – whatever they can manage.

★ Give the young person a means of sharing good news and letting you know if anything has upset them, eg through email, a liaison book or a go-between.

★ Establish communication and build rapport wherever possible by email. ★ Make hands-up, thumbs-up or eye contact and a nod generally acceptable at registration if the young person is struggling to answer.

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questions through their friends. Move away to make it easier for them to answer.

★ Tell the class or group that you welcome all forms of contribution – listening, speaking or making notes.

HANDOUT 10B

communication. For example: holding up, underlining, circling or pointing to their answer; writing on sticky notes, a dry-wipe board or a computer screen; texting; emailing. Ask them which method they prefer for different activities.

★ Provide opportunities to talk in situations that may be less threatening to the young person. For example: ‘Please could you take [N] to the lockers and show her where to put her bag?’; ‘Why not take your parents to the hall and get them a cup of tea before the rush?’; ‘Please help [N]. He’s not sure what he’s got to do’.

★ Make sure that peers don’t pressurise the young person to speak and understand that they will speak in their own time. Check for, and stop, actual or cyber bullying and teasing.

★ Look for positive behaviour and let the young person know how well they are doing. ★ Let the young person sit at the back or side of the classroom to get a good vantage point.

★ Encourage general creativity and expression through art, film making and design. ★ Encourage independence and ensure success. Rather than doing things for the young person, do things with them initially and then withdraw, or make things easier.

★ Have the same expectations of good behaviour as for any other young person. PLEASE DO NOT: ★ Be hurt or offended when the young person remains silent. ★ Confuse a fixed facial expression with glaring, defiance, being uninterested or smirking. ★ Beg, bribe, persuade or challenge the young person to speak, or make it your mission to get them to talk.

★ Make the young person say ‘Hi’, ‘Please’, ‘Thank you’, etc. They are not being rude. ★ Penalise the young person for not talking or tell them they are talking too quietly. ★ Ask direct questions which put the young person on the spot, especially when other people are watching and waiting for an answer. Use comments which they might respond to.

★ Look directly at the young person when you are hoping that they might say something. ★ React when the young person speaks in public. Simply carry on as if they have always spoken, responding positively to what they say, rather than the fact that they spoke.

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ENSURING AN ANXIETY-FREE ENVIRONMENT

PLEASE DO: ★ Include activities in which speech is optional, making this clear before you start. ★ Include the young person in other activities by offering alternative forms of

10b

★ Make the young person repeat themselves in public if you don’t hear them. ★ Chastise the young person in public – have a quiet word in private about your expectations.

★ Treat the young person too delicately – they enjoy banter the same as anyone else!

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10b

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HANDOUT 10B

PLEASE DO NOT: ★ Expect the young person to initiate interaction, even in ways which don’t require talking. Initiation is extremely difficult for most individuals with SM. Make sure that you or other people take the lead to enable the young person to find a partner, get help, obtain an item or report a loss, bullying or illness, for example. It will also be important to ensure access to such basics as the toilet, food and water without needing to speak.

★ Follow opting out with special treatment or privileges because this can delay gradual participation.

★ Anticipate the young person’s every need. Instead, hold back, give permission (‘It’s OK to …’) and create opportunities for them to start taking the lead.

★ Allow the young person to become isolated. Actively foster friendships with peers, both in and outside the educational or work setting, through shared projects, interests and activities.

★ Object if the young person talks to you through their friends – they could be valuable allies in the young person’s intervention programme. But make sure that the young person is comfortable enough to communicate with you non-verbally when needed; for example, they could confirm the message you received by nodding or shaking their head.

★ Be surprised if the young person looks confused, does the wrong thing or does nothing. Anxious individuals are often too tense to process information quickly or accurately, so repeat instructions quietly and calmly, as necessary.

★ Spring surprises on the young person. Instead, prepare them for changes and transitions with advance visits, timetables and brochures or photographs, as appropriate.

★ Leave the young person out of plans for school or college trips or work experience. These involve environments which are usually much less stressful than the classroom.

★ Dwell on what the young person can’t do. Discover their interests and talents and let them shine. J

Other useful handouts Handout 4 ‘What to say when …’ Handout 5 ‘Selective mutism is a phobia’

HANDOUT 11

ENABLING QUIETER STUDENTS TO COMMUNICATE Communication and interaction are challenging for many students. Some ‘freeze’ and are unable to speak at times, despite conversing confidently and fluently when they are relaxed with friends or close family. You can help to bridge this gap by (a) having a private word with students to show that you understand and (b) avoiding situations which put unnecessary pressure on them to communicate in front of their peers. Ironically, the less insistence there is on talking, the easier it is for these students to relax, speak and gradually work towards agreed targets, such as taking a turn to read aloud in class. By adopting the following guidelines you can bring out the best in anxious students. 1 Some students find it painfully difficult to initiate conversation. This includes asking for help or clarification, seeking permission, using social greetings and making friends. They usually do nothing in this situation, or simply loiter, hoping someone notices that they need help or want to be included. If they are getting desperate, some will resort to unusual behaviour to gain attention. Try to: a) Remember that when anxious students need help, they have difficulty making the first move. They dread drawing attention to themselves in case this leads to a joke or a question or a negative comment which they can’t take in their stride. Ask quietly during the lesson or session if there is anything they are not clear about and ensure afterwards that assignments, etc are understood. b) Acknowledge written requests and follow them up by talking things through quietly in ways which do not draw unnecessary attention to the student. c) Ensure that students can leave to use the toilet, or for any emergency, without seeking permission. Consider a whole-class system, such as signing out, that does not discriminate against individuals who have difficulty making requests. d) Make a seat available to the student, rather than expecting them to find their own place. e) Always smile at the student, make them feel welcome and say ‘Hello’ even when there is no reply. Ensure that no one takes it personally if the student maintains a blank or fixed expression and does not actively engage. These are signs of anxiety rather than aloofness and, with the right support, the situation will improve.

11 ENABLING QUIETER STUDENTS TO COMMUNICATE

An advice sheet for people working with older school-aged children and young people

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HANDOUT 11

2 Some students freeze when asked a direct question, particularly within earshot of other people. Try to: a) Agree with the student that you will give advance warning of any questions or that they will signal if they are comfortable to be chosen. b) Avoid asking direct questions and allow the student to make their contribution later on, either in writing or on a one-to-one basis. c) Avoid asking the student questions across the room, so that they have to answer to everyone. Stand next to them, so that you can turn to them and address them more privately in a quieter voice. d) Move on calmly to someone else if the student cannot answer, without letting the student feel that they have failed; for example, ‘You carry on thinking about that. Anyone else want to have a go?’ Feeling that other people are watching and waiting for an answer makes it worse for quieter and anxious students. 3 Many students don’t like to run the risk of getting things wrong or meeting disapproval. So any question where there is no definite or simple answer is likely to cause distress and lead to a silent struggle. Try to: a) Tell the student that it is OK to say ‘I don’t know’ or ‘I’m not sure’. b) Give a choice, eg ‘Is it nearer London or Liverpool?’ c) Stick to closed questions which have simple factual answers and can be answered in a few words. Leave open-ended questions, opinions, alternatives and explanations until the student is more confident. d) Offer possible alternatives if the student does not answer; for example, ‘“Well, do you think it was a good idea, not so good, or somewhere in-between?” 4 If you make an assumption or a genuine mistake, the student will find it extremely difficult to correct you. If they say nothing, you cannot assume that they agree with you. If it’s a public situation, lightly move the conversation on, and check later when one-toone. Try to: a) If you offered a choice, repeat it and add “Or something else?” b) Check your facts or say “I’m not sure if I’ve got this right”. Ask ‘yes/no’ questions to clarify a situation, rather than leave the student struggling in silence. Alternatively, give them a few moments to gather their thoughts and write down their comments. c) Double-check that the student feels ready for a task or an assignment; for example, ”This is what I think you’re ready to do. But is there something easier you’d like to do first to prepare for it?” For instance, they might like to run through a presentation with a supportive adult before delivering it to the whole class. Write down the assignment and ask them to either tick it or write an alternative by the end of the day.

HANDOUT 12

DO I ANSWER FOR MY CHILD? The short answer is ‘No!’ It’s natural to step in when your child freezes after being asked a question. But if they get used to someone answering for them, they will adopt the role of silent partner whenever that person is around. One day, your child will answer and it’s so important to have everything in place for that moment when they are ready to speak out. A few Golden Rules: Don’t answer for your child. If you adopt the routine overleaf, your child will learn that it’s not so bad to be asked a question; everyone seems relaxed about it, whether they answer or not. They will be far less wary of social situations in general. Don’t put your child under pressure to answer. Calmly convey that it’s fine if they answer and fine if they don’t. You know they’re trying hard and doing their best. Don’t apologise for your child. They’ll feel they’ve done something wrong. If appropriate, you can explain to the person later that your child wasn’t being rude, or share how it makes you feel that others don’t see your child as they really are.

But now for the long answer …

12 Do I answer for my child?

An advice sheet for parents of children who have selective mutism

Follow the routine overleaf whenever someone asks your child a question and you’ll be surprised how much easier it gets and how quickly your child succeeds in answering. If your child speaks very quietly, don’t ask them to speak louder. Ask the person waiting for an answer, ‘Did you get that?’ They will often take a guess and your child can then nod or shake their head. And remember - although you are not going to answer for your child again, it’s fine for you to repeat what they say! It’s not usually necessary to tell younger children what you’re doing or why. But if they ask, or you want to prepare an older child, see the explanation below. Why does this work? Your child will learn, without any pressure, that:

★ questions are for the person who’s been asked – no one else will answer ★ you know they will get good at answering if they keep trying ★ it’s not a big deal if they don’t manage it – no-one minds, it’s still a good day!

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HANDOUT 12

1 Wait for a full five seconds (slowly count to five). If your child nods or shakes their head for ‘yes/no’, that’s fine. Add a comment to move the conversation on, eg ‘Yes, we came last week, didn’t we?’ But with other sorts of questions, your child will probably find it easier to answer if you don’t look at them. Fiddle with something if it helps! 2 If there is no response, make it a private conversation between you and your child:

★ gently repeat the question or ★ turn it into a choice ‘X or Y?’ or ★ rephrase it, so that your child only needs to say ‘Yes’ or ‘No’    or nod or shake their head. 3 Wait for a full five seconds. Face your child, so they can’t whisper in your ear. If your child answers or gestures, smile and add a comment to move things on. Keep any acknowledgement of this great achievement for a private moment – your child doesn’t want attention drawn to their talking in public. 4 If there is no response, move the conversation on without answering, eg:

★ ★ ★ ★

WAIT

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say to your child, ‘We’ll have a think about that, won’t we?’ or ‘Tell me later’ ask the other person a question to divert attention from your child change the subject say your goodbyes.

REPEAT/REPHRASE

WAIT

MOVE ON

HANDOUT 13

EASING IN FRIENDS AND RELATIVES An informal approach to building rapport and facilitating speech Do you have a family friend or relative who your child sees on a fairly regular basis but is unable to speak to? Try these six steps at home, over several sessions or over a few hours. C = child (or young person)   P = parent   F = familiar adult

Whenever C speaks, P and F must not draw attention to this fact, but calmly respond to what C says as if they’ve always spoken.

1 Educate the familiar adult Talk privately to F to ensure they understand the nature of selective mutism and accept that it is a phobia which needs sympathetic support to overcome. You need to agree:

★ C is not being rude, difficult or silly. Their silence is caused by anxiety, like stagefright, so no one must take it personally.

★ No one will put pressure on C to talk – no bribery, persuasion, negative comments or expectation to say ‘Hello’, ‘Please’, ‘Thank you’, etc.

★ It will help C to talk in F’s presence if F initially avoids watching C while C is talking or trying to talk. 2 Reassure the child

13 EASING IN FRIENDS AND RELATIVES

An advice sheet for parents of children who have selective mutism

Before F arrives, tell C that F does not expect C to talk to them unless they want to. They just want to have a nice time chatting to P and possibly joining in whatever C is doing or wants to show them. Set up C with a practical activity they enjoy. Tell C they can chat to you as normal and F will not butt in or make any comments about them talking. Remind them that if they want to be brave and have a go at talking to F, that’s fine, but it’s up to them and F won’t be upset if they don’t. 3 Be comfortable in the same space The first step is for C to feel comfortable around F, so stick with this stage until C appears fairly relaxed and is moving and smiling easily.

★ F greets C but does not ask any questions. F can make positive comments about C (eg admire a picture they have drawn) but, initially, their focus should be on lighthearted chat with P.

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HANDOUT 13

★ P should give F more attention than C initially, to let C physically relax in the same room at their own pace. At this point, young children will very often dip in and out of the room, as if they are testing the water.

★ P includes C by making casual comments that don’t require an answer (eg ‘We had a great time at the zoo, didn’t we?’), and distracts C with physical activity, such as handing out biscuits, drawing a picture, finding their model collection or decorating cupcakes.

★ P can ease C in gently by asking C ‘yes/no’ questions which C can answer nonverbally by nodding or shaking their head.

★ However … If C uses gesture to try to tell P something (eg looks at the biscuit tin) P can respond if it’s obvious what C means (eg ‘Yes, you can have one and offer F one too’). However, if this is not what C meant, or if C’s gesture is unclear, don’t try to guess what C means. This creates a tension which is in conflict with the calm atmosphere you are trying to create. It also reduces C’s incentive to talk! P can calmly say, ‘Sorry, I’m not sure what you mean. Tell me in a little while’ or ask C an ‘X or Y?’ question (see below).

★ If C tries to pull P out of the room, P says, ‘Don’t pull me, I’m talking to F’. Then distract C, eg: ‘Why don’t you go and get your ____?’; ‘Shall we look in the oven and see if the cakes are ready?’; ‘Could you go and pick me some mint leaves please?’ Stay calm and stick with it. After 10 minutes in the room with F, C’s anxiety will have dropped considerably! 4(a)  Talking to parent in front of familiar adult  Once relaxed in F’s presence, the next goal is for C to talk to P face-to-face with F in the same room. (Whispering in P’s ear is not an option!)

★ P starts to ask C questions that cannot be answered ‘Yes’ or ‘No’, so C can no longer just nod or shake their head. Initially, ‘X or Y?’ questions are best, eg: ‘Do you want cola or juice?’ Wait for an answer (at least 5 seconds) while F looks away and stirs their tea, studies the newspaper, looks in their bag for a tissue, etc.

★ If there is no answer, and there were more than two choices, add ‘Or something else? Wait for an answer.

★ If there is no answer, P offers no more choices. P smiles and says ‘Tell me in a little while’ and carries on talking to F.

★ If C wants to whisper in P’s ear, or looks on the verge of speaking, P maintains P

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eye contact with C and says, ‘It’s OK to talk with F here’. Smile and wait for an answer (at least 5 seconds).

HANDOUT 13

★ If this isn’t working, P says, ‘You can tell me while F _____’ (eg checks their

★ C may speak in a very quiet voice, which is fine. Don’t ask C to repeat because their voice will get louder as they relax.

★ C may feel more comfortable talking in the doorway at first, rather than in the room; again, this is fine. They will come closer of their own accord.

★ Once C is answering ‘X or Y?’ questions, P moves on to simple questions that can be answered in a few words; eg ‘What?’, ‘Who?’, ‘Which?’, Where?’, ‘When?’. Wait for an answer (at least 5 seconds).

★ If no answer, P prompts C by offering an alternative ‘X or Y?’ question; (eg ‘Was it Daddy or Uncle Pete?’) and works through the ‘X or Y?’ sequence above. 4(b)  Interacting with familiar adult  A simultaneous goal is for C to interact non-verbally with F, using eye contact, relaxed facial expressions and gesture:

★ F shows interest in what C is doing or shares an activity. F chats away without expecting an answer in the style of a running commentary, leaving pauses so that C can comment if they feel ready, eg: ‘You’re cutting out some really good shapes!’; ‘I wonder if that’s a flower? Or maybe it’s a star …’. As C relaxes, F asks occasional questions which C can answer by nodding or shaking their head. 5 Talking to familiar adult

When C can talk to P in front of F (4a), and engage with F non-verbally (4b), and is happy, relaxed and occupied, the goal is for C to answer F.

★ F directs occasional questions via P, eg ‘Wow, where did C get this?’ P repeats the question, or rephrases it as an ‘X or Y?’ choice, so that C can answer P rather than F. Then P tells F the answer. After a few successes, C may respond without waiting for P to repeat or rephrase the question.

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EASING IN FRIENDS AND RELATIVES

phone messages, or makes a drink, or gets on with the crossword puzzle). This enables F to appear uninterested while P repeats the sequence.

13

★ F occasionally asks C questions by providing an alternative ‘X or Y?’ question, eg: ‘C, I’ve forgotten your cat’s name. Is it Lucky or Licky?’ (it may help to be a bit silly!); or ‘Which level shall we do now, C – two or three?’ It helps to include C’s name, so that C does not wait for P to answer, and to remind P not to answer inadvertently for C.

★ Wait. Allow plenty of time for C to answer (at least 5 seconds) but don’t stare at C and don’t worry if C doesn’t answer.

★ If no answer, F smiles and calmly moves on, saying something like ‘I think it must be Licky because she’s got a nice pink tongue’ or ‘I expect I’ll remember soon’ or ‘How about I choose then?’. Then F focuses on the activity, or talking to P for a while, before trying again.

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HANDOUT 13

★ Alternatively, P repeats or rephrases the question as above, but never actually

EASING IN FRIENDS AND RELATIVES

Continued

answers the question for C.

★ F repeats with more ‘X or Y?’ questions. After C has answered a couple of times, take a break; such a massive achievement can be exhausting for C.

★ When C can answer ‘X or Y?’ questions easily, F asks ‘Wh ___?’ questions, eg ‘What colour is your rabbit?’:





– ‘What?’, ‘Who?’, ‘Which?’, ‘How old/many?’ questions are best initially because they can usually be answered with single words.



– ‘Where?’ and ‘When? are good for short phrases.



– ‘How did?’ and ‘Why?’ questions should be avoided until later because these questions often require more explanation than C can manage initially. – Be aware that ‘Which?’ can often be answered by pointing.

★ If there is no answer, F prompts C by falling back on an ‘X or Y?’ question, eg ‘Do they sleep outside or indoors?’ Wait for an answer.

★ Natural conversation should follow if F shows an interest: eg by helping to clean out the rabbit hutch or asking C to show them how a phone app works. Structured games and problem-solving activities are another good way to help conversation along. 6 Talking to familiar adult alone

The final step is for C to talk to F without the comfort of P’s presence.

★ As soon as C appears to be comfortable with F, P should withdraw for short periods, so that C and F are engaged in an activity without P. P can stay in the room but needs to concentrate on something else.

★ Once C can talk to F, P must make excuses to leave the room for a while, so that C does not have time to associate talking to F with P’s presence.

★ On subsequent visits, P should always be present initially but leave sooner, and for longer, until all of C’s anxiety around talking to F has subsided. Good luck! Say ‘It’s OK to talk …’ or ask a question. Parents – practise and memorise this sequence!

Wait for C to speak ... If no response … Rephrase question with an alternative, ‘X or Y?’ Wait … If no response … Move on.

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REPHRASE ‘X or Y?’

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EASIEST

Familiar adults – gradually increase the complexity of questions

‘Yes/no’ questions that can be answered by nodding or shaking head

Questions that can be answered by pointing, eg ‘Which one?’, ‘Can you show me?’

‘X or Y?’ questions for one-word answers

‘What?’, ‘Who?’, ‘Where?’, ‘When?’ for short answers  Reasoning questions, eg ‘Why?’, ‘How come?’, ‘What’s the difference ...?’, ‘Can you explain ...?’  Personal questions, eg ‘How do you feel about ...?, ‘What do you make of that?’ HARDEST

Why does this work? Your child will be helped to face and overcome their fear through:

★ ★ ★ ★

relaxation –there’s no need for them to talk, until they feel ready confidence– you convey your belief that they will succeed expectation– you remove their need and opportunity for avoidance strategies a systematic progression– your child takes tiny steps towards talking, and is only eased towards the next step when they are relaxed and ready.

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TALKING IN PUBLIC PLACES

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HANDOUT 14

An advice sheet for the adults who children with selective mutism talk to freely and comfortably Note: this is not for adults who need to prompt or question the child to sustain conversation.

TALKING IN PUBLIC PLACES An informal approach to generalising speech across different settings Are you one of the people who a child with selective mutism (SM) talks to easily and spontaneously when no one else is listening? If so, you can gently help them discover that it’s ‘safe’ for other people to hear their voice. Children who have SM need to talk in as many places as possible, so that nowhere becomes ‘off limits’. And enabling them to speak to you in public, when other people are nearby, is the first vital step towards expanding their talking circle. This handout will help you gradually achieve this. But please take time to read it a few times for reassurance that the techniques let you work at your child’s pace, so they don’t become unduly anxious. You have probably adopted several ‘rescue’ strategies for when you are together in public places and talking becomes difficult. Perhaps a combination of gesture, whispering and guessing sounds familiar? It’s natural to fall back on these modes of communication when children become silent but, unfortunately, these strategies actually strengthen fear of speaking. Of course, never pressurise children to talk when they are not comfortable but, equally, don’t convey that you think talking is impossible for them. By changing your support strategies, and talking openly about what you are doing and why, you can gently provide the opportunities children need to master their anxiety and gain confidence. To start, check that you are not falling into any of the rescue ‘traps’ below when you are alone with your child. This is a good time to practise the techniques initially! You will find it increasingly natural to use the same techniques when strangers are in the distance; then as strangers get closer; until eventually your child can even talk to you in front of people they know. Key: C = child or young person 1 Talk to the child about their fear

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When C is relaxed and comfortable at home, talk openly and casually about SM like any other fear. For example: ‘Talking feels scary at the moment, but you’ll get braver and it will get easier and easier’; ‘I know talking feels hard at the moment, but you’ll get there’; ‘No one will mind if you don’t talk straightaway. They know children often need a while to settle in first’; ‘It’s OK to feel scared about going somewhere new, that’s normal. It won’t last’.



C needs to believe:

★ You are not worried and are confident they’ll get over their fear. ★ Their fears will pass and are not part of their personality. ★ If ever they can’t answer, it’s not a big deal and no one will mind.

HANDOUT 14

2 Smile

Continued

Check your face! If you are worrying that C won’t talk, your face will be tense and immobile. An anxious face looks like disapproval or sadness to a child. You may be worried on the inside but, on the outside, try to look happy, sound relaxed and act as if it’s only a matter of time before C talks.

3 Give your child time to respond

To turn things around, you will need to do the hardest thing of all – wait a full 5 seconds after asking a question, even if you sense that C is aware of other people nearby. It’s important to talk about this, not at the time but when you are both relaxed, using whichever combination of the following explanations feels right.



a) I’ll always give you a chance to answer because I know it’s going to get easier and easier for you.



b)  If I guess I might get it wrong.



c) I’m helping you to be braver about talking. It’s OK, you only need to talk when you feel ready, just see how you feel.

★ So … wait a slow count of five. Then, if no response … 4 Don’t guess!

TRAP 1

Do not guess the answer or offer items until C finally nods or chooses one. Every time you guess correctly, C is less likely to talk the next time. C may not be able to answer straightaway but there are several ways to make it easier for them to speak as this handout explains …

TALKING IN PUBLIC PLACES



14

5 Prompt with alternatives (X or Y?)

This is an acceptable alternative to guessing. Give C a choice of two:

★ Prompt by providing an alternative, ‘X or Y?’, eg ‘Shall we go on the slide or swings first?’ ‘Which pizza do you fancy tonight – mushroom or pepperoni?’ Wait … If there are more than two choices add ‘Or something else?’ Wait ...

★ If there is no response, smile and move on (change subject) or move away, eg ‘That’s OK, tell me later’ (don’t go to the pizza aisle just yet) ‘That’s fine, I can decide’ (don’t always choose their favourite) ‘Come round the corner and tell me’ (move to a ‘safe’ place).

★ If C tries to communicate by gesture, follow procedure 6. P

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HANDOUT 14

6 Don’t let gesture be a substitute for speech

★ It’s natural for C to point to an object to show what they want; or to

TRAP 2

answer a ‘yes/no’ question such as ‘Would you like an ice-cream?’ by nodding or shaking their head. Follow these up whenever possible with a question where gesture won’t do, eg ‘What sort?’; ‘Chocolate flake or no flake?’. Try to ask fewer ‘yes/no’ questions and keep items out of sight to reduce pointing.

★ If C tries to tell you something more complex by using gesture, don’t get into a game of charades! Quickly seek clarification, eg ‘Sorry, I don’t know what you mean’.

★ If C doesn’t answer, provide an alternative, ‘X or Y?’, eg: – ‘Do you want me to look at something or listen to something?’ (C is pulling at your sleeve) – ‘Are you showing me the slide or the dog?’ (C is pointing across the park) – ‘Does that mean you want to go or you want to stay a bit longer?’ (C is shaking his or her head) – ‘Are you thinking it’s a good idea or a bad idea?’ (C is looking surprised) – ‘Does that mean you can’t decide or you don’t want anything?’ (C is shrugging his or her shoulders). Wait for an answer (a full 5 seconds).

★ If no response, move on or move away, as described in procedure 5. 7 Don’t encourage whispering in your ear

TRAP 3 The closer people get, the quieter C’s voice is likely to become. That’s OK, it will get louder as C becomes desensitised to talking in public. Get down to C’s eye level, if necessary, and accept a quiet voice, but don’t let C hide the fact that they are speaking, by whispering in your ear. This strengthens their belief that talking in public is not safe, making it harder to talk another time.

★ Avoid turning or lowering your head, so that C can whisper in your ear. ★ Maintain eye contact with C and quietly say ‘It’s OK to talk here’. Smile and wait (a full 5 seconds).

★ If no response, give appropriate reassurance, eg ‘It doesn’t matter if anyone from school sees you – they already know you talk to me’; ‘I know you feel worried but nothing bad’s going to happen’. Wait …

★ If no response, but you have a good idea of what C wants to say, prompt with an alternative, X or Y?’, eg ‘Cola or lemonade?’ Wait …

★ If no response, smile and move on: ‘That’s OK, tell me later’ (don’t start guessing) or move just far enough away so that C can talk (see procedure 5).

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8 Be aware of position If C is not responding and darts looks at bystanders, it is often the fear of being watched, rather than being overheard, that is increasing their anxiety.

★ Reduce anxiety by turning away or moving so that you can talk side-by-side, out of people’s vision, eg at a wall display or notice board or behind a screen. As C relaxes, gradually return to your original position.

★ C may initially feel more comfortable at the side of a room or near a doorway. Respect this and wait for their anxiety to subside before moving to a more central position. 9 Be positive and realistic

Keep your own voice low-pitched and calm and never convey anxiety, frustration, disbelief or disappointment because this will increase C’s already negative associations with the expectation to talk.

★ If it has taken a lot of persuasion just to get C to attend an event, acknowledge their effort and achievement: ‘You’re doing really well!’

★ Whenever C talks, give a big smile and respond quietly and positively without making a huge fuss about the fact that they spoke, eg ‘Oh good – that’s my favourite flavour too!’

★ Later, out of public gaze, you can be more specific: ‘Wow, it was fantastic the way you helped me out there and ignored everyone else in the shop!’

★ Occasionally, time is of the essence and you need to be realistic to ensure success. For example, rather than cave in and resort to guessing when you finally reach the fast-food counter, it is better to ask C what they want before joining a long queue. There will be plenty of other opportunities to practise at the counter when the place is less busy.

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★ Don’t worry if C speaks extremely quietly – they will get louder the more they talk in public and learn that it is ‘safe’.

★ Don’t ask C to speak louder. C may find this critical or unnecessary. Be natural and honest, eg: ‘Pardon?’; ‘Sorry, there’s too much noise, what was that?’. Let C work out what they need to do!

★ If a stranger unexpectedly asks C a question, follow the same routine: smile, wait, prompt, wait and move on, if necessary, rather than answer. 10 Keep it up!

You may be convinced that these techniques won’t work because your child never speaks to you in public when you are close to other people. But perhaps C never speaks in those situations because you have never consistently put these techniques into practice!

★ Set yourself the task of applying these techniques consistently for two weeks before dismissing them.

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★ Don’t expect it to be easy. The techniques may feel counterintuitive at first but children need you to provide the opportunity for them to challenge their fears safely and discover that they can rise above them.

★ This is not about making children go without things, to force them to speak. It’s about calmly conveying that you know C will be able to speak as their anxiety subsides. C will gain strength from your faith in them. You talk to each other at home; it can be the same outside, especially if you move slightly out of other people’s vision and earshot. For example, when it’s quiet and there’s no queue, don’t be afraid to order only for yourself at the fast-food counter, giving C ‘a bit longer to think’ about what they want. There is now a very good chance that C will tell you while the server gets your order. If they don’t, you can return after C has told you at your table (pick a less public one at the side rather than in the centre of the room). There is no question of C going without a meal; C just needs to find the right moment to summon up courage and speak. Persevere and you will find that moment coming sooner and sooner.

★ If you feel that you are getting nowhere, take a break! Stick to light-hearted comments without asking C any direct questions. Fall back on a question that C can answer by nodding or shaking their head. Then move further away from bystanders and try again.

★ Keep a record of where C has managed to speak to you in public; how many other people were present; how close they were; and whether any were connected to C’s school or other organised activities. This will enable you to see what progress is being made, what reassurances you may need to give, and how you can gradually increase the challenge next time. Good luck! If C wants to whisper, say ‘It’s OK to talk here’. Practise and memorise this sequence!

Wait for C to speak ... If no response … Offer an alternative, ‘X or Y?’ or Replace gesture with an alternative, ‘Do you mean X or Y?’ Wait … If no response … Move on or move away. Don’t guess!

WAIT

REPHRASE ‘X or Y?’

WAIT

MOVE ON

Why does this work? Your child will stay calm and learn that:

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★ with an expectation to do only what they can manage, there is no need for avoidance strategies.

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THE INFORMAL SLIDING-IN TECHNIQUE This technique will help young children talk to familiar adults without anxiety, at their own pace. Depending on the child’s initial anxiety level, the following steps can be accomplished either in a single session or over 2–3 weeks. Children over five years old may do better with the more formal version of this technique (Handout 16).

Key [P] = Parent or other talking partner; [N] = Name of child; [A] = new Adult.

Steps 1 [P] and [N] are given time and space to play together, uninterrupted, until [N] talks easily to [P]. This could be in either the corner of the main room or a separate area, depending on [N]’s anxiety level. If in a separate room, try to leave the door slightly open, but some children only relax and talk with the door shut. It may take several sessions to gain [N]’s trust that it is ‘safe’ to talk. 2 If using a separate area, [P] warns [N] that [A] may need to come in for a very short time but will not interrupt their game. This is not necessary if [P] and [N] are playing in an open area, and [A] has been occupied on the other side of the room. [P] engages [N] in an activity that involves talking: a game or an activity that [N] enjoys and finds very easy to do. 3 [A] waits until [N] can be heard talking freely and then approaches or enters the room. [A] replaces some toys, finds a book, gets a drink or reads in a nearby chair, for example, keeping their back turned. If [N] comments, it is fine for [A] to say something like ‘You carry on, I’m just going to ...’ and then turn their back. If [N] becomes silent, [A] leaves or moves away after two minutes. If [N] seems happy to keep talking, [A] can stay longer. When [A] leaves, [P] focuses on making the rest of the play session relaxed and fun. There is no need to discuss what has happened unless [N] mentions it. If necessary, reassure [N], eg ‘It’s OK to talk to me in front of [P]. She just wants you to have a nice time’. Repeat this step once or twice (either after a short break or on separate occasions), until [N] can talk to [P] with [A] nearby. 4 [A] then shows interest in [N]’s game or story and asks whether they can watch or listen too. [A] faces [P] and [N] this time but looks at the activity rather than at [N]. [A] waits until the end of the activity before leaving, saying how much they enjoyed it. The hope is that [N] will continue to talk despite being watched but, if not, repeat this step, waiting a bit longer before turning round to ensure that [N] is relaxed and involved with the activity.

15 THE INFORMAL SLIDING-IN TECHNIQUE

A technique for parents and early years practitioners working with children who have selective mutism

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5 If [N] continues to talk, [A] slowly moves in to join [P] and [N], sitting at their table or on the floor, closer to [P] so that [N] does not feel too overwhelmed. [A] talks to [P] rather than [N], making general comments rather than asking questions, eg ‘I love this story’. It may help if [A] says something wrong because [N] may correct this without thinking, eg ‘[N]’s got the horse’. If [N] doesn’t respond, [P] can pass on, ‘Is that right, have you got the horse?’ and then pass back the answer, ‘No, [N] says it’s a zebra!’ 6 Once [N] tolerates [A]’s presence easily, and continues talking to [P], [A] says something like ‘This looks great fun – I’d love to play too if that’s all right’. [A] now either takes turns in a game; takes turns with [P] to read a page of a story* with [N] saying the repeated line on each page; or starts to build a model, etc, asking more questions through [P], eg ‘Does [N] know where this goes, Mummy?’ [P] passes on the question and returns the answer as in step 5. If [N] doesn’t reply after five seconds, calmly move on, eg ‘It’s OK, I’ve worked it out now!’ Don’t prolong this stage too long – once [N] has spoken a few times, move away because this is a massive step which can quickly become overwhelming if [N] is not given some space. 7 When [N] is talking comfortably through [P], or in a turn-taking game, [A] asks [N] direct questions, starting with ‘X or Y?’ choices, eg ‘This is a funny-looking animal. Do you think it’s a horse or a cow?’ 8 Once [N] is talking directly to [A], it is time for the final step. At the next session, or after a short break, repeat step 7, with the aim of [N] talking to [A] without the reassurance of [P]’s presence. At first, [P] leaves [N] to play alone with [A] but remains in the same room. If this does not cause any problems, a warning is then given that [P] has to pop out for a short while but will be back.

On no account should [P] leave the building without informing [N].

* Examples of books with repeating lines (there are many more!) ‘The Gingerbread Man’ (a classic folktale); Me Too! by Mercer Mayer (2001); Oh No! by Candace Fleming (2012); Jump, Frog, Jump by Robert Kalan (1989); Pierre by Maurice Sendak (2007).

HANDOUT 16

THE SLIDING-IN TECHNIQUE This technique helps individuals talk to familiar adults. It should be used as part of an overall programme, as described in The Selective Mutism Resource Manual (Johnson & Wintgens, 2016). The following steps can be accomplished in about 1½–2 hours over a single session or in several 10–15 minute sessions held three to five times a week (more suitable for very anxious children or when time is at a premium). Children less than five years old require the informal version of this technique (Handout 15).

Key [P] = Parent or other talking partner (eg the child’s sibling or school keyworker); [N] = Name of child or young person; [A] = new Adult. If you are using school or clinic premises, arrange a quiet place and time for [P] and [N] to play, read or talk together uninterrupted, possibly over several sessions, as the Sliding-in Technique cannot start until [N] is comfortable talking to [P] in this setting using their normal speaking voice. Make this easier for [N] by ensuring that activities are easy and enjoyable, so [N] does not feel tested. This is a good time to find out which rote sequences [N] can recite confidently, eg counting, days of the week, months of the year, letters of the alphabet.

16 The Sliding-in Technique

A technique for parents and staff working with school-aged children and young people who have selective mutism

Steps 1 [P] or [A] explains to [N] that they know how hard it is for [N] to talk to new people. That, whenever they try, a nasty feeling or panic reaction stops the words coming out. You are going to show them a way to get rid of that feeling, so that talking feels much easier. Explain that first [N] will get comfortable talking to [P] and then [A] will very gradually get closer and join in. You will break it down into such tiny steps that [N]’s usual panic feelings won’t have a chance to build up. [N] is bound to feel a bit worried or anxious at first because it’s new, but not enough to stop them talking.

Tell [N] exactly what they need to do as you go along and that they must make sure you only change one thing at a time – that is the secret to making it work! Stress that it’s up to [N] how far you go in each session. You will only continue for as long as they feel comfortable, or until it is time to stop (always tell [N] how long the session will last).

2 Introduce an appropriate recording system, such as a sticker chart for younger children, where you will write the instructions for each target as you go along. Each target can be described as a target, a goal, an assignment or a step, depending on [N]’s age and interests. After each target is achieved, [N] will check it off with a tick, sticker or star; or, if older, a note of their anxiety level on a scale from 0 (no anxiety) to 5 (panic stations).

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Older teens with a good understanding of the rationale can usually work through without checking off each step but it is useful to check their anxiety level intermittently, asking them to hold up zero to five fingers. More than three fingers means you need to take a break, slow down or repeat earlier targets to bring their anxiety down.

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Write down (or draw for children who have comprehension difficulties) two to four targets that [N] has already achieved. For example, listening and learning about SM; a rapport-building activity with [A]; and two talking activities they recently did with [P] such as playing a game, reading aloud or counting to a hundred in tens. Use these targets to show [N] how the recording system works. It’s a nice bonus for young children because they get stickers straightaway! After every target achieved, [A] returns to congratulate [N], check off the target and set a new one. Keep things very calm and don’t rush selecting a sticker, etc. This is an important time for [N]’s anxiety level and heart rate to drop before attempting the next target. When [N] does particularly well and uses a louder voice, for example, feel free to give two stickers!

3 Now the target-setting begins. Each target is explained and written down, one at a time, in a confident manner: ‘This is what we do next’, rather than ‘Shall we try this?’ or ‘Do you think you can manage this now?’ [N] is told that, to make it as easy as possible, the first target is to repeat the talking activities with [P] which they have just checked off. [A] leaves the room, closes the door and moves some distance away while they do them. (In an openplan setting, you may get away with going round the corner and waiting out of sight.)

The targets are different, of course, because now [N] knows that [A] is outside. Write down the first target (an activity that involves talking, is very easy to do, and takes less than three minutes). Agree a signal so that [N] or [P] can let [A] know they have completed the target (eg ring a bell, knock on the table or open the door). [A] takes up their position but may return to the door a little early to check whether they can hear [N]’s voice.

4 Afterwards, [P] may report that [N] could not talk or spoke in a whisper. In both cases, [A] takes responsibility and says that they were standing too close for [N] to talk or ‘use their big voice’; eg ‘I’m not surprised you found that hard. You must have been very worried that I could hear you’. Add an extra clause to [N]’s target (‘with [A] waiting … at the end of the corridor/in the staffroom/upstairs/in the garden’, etc), to stress that it will be impossible for [A] to hear [N]. Repeat steps 3 and 4 until [N] achieves, and checks off, both targets. If [N] does not achieve a target, this is because the steps were not small enough, not because [N] failed. [N] does not get a sticker, etc on these occasions but this is not mentioned. Attention is diverted to a different target. Keep the focus on achievement, rather than disappointment.

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It is essential that [N] uses their voice throughout the programme, albeit at a reduced volume. If whispering is allowed to persist, [N] will not learn that their anxiety can be overcome. There is no need to spell it out, but it will soon become clear to [N] that the targets are to talk rather than whisper. [A]’s ongoing feedback will be very important here, eg ‘Oh no! I’ve scared your big voice away, haven’t I?’

HANDOUT 16

If [N] does not achieve a target, make the target easier or: and congratulate [N] on doing so well. Don’t fill the remainder of the time by repeating targets or doing an unchallenging activity because this loses momentum and removes the need for [N] to stretch herself or himself.

★  For long sessions, take a break. [A] leaves [N] to relax with [P] for a while. Then repeat the last two successful targets and progress in smaller steps. 5 If [A] is a long distance away, repeat the activity with [A] a bit closer until [A] is at least in the same building! 6 Now change the activity to counting if this has not already been done. [P] and [N] count to 10, then 20, taking it in turns: [P] says ‘one’, [N] says ‘two’, and so on. Aim for a good pace and steady rhythm (slightly faster than one digit per second). (Note: if [N] whispers, make it easier by changing the target to [P] and [N] counting to 10 together; then counting together to nine with [N] saying ‘ten’ on their own; before trying the original target again.) It is essential for [N] to start each target with their voice. In this way, even young children can note the exact moment when their throat tightens to a whisper, and become increasingly adept at recovering the original, relaxed sensation. A target can be regarded as achieved as long as [N] starts and finishes with voice.

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★ For short sessions, end the session early. Focus on achieved targets

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7 The next target is to repeat the counting activity as [A] approaches the closed door. This can be done in one or several steps, depending on [A]’s starting point. [A] returns to the same location while [P] and [N] count alternately to 10 to get [N]’s voice ‘flowing’. Then, as [P] and [N] continue to 20, [A] walks towards the door ([A] agrees to count to 10 before starting their approach). Continue to change either [A]’s starting position or the activity (eg take turns saying the days of the week or letters of the alphabet) until [N] can talk with [A] standing right outside the room. 8 Repeat the counting activity to 10 but, this time, [A] does not quite shut the door on their way out of the room – the door should be pulled to, but not closed. At the end of the activity, [A] does not wait for the agreed signal and enters the room to congratulate [N] and check off the target. It is now established that the signal is not needed because [A] can hear and knows when [P] and [N] have finished. (Note: if [N] whispers throughout, [P] and [N] repeat step 7, counting alternately to 10 with the door fully closed to recover [N]’s voice. Then repeat, with [A] opening the door a fraction just before the end of the counting. If [N]’s voice drops to a whisper for their last few numbers, it is time to either end the session or take a break. It may help to tell [N] that you have already heard their voice through the door, and to remind them that you are not planning to come into the room at the moment. If they can manage to keep their voice going with the door not properly shut, they will have faced

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their biggest challenge and their anxiety will start to fade. Once achieved, the next target is to open the door fractionally halfway through the counting and, finally, to repeat step 8.) At the start of every new target-setting session, ease [N] back to the point they reached before by repeating the last two or three targets achieved in the previous session. By keeping targets short, it should always be possible to move forward at each session, despite backtracking initially. If targets are repeated during the same session, don’t write them out again. [N] adds a second sticker or tick to the same target to represent consolidation rather than progress. When repeating previous targets at the start of a new session, however, write them out again because they represent a significant new starting point.  9 Repeat step 8 but [P] and [N] count to 20 (or as high as [N] can manage easily), taking it in turns. Despite the door being pulled to, [N] is told they are doing very well to count with the door open. If [N]’s voice is extremely quiet, but more than a whisper, repeat this step with another rote sequence such as the days of the week, months of the year or letters of the alphabet, depending on [N]’s age. 10 The next target is for [P] and [N] to count to 20 as before, with the door pulled to but not fully closed. This time, [A] s-l-o-w-l-y opens the door halfway through the counting: ‘Just a little bit, not enough for me to come in’. Aim to open the door a good 15 centimetres for the last few numbers. (Note: if [N] whispers, open the door by smaller degrees, or don’t open it until later in the counting sequence. Eventually, [N] will be able to talk with the door open 15 cm, but it may be necessary for [N] to rest and resume this activity on another day.) Be flexible and take steps faster or slower according to [N]’s anxiety level. For example, if [N]’s voice is quiet but strong at step 10, combine steps 11–13 and ask [A] to join in the counting as they open the door and walk into the room. 11 It is now time for [A] to join in the turn-taking circle from their position outside the room. [P] and [N] count alternately to 10 but then [A] says ‘eleven’, [P] ‘twelve’, [N] ‘thirteen’, and so on, up to 20. If young children are only confident counting up to 10 or 12, [A] joins in after [N] says ‘six’. 12 Repeat with a different rote sequence depending on [N]’s age (see step 8.). This time [A] joins in from the beginning after [P] and [N] have taken their turns.

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13 Repeat a turn-taking count to 20 with [A] entering the room halfway through, s-l-o-w-l-y opening the door, stepping into the room, closing the door and walking over to sit with [N] and [P] as they finish counting to 20. If [N]’s voice is fairly strong and [N] is good at counting, [A] does not end there but continues by saying ‘twenty-one’, looking to [P] to continue the sequence. Stop counting at 30 and give [N] two ticks, stickers or stars; not

HANDOUT 16

only was the current target achieved, but also the next one (counting in a circle with [A] sitting at the table).

If [N] whispers, mouths the words, or says nothing as [A] approaches, build up to this target slowly by stopping as soon as [A] has opened the door; and repeating with [A] moving further into the room each time. Or [A] can enter the room backwards and take an outward-facing chair at the table, delaying eye contact until step 14.) 14 Repeat the previous target, explaining that [A] will walk over and sit down to finish the counting. The real difference this time is that [A] will not leave the room at the start of the counting, but there is no need to draw attention to that when writing the target. [A] stands at the doorway while [P] and [N] begin the counting; approaches the table at about number 8; sits down at about number 15 and continues counting to 20 while sitting at the table. If [N] does not sound anxious and makes eye contact with [A], omit the next step. Step 14 is omitted when working through in a single session or if [N] and [P] are sitting very near to the door. 15 [A] no longer needs to move away from the table. Count to 10 in the usual order, followed by the days of the week, then go back round the circle in reverse order, counting to 10 and saying the days of the week. This gets [N] used to speaking after [A] rather than [P]. Alternatively, substitute any of the sequences listed in step 8.

[N]’s voice may be quiet but it should not sound strained.

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(Note: if [N] looks surprised and does not continue the extended sequence, nothing has been lost. [A] simply apologises straightaway with a comment such as ‘Oh no! You were doing so well. I went on to the next target by mistake – sorry, that’s my fault’.

16

16 [N] is now ready for structured turn-taking games or activities requiring a single-word response. See Appendix A of The Selective Mutism Resource Manual for ideas, and progress to sentences after two or three activities, ensuring that [N] has no difficulty with the content or skills required. It is important for [N] not to worry about what they are saying; the focus is on staying relaxed so that [N]’s voice can flow. Keep all activities as short as possible, to save time and maintain momentum. Reverse the order of turns so that [N] both responds to and addresses [A]. [N] may still be looking at [P] while addressing [A], in which case introduce an activity involving [N] looking at [A] to get a clue or signal. If [P]’s time is limited, or sessions are difficult to arrange, [P] can slide out after one turn-taking game in step 15. 17 In this final step, [N] repeats an easy activity with [A] alone, on the understanding that [P] will return later on. [P] waits for the activity to begin and then leaves the room. If more than one talking partner has been involved (eg both parents), [N] chooses who will leave the room first, and carries out this step first without [P1] and then without [P1] or [P2]. This is a great achievement: [A] has now become one of [N]’s talking partners, and can lead the next session without [P] present.

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(Note: sliding out [P] is vital for [N]’s independence and confidence in talking to other people. If smaller steps are needed, [P] can initially move to a different part of the room, or just watch before leaving the room. Likewise, [P] may accompany [N] to the next session but leave the session for longer periods. Next, [N] should start the session without [P], knowing that [P] will join them for the final activity.) It is sensible to consolidate the use of single words and sentences by playing a couple of games for each type of language activity, eg picture naming, picture description, questions and directions, etc. But do not delay generalisation to other people and other settings unnecessarily. Once speech has been established with [A] in this way, [A] becomes a talking partner [P] and can use the same technique to establish talking with other adults and peers, and gradually increase group size. Sessions can generally move faster now, without such a detailed breakdown into small steps. Support the development of spontaneous speech by only gradually moving from structured to unplanned activities (see Appendix A in The Selective Mutism Resource Manual for ideas).

HANDOUT 17

THE SLIDING-IN TECHNIQUE USING TELEPHONE HANDSETS This technique helps individuals use their voice with a familiar adult with whom they have good rapport. It should be used as part of an overall programme, as described in The Selective Mutism Resource Manual (Johnson & Wintgens, 2016). The procedure is carried out somewhere free from observers and interruptions, either outside or inside the building. It should preferably be done in one session of up to an hour but, if anxiety levels are extremely high, have shorter sessions with recovery breaks.

Key [N] = Name of child or young person who has selective mutism; [A] = the Adult

Preparation [N] communicates with [A] by texting, and gets used to leaving voicemail messages on [A]’s phone. The method is explained to [N] in terms of ‘graded exposure’: feared events or objects lose their power to trigger the fear reflex when they are approached slowly enough to keep anxiety at a low level. [N] does not need to be concerned about having a conversation. They will first get used to doing some simple counting with [A] nowhere near them, and then very gradually close the gap. [N] is reassured that [A] will talk them through the procedure so they’ll know exactly what to do. They can hang up at any time and revert to texting until they’re ready to start again.

Steps 1 Positions are taken far enough apart for [N] to speak out of [A]’s earshot. It is established via texting that [N] is ready to start. 2 [A] now calls [N] who answers but does not need to say anything. [A] starts off the counting, saying ‘one’. [N] follows with ‘two’, [A] says ‘three’, and so on. An initial target might be to count alternately to 10 and then pause or hang up to take a couple of slow breaths in and out. 3 The next target is to count alternately while getting closer to each other. [N] might stay put while [A] approaches, or vice versa. They could both walk and meet somewhere in the middle – let [N] decide. Either do this in one long count, or break it down into shorter counts; for example, count as [A] moves from their car to the front door, then steps into the hallway, kitchen, back garden and finally joins [N] on the bench at the end of the garden.

17 THE TELEPHONE SLIDING-IN TECHNIQUE

A technique for parents and staff working with school-aged children and young people who have selective mutism

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17 THE TELEPHONE SLIDING-IN TECHNIQUE

Continued

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HANDOUT 17

4 If [N]’s voice decreases to a whisper for more than two numbers, stop the count and ask [N] to take a few steps back to where they were for the last voiced number. Tell [N] how well they are doing and stress that there is no rush; it is good to have breaks and take things slowly. Say that you will hang up so you can both take a few slow breaths in and out. Text ‘Are you ready?’ to [N] and wait for a reply. Call back and count to 10 alternately without moving to get a steady audible voice before resuming the approach. 5 As [A] and [N] reach each other they hang up and continue counting to the next multiple of 10. Good job! The sessions now continue as for the Sliding-in Technique (Handout 16) or the reading route (Handout 18).

HANDOUT 18

THE READING ROUTE This technique helps individuals move from reading to conversation with a familiar adult with whom they have good rapport. It should be used as part of an overall programme, as described in The Selective Mutism Resource Manual (Johnson & Wintgens, 2016). It is suitable for individuals who can read aloud to the adult using a natural (not whispered or strained) voice, even if this is very quiet initially. Volume can be expected to increase as the steps are repeated and the associated anxiety decreases.

Key [N] = Name of child or young person who has selective mutism; [A] = the Adult.

Preparation

18 The reading route

A technique for parents and staff working with school-aged children and young people who have selective mutism

Sessions are carried out on a one-to-one basis. Ensure that all reading material is well within [N]’s reading capability. Choose texts that are age-appropriate and suited to the individual, for example, a joke book, newspaper, celebrity magazine, novel or book from the school reading scheme. The end of the identified passage must always be made clear so that [N] knows when they have achieved the target and can stop reading.

Steps 1 [N] reads a short passage or poem. 2 [A] and [N] take turns reading alternate sentences or lines from the same short passage or poem. This is repeated with different reading material. If the voice is steady and at a reasonable volume, go straight to (d). Otherwise, use (c) to gradually improve the voice through repetition and relaxation, and to move from reading to more interactive turn taking. 3 [A] and [N] read different characters’ lines from a set number of pages or for a set number of minutes. Some reading schemes include playscripts for this purpose. Local amateur dramatic companies can often lend comedy and pantomime scripts and television programme scripts are available to download online. See also ‘I Say!’ in Appendix F ‘Talking resources’. And/or [N] reads the days of the week and months of the year and then says them alternately with [A], aiming for steady pace, rhythm and voice (may be quiet but should not be strained). Or [N] and [A] count to 10 and then 20, taking it in turns to say a number.

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18 The reading route

Continued

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HANDOUT 18

4 Reading games and activities involving turn taking, sentence completion and questions and answers.* 5 Activities involving turn taking, sentence completion and questions and answers without reading.*

* See Appendix A of The Selective Mutism Resource Manual, Stages 5– 7 for activity ideas which are coded by various anxiety triggers. Start with structured, factual activities which cause least anxiety, and gradually introduce less structured activities. One at a time, [N]’s friends and/or other adults may be invited to join in activities that [N] manages easily.

WHEN THE WORDS WON’T COME OUT Information about selective mutism for teenagers and adults

Please read this booklet if you can speak in some situations but not others and if any of the following are true:

★ you feel physically frozen or paralysed when you try to talk ★ you want help to speak more freely ★ it’s easier not to talk ★ you have given up hope of talking without anxiety ★ you are sick of people trying to ‘help’ ★ you believe things are fine as they are ★ you feel let down by professionals in health or education services ★ you want to know more about selective mutism. You may have struggled with talking for many years. This can affect the choices you make and your ability to influence other people and be the person you really are. You may have reached the point where you are desperate for help or ready to give up. Either way, it’s impossible for you to make an informed decision about what to do next until you understand what you are dealing with. This booklet summarises what selective mutism (SM) is, how it messes with your mind, how it can be overcome and the most important change you can make TODAY.

What is SM? SM is a condition in which individuals are able to talk freely in situations where they are relaxed and relatively free of anxiety, but they become frozen and unable to speak in other situations. This may be accompanied by all the signs of extreme anxiety – racing heart, muscular tension, tight chest and throat, difficulty breathing … or a dull feeling of nothingness because you know you won’t be able to speak, so what’s the point of even trying? SM is often described as a fear of speaking and you may identify with intense feelings of dread or panic at the thought of having to speak to certain people. Or you may say you’re not afraid of speaking; you’re afraid of looking an idiot when you can’t speak and terrified you won’t be able to speak when you need to. It all boils down to the same thing. SM is an anxiety disorder and people with SM have developed a phobia of talking to, or being overheard by, certain people.

1

Normally when people have phobias, their families and the general public are sympathetic and don’t force them to do the things they have a phobia about. It may seem odd – after all, some phobias are pretty weird, such as phobias of buttons, kittens or bananas – but we realise that the person is not refusing to board a plane or eat bananas or whatever. They just cannot, under any circumstances, physically make themselves do it. It’s not a choice; if they had any choice at all, they’d choose not to have the stupid phobia. So the main obstacle for you is that most people have no idea that SM is a phobia and do all the things that make phobias worse. They put all sorts of pressure on you to speak and make you feel really bad about not speaking (as if you didn’t feel bad enough already).

Can’t talk

PRESSURE

Increased anxiety

from self, family, teachers and wider community Even harder to talk AVOIDANCE of specific situations PHOBIA cycle

PANIC FREEZE

Relief from anxiety (but increased dread of talking) Sadly, the longer you live with SM, the more it threatens to alter your self-image. You’re an intelligent person; you know things don’t happen without a reason. So, in the absence of any other explanation, you start to believe what other people are saying about you; that you are shy, different, rude, difficult, stubborn or not worth the bother. These are simply the opinions of individuals who got it wrong. Had they known the truth, they would have used different words: guarded, scared, hurt, determined, focused, a survivor. Even if you reject the opinion of other people, you may create your own reasons to justify your fear; you hate your voice, you can’t think quickly enough, you are poor at conversation. (By the way, everyone is shocked by the sound of their own voice, and no one can think quickly or communicate well when they are anxious!) Inevitably, other people are affected by your silence. Many assume you don’t want to talk; they do not know how to approach you; they worry about doing the wrong thing. And so …

2

they ignore you. That can have a devastating effect. Unless you are one of the lucky people who have always felt secure in their family’s unconditional love and the social acceptance of friends, you may reach the wrong conclusion and think that other people find you stupid or dull, unlikeable or unattractive, or a misfit. And perhaps the greatest untruth of all … nagging away at you is the feeling that you ought to be doing better. But no one arranged for you to have the equivalent of swimming lessons or extra Maths, so how were you supposed to improve? Over the years, all of this can amount to a hefty burden of confusion, resentment, guilt, shame and isolation which chips away at your self-esteem, intensifies your negative associations with communication and distorts your perception of yourself and other people. In short, you’ve already had to deal with far more than most people you grew up with. You are stronger than you think. None of this is your fault – life isn’t always fair and you have been extremely unlucky to miss out on the support and understanding which is now available to young children who have SM. You are as unique, likeable and valuable as everyone else. And the good news is, phobias can be cured! At any age!

How do phobias start? You know how a particular smell or piece of music can trigger past memories and sensations? Powerful feelings are commonly linked to something in the environment, and that environmental trigger can generate the same feelings years later. It’s different for everyone but, in the case of SM, there will have been a time in your childhood when feelings of extreme distress, despair or panic became associated with being expected to talk; eg you desperately wanted your parents and a stranger tried to comfort you; or you were told off by a teacher. You may have been too young at the time to talk back, or you may have been too ill or alarmed to talk (the ‘freeze’ response). Since then, similar people have acted as a trigger, so that, when they try to talk to you, the same ghastly feelings have flooded back with the sensation of being unable to speak. Even though these feelings are recalled from the past, people with phobias experience the current situation as unbearably threatening, and do all they can to avoid reliving those childhood sensations. You may have discovered, for example, that if you stay indoors all day and never answer the phone, you will be spared those feelings. This is the ultimate price you pay. Through sheer bad luck and subconscious association, SM has made you a prisoner in your personal comfort zone.

The key to your freedom … … lies in understanding how your brain works.

3

conscious brain (frontal cortex)

automatic brain (limbic system and amygdala)

The amygdala controls our automatic fear reflex. Its role is to keep us safe and alert. It prepares our bodies to cope with danger by triggering the release of stress hormones which cause physical reactions such as increased heart rate, rapid shallow breathing, a rush of blood to the arms and legs, sweating and muscular tension. The limbic system interprets physical and chemical changes in our bodies and labels them as emotions or feelings. The frontal cortex is where rational, conscious thought takes place. One of the effects of stress is ‘brain freeze’. It’s impossible to think rationally and our mind goes blank. These three areas are closely interlinked and influence each other without us realising it. It can be very hard to separate thoughts, feelings and physical sensations, in order to know which are real and which are illusions.

THOUGHTS

BODY

FEELINGS

For example, you may be aware of your heart racing and feel nervous or afraid, but it could be coffee, energy drinks or nicotine that increased your heart rate, rather than stress. Or you might be good at driving but think so much about what people will say if you fail your test that you are too tense to put the car in gear. Unhelpful thoughts like this have a way of coming true!

4

And, in the case of selective mutism, the conviction that you cannot speak to certain people triggers the amygdala’s fight–flight–freeze reaction – your body goes into overdrive and you feel as if you are in great danger; it truly is the most horrible sensation. You have three options: attack (we usually save that for those closest to us!); escape (no wonder you do all you can to avoid feeling like this); or freeze. Your body stiffens, your throat closes up, you’re stopped in your tracks. Your feelings are REAL, but the threat to you is IMAGINARY. That doesn’t mean you’re going mad. It’s just how phobias work.

How to switch off your amygdala Anyone who’s got over a phobia will know that, once the amygdala is switched off, it’s like something has lifted. You’re free and the same trigger no longer has any effect. There are several proven ways to achieve this:

★ Graded exposure. By facing your fear in tiny, bearable steps, your automatic brain learns through repeated experience that there is no need to sound the alarm. You plan the steps and stay in control.

★ A fresh start. By anchoring your fears to specific people (eg people in your last school or job), rather than people in general, it is possible to feel comfortable around strangers and move more easily to a new environment.

★ Complete relaxation. It’s impossible to feel both stressed and relaxed at the same time. So, when you are distracted by enjoyable activities which demand physical release and concentration, you are less likely to be plagued by unhelpful thoughts. Your body will relax; you’ll breathe more deeply; you’ll laugh; you’ll say something without thinking. When this happens, try to stay calm; stay in control; keep the words flowing. Tell yourself it’s safe to talk.

What else will help? We can make the link between THOUGHTS, BODY and FEELINGS work to our advantage:

★ When you smile – even a fake smile – your brain releases feel-good chemicals, making both you and those around you feel better. Do it often!

★ Tension produces anxiety so regularly check your body for tightness and rigidity. Try to unclench your muscles, go floppy, sink back into the chair, relax ...

5

★ Slow, deep, calming breaths will slow down your heart rate and make you feel calmer (try it in the dentist’s chair!).

★ Exercise, eat healthily and get enough sleep. ★ Recall positive memories and emotions from the past: your happiest, proudest, strongest moments. Relive them for a few minutes and things that usually worry you will seem less important.

★ Act and look confident and you will start to feel confident. It’s not the other way round!

★ Recognise that your negative associations with speaking are memories and beliefs from the past. They belong to a small, innocent person, not the older, wiser person you are now.

★ Whenever you can, practise humming quietly with your lips together – feel the vibration in your throat which means your vocal cords are relaxed. If you feel your throat tighten, loosen it by breathing out with a hum. As you hum, you release your voice.

The most important change you can make TODAY Take your time to re-read this booklet, then use your conscious brain to start separating and overriding the automatic cycle of thoughts, sensations and feelings:

THOUGHTS

BODY

6

FEELINGS

★ Rather than focus on the emotions of fear, dread or panic, tune in to your body and notice what is happening. Eg ‘My heart is racing; my shoulders are raised and tense; my ribcage is rigid; my throat muscles are tightening; I’m holding my breath.’

★ Tell yourself that your body is producing unpleasant physical sensations, but you can handle it; they weren’t triggered by a real threat. The sensations will subside if you take slow, deep, calming breaths and repeat, ‘This will pass; my fear is imaginary.’

★ Note and challenge unhelpful thoughts; are they true? Or have they come from years of inaccurate information and subconscious association? You have done nothing wrong; you have as many good qualities and talents as the next person; it is OK to make mistakes; people are more interested in their own lives and insecurities than yours. Of course, it isn’t easy to make any of the changes in this booklet without support and they will take time. But just believing they are possible is the best start you can make. Finding a friend, relative, mentor or professional who is willing to help you take things further is a close second … Get them to read this booklet too and then you won’t need to explain it all.

Further reading The Selective Mutism Resource Manual (2016) by Maggie Johnson and Alison Wintgens, Speechmark Publishing Ltd. First Steps Out Of Anxiety (2010) by Dr Kate Middleton, Lion Books, Oxford.

Many thanks to Lizzie Helps and Matt Thompson for their artwork Easy-to-read A4 version

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7

Further reading The Selective Mutism Resource Manual (2016) by Maggie Johnson and Alison Wintgens, Speechmark Publishing Ltd. First Steps Out Of Anxiety (2010) by Dr Kate Middleton, Lion Books, Oxford

Many thanks to Lizzie Helps and Matt Thompson for their artwork A5 print version

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PHOTOCOPIABLE The Selective Mutism Resource Manual second edition Speechmark Publishing Ltd © Maggie Johnson & Alison Wintgens, 2016

WHEN THE WORDS WON’T COME OUT Information about selective mutism for teenagers and adults

Please read this booklet if you can speak in some situations but not others and if any of the following are true:

★ you feel physically frozen or paralysed when you try to talk

THOUGHTS

BODY

FEELINGS

★ you want help to speak more freely ★ Rather than focus on the emotions of fear, dread or panic, tune in

★ it’s easier not to talk ★ you have given up hope of talking without anxiety ★ you are sick of people trying to ‘help’ ★ you believe things are fine as they are ★ you feel let down by professionals in health or education services

to your body and notice what is happening. Eg ‘My heart is racing; my shoulders are raised and tense; my ribcage is rigid; my throat muscles are tightening; I’m holding my breath.’

★ Tell yourself that your body is producing unpleasant physical sensations, but you can handle it; they weren’t triggered by a real threat. The sensations will subside if you take slow, deep, calming breaths and repeat, ‘This will pass; my fear is imaginary.’

★ Note and challenge unhelpful thoughts; are they true? Or have

★ you want to know more about selective mutism. You may have struggled with talking for many years. This can affect the choices you make and your ability to influence other people and be the person you really are. You may have reached the point where you are desperate for help or ready to give up. Either way, it’s impossible for you to make an informed decision about what to do next until you understand what you are dealing with. This booklet summarises what selective mutism (SM) is, how it messes with your mind, how it can be overcome and the most important change you can make TODAY.

1

they come from years of inaccurate information and subconscious association? You have done nothing wrong; you have as many good qualities and talents as the next person; it is OK to make mistakes; people are more interested in their own lives and insecurities than yours. Of course, it isn’t easy to make any of the changes in this booklet without support and they will take time. But just believing they are possible is the best start you can make. Finding a friend, relative, mentor or professional who is willing to help you take things further is a close second … Get them to read this booklet too and then you won’t need to explain it all. 10

★ When you smile – even a fake smile – your brain releases feelgood chemicals, making both you and those around you feel better. Do it often!

★ Tension produces anxiety so regularly check your body for tightness and rigidity. Try to unclench your muscles, go floppy, sink back into the chair, relax ...

★ Slow, deep, calming breaths will slow down your heart rate and make you feel calmer (try it in the dentist’s chair!).

★ Exercise, eat healthily and get enough sleep. ★ Recall positive memories and emotions from the past: your happiest, proudest, strongest moments. Relive them for a few minutes and things that usually worry you will seem less important.

★ Act and look confident and you will start to feel confident. It’s not the other way round!

★ Recognise that your negative associations with speaking are memories and beliefs from the past. They belong to a small, innocent person, not the older, wiser person you are now.

★ Whenever you can, practise humming quietly with your lips together – feel the vibration in your throat which means your vocal cords are relaxed. If you feel your throat tighten, loosen it by breathing out with a hum. As you hum, you release your voice.

The most important change you can make TODAY Take your time to re-read this booklet, then use your conscious brain to start separating and overriding the automatic cycle of thoughts, sensations and feelings: 9

What is SM? SM is a condition in which individuals are able to talk freely in situations where they are relaxed and relatively free of anxiety, but they become frozen and unable to speak in other situations. This may be accompanied by all the signs of extreme anxiety – racing heart, muscular tension, tight chest and throat, difficulty breathing … or a dull feeling of nothingness because you know you won’t be able to speak, so what’s the point of even trying? SM is often described as a fear of speaking and you may identify with intense feelings of dread or panic at the thought of having to speak to certain people. Or you may say you’re not afraid of speaking; you’re afraid of looking an idiot when you can’t speak and terrified you won’t be able to speak when you need to. It all boils down to the same thing. SM is an anxiety disorder and people with SM have developed a phobia of talking to, or being overheard by, certain people. Normally when people have phobias, their families and the general public are sympathetic and don’t force them to do the things they have a phobia about. It may seem odd – after all, some phobias are pretty weird, such as phobias of buttons, kittens or bananas – but we realise that the person is not refusing to board a plane or eat bananas or whatever. They just cannot, under any circumstances, physically make themselves do it. It’s not a choice; if they had any choice at all, they’d choose not to have the stupid phobia.

2

So the main obstacle for you is that most people have no idea that SM is a phobia and do all the things that make phobias worse. They put all sorts of pressure on you to speak and make you feel really bad about not speaking (as if you didn’t feel bad enough already). Can’t talk

PRESSURE

Increased anxiety

Even harder to talk

PHOBIA cycle

your automatic brain learns through repeated experience that there is no need to sound the alarm. You plan the steps and stay in control.

★ A fresh start. By anchoring your fears to specific people (eg PANIC FREEZE

Relief from anxiety (but increased dread of talking)

Sadly, the longer you live with SM, the more it threatens to alter your self-image. You’re an intelligent person; you know things don’t happen without a reason. So, in the absence of any other explanation, you start to believe what other people are saying about you; that you are shy, different, rude, difficult, stubborn or not worth the bother. These are simply the opinions of individuals who got it wrong. Had they known the truth, they would have used different words: guarded, scared, hurt, determined, focused, a survivor.

3

Anyone who’s got over a phobia will know that, once the amygdala is switched off, it’s like something has lifted. You’re free and the same trigger no longer has any effect. There are several proven ways to achieve this:

★ Graded exposure. By facing your fear in tiny, bearable steps,

from self, family, teachers and wider community

AVOIDANCE of specific situations

How to switch off your amygdala

people in your last school or job), rather than people in general, it is possible to feel comfortable around strangers and move more easily to a new environment.

★ Complete relaxation. It’s impossible to feel both stressed and relaxed at the same time. So, when you are distracted by enjoyable activities which demand physical release and concentration, you are less likely to be plagued by unhelpful thoughts. Your body will relax; you’ll breathe more deeply; you’ll laugh; you’ll say something without thinking. When this happens, try to stay calm; stay in control; keep the words flowing. Tell yourself it’s safe to talk.

What else will help? We can make the link between THOUGHTS, BODY and FEELINGS work to our advantage:

8

without us realising it. It can be very hard to separate thoughts, feelings and physical sensations, in order to know which are real and which are illusions. THOUGHTS

FEELINGS

BODY

For example, you may be aware of your heart racing and feel nervous or afraid, but it could be coffee, energy drinks or nicotine that increased your heart rate, rather than stress. Or you might be good at driving but think so much about what people will say if you fail your test that you are too tense to put the car in gear. Unhelpful thoughts like this have a way of coming true! And, in the case of selective mutism, the conviction that you cannot speak to certain people triggers the amygdala’s fight–flight–freeze reaction – your body goes into overdrive and you feel as if you are in great danger; it truly is the most horrible sensation. You have three options: attack (we usually save that for those closest to us!); escape (no wonder you do all you can to avoid feeling like this); or freeze. Your body stiffens, your throat closes up, you’re stopped in your tracks. Your feelings are REAL, but the threat to you is IMAGINARY. That doesn’t mean you’re going mad.

Even if you reject the opinion of other people, you may create your own reasons to justify your fear; you hate your voice, you can’t think quickly enough, you are poor at conversation. (By the way, everyone is shocked by the sound of their own voice, and no one can think quickly or communicate well when they are anxious!) Inevitably, other people are affected by your silence. Many assume you don’t want to talk; they do not know how to approach you; they worry about doing the wrong thing. And so … they ignore you. That can have a devastating effect. Unless you are one of the lucky people who have always felt secure in their family’s unconditional love and the social acceptance of friends, you may reach the wrong conclusion and think that other people find you stupid or dull, unlikeable or unattractive, or a misfit. And perhaps the greatest untruth of all … nagging away at you is the feeling that you ought to be doing better. But no one arranged for you to have the equivalent of swimming lessons or extra Maths, so how were you supposed to improve? Over the years, all of this can amount to a hefty burden of confusion, resentment, guilt, shame and isolation which chips away at your selfesteem, intensifies your negative associations with communication and distorts your perception of yourself and other people. In short, you’ve already had to deal with far more than most people you grew up with. You are stronger than you think. None of this

It’s just how phobias work. 7

4

is your fault – life isn’t always fair and you have been extremely unlucky to miss out on the support and understanding which is now available to young children who have SM. You are as unique, likeable and valuable as everyone else. And the good news is, phobias can be cured! At any age!

pay. Through sheer bad luck and subconscious association, SM has made you a prisoner in your personal comfort zone.

The key to your freedom … … lies in understanding how your brain works.

How do phobias start? You know how a particular smell or piece of music can trigger past memories and sensations? Powerful feelings are commonly linked to something in the environment, and that environmental trigger can generate the same feelings years later. It’s different for everyone but, in the case of SM, there will have been a time in your childhood when feelings of extreme distress, despair or panic became associated with being expected to talk; eg you desperately wanted your parents and a stranger tried to comfort you; or you were told off by a teacher. You may have been too young at the time to talk back, or you may have been too ill or alarmed to talk (the ‘freeze’ response). Since then, similar people have acted as a trigger, so that, when they try to talk to you, the same ghastly feelings have flooded back with the sensation of being unable to speak. Even though these feelings are recalled from the past, people with phobias experience the current situation as unbearably threatening, and do all they can to avoid reliving those childhood sensations. You may have discovered, for example, that if you stay indoors all day and never answer the phone, you will be spared those feelings. This is the ultimate price you

conscious brain (frontal cortex)

automatic brain (limbic system and amygdala)

The amygdala controls our automatic fear reflex. Its role is to keep us safe and alert. It prepares our bodies to cope with danger by triggering the release of stress hormones which cause physical reactions such as increased heart rate, rapid shallow breathing, a rush of blood to the arms and legs, sweating and muscular tension. The limbic system interprets physical and chemical changes in our bodies and labels them as emotions or feelings. The frontal cortex is where rational, conscious thought takes place. One of the effects of stress is ‘brain freeze’. It’s impossible to think rationally and our mind goes blank. These three areas are closely interlinked and influence each other

5

6

FORM 1A

Name _______________________________

Date of birth ___ / ___ / ___

Age_________________

Gender M / F

Date of interview ___ /___ / ___

School _______________________________

Teacher ___________________

Head teacher ________________________

SENCo ____________________

Referrer _____________________________________________________________ Reason for referral _____________________________________________________ ___________________________________________________________________ Present at interview ____________________________________________________ CONFIDENTIALITY: remember that the information the parents give you is subject to the same rules of confidentiality as any clinical information. However, explain that it is sometimes helpful to discuss some points with the school. Ask the parents to let you know if there is any information that they do not wish the school to know, and reassure them that their wishes will be respected, as long as this does not compromise the child’s well-being.

PARENT INTERVIEW FORM

PARENT INTERVIEW FORM

1a

PLEASE NOTE: suggested questions to ask the parents are in bold type in each section; items for the interviewer to keep in mind are in italics.

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1a PARENT INTERVIEW FORM

Continued

FORM 1A

1 PRESENTING PROBLEMS What concerns do you have about [N]? List all concerns; find out which are the main ones; probe for more, however small. Maybe ask ‘Do you think your child is getting on in every other way as well as any other child of the same age? Check how long they have been a problem. Who is worried? Why are they worried? What helps or hinders the problem(s)?

Have you had any thoughts about a possible explanation? Are there people or events that parents think could be wholly or partly responsible for their concerns about [N]? Do they need help to understand contributing factors or manage any misplaced guilt or blame?

What questions do you want answered?

What do you want to get out of coming to see us?

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FORM 1A

2 FAMILY

Ask about ages and occupations. Ask where people live, and how often they see the family.

Who lives at home at the moment? Tell me about your parents? And siblings? Which family members are most significant to [N]?

Has [N] had to cope with the loss of any significant family members, friends or pets? Is, or has, any of the family been mute, shy or quiet? Is there any family history of late talking or other speaking problems? Any history of reading or learning problems? Any history of anxiety or similar problems? Who speaks which language to whom in the presence of the child? Put all this information on the genogram.

Continued

PARENT INTERVIEW FORM

Draw a genogram or family tree.

1a

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1a PARENT INTERVIEW FORM

Continued

FORM 1A

3 SPEAKING PATTERN – WITH DIFFERENT PEOPLE IN DIFFERENT SETTINGS Start to gather information to give a baseline picture of the extent of the child’s communication. Explore non-verbal communication, ability to initiate as well as respond and conditions under which the child does not talk fully and freely.

To whom does [N] speak fully and freely, and in what settings?

Does [N] speak a little to some people? Who? When? For what purposes?

How does [N] communicate when he/she does not talk?

How do other people react to this?

What about speaking in any groups or special activities after school or at the weekend? Whether Brownies or Cubs, ballet, kung fu or church, check the extent to which the child communicates in these settings. If not attending such activities, have they ever been thought about or tried? Check the parents’ attitude.

To what extent do you think [N] is aware of the difficulties?

What comments has [N] made? How much has the problem been discussed with the child? Does he/she want to be able to speak out more comfortably?

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FORM 1A

4 SCREENING QUESTIONS

further investigation and possible inclusion in an overall intervention plan. It may be helpful to put the same questions to other people who spend time with the child regularly.

NOTE If you are concerned about the informant’s knowledge of age-appropriate development, ask for specific examples of what [N] can do or how [N] tackles certain tasks.

When [N] is feeling relaxed, do you or any close members of the family have any concerns about [N]’s: – movement or coordination (balance, ball skills) – fine motor coordination (using cutlery, doing up/undoing buttons) – speech and language (understanding, using words and sentences, pronunciation) – social communication skills (interacting and playing with closest family members)

Continued

PARENT INTERVIEW FORM

to find out whether the child has other difficulties besides selective mutism which warrant

1a

– sensitivity (to certain sounds, textures, being touched, etc.)?

Are you concerned about [N]’s general intelligence or learning?

Are there any other specific anxieties or phobias?

Do you have any concerns about [N]’s behaviour?

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EXTENDED PARENT INTERVIEW form

1b

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FORM 1B

EXTENDED PARENT INTERVIEW FORM Name _______________________________

Date of birth ___ / ___ / ___

Age_________________

Gender M / F

Date of interview ___ /___ / ___

School _______________________________

Teacher ___________________

Head teacher ________________________

SENCo ____________________

Referrer _____________________________________________________________ Reason for referral _____________________________________________________ ___________________________________________________________________ Present at interview ____________________________________________________ CONFIDENTIALITY: remember that the information the parents give you is subject to the same rules of confidentiality as any clinical information. However, explain that it is sometimes helpful to discuss some points with the school. Ask the parents to let you know if there is any information that they do not want the school to know, and reassure them that their wishes will be respected, as long as this does not compromise the child’s well-being. PLEASE NOTE: suggested questions to ask the parents are in bold type in each section; items for the interviewer to keep in mind are in italics.

FORM 1B

1 PRESENTING PROBLEMS

List all concerns; find out which are the main ones; probe for more, however small. Maybe ask ‘Do you think your child is getting on in every other way as well as any other child of the same age? Check how long these concerns have been a problem. Who is worried? Why are they worried? What helps or hinders the problem(s)?

Have you had any thoughts about a possible explanation? Are there people or events that parents think could be wholly or partly responsible for their concerns about [N]? Do they need help to understand contributing factors or manage any misplaced guilt or blame?

Continued

EXTENDED PARENT INTERVIEW form

What concerns do you have about [N]?

1b

What questions do you want answered?

What do you want to get out of coming to see us?

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1b EXTENDED PARENT INTERVIEW form

Continued

FORM 1B

2 FAMILY Draw a genogram or family tree. Ask about ages and occupations. Ask where people live, and how often they see the family.

Who lives at home at the moment? What can you tell me about your parents and siblings? Which family members are most significant to [N]?

Has [N] had to cope with the loss of any significant family members, friends or pets? Is, or has, any of the family been mute, shy or quiet? Is there any family history of late talking or other speaking problems? Any history of reading or learning problems? Any history of anxiety or similar problems? Who speaks what language to whom in the presence of [N]?

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Put all of this information on the genogram

FORM 1B

3 DEVELOPMENTAL HISTORY

Were there any physical problems? Get an idea of the significance of the pregnancy and parents’ attitude to the baby right from the start.

Did you have any problems getting pregnant? How did the pregnancy go, and how did you feel about it?

Tell me a bit about the birth and the first few days. Any anxieties around the birth of the baby – birth weight, medical treatment, psychosocial factors?

Did you feel at all unhappy in the early days or months after the birth? Any postnatal depression that might have affected bonding and attachment?

FEEDING AND EATING How did you feed [N]?

Have you had any worries about [N]’s feeding or eating since?

Continued

EXTENDED PARENT INTERVIEW form

PREGNANCY AND BIRTH

1b

Check for any difficulties with chewing or swallowing, fads, allergies or special diets, worries about weight or growth.

Is there any anxiety about [N] eating or vomiting in public or in certain situations?

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1b EXTENDED PARENT INTERVIEW form

Continued

FORM 1B

SLEEPING How did [N] sleep in the first few months, and how did you cope?

Have you had any problems since that time?

What is [N]’s sleeping and night-time routine like now?

Can [N] get off to sleep on his or her own? Check for own or shared room, bed-time routine, night waking and nightmares. Any signs of anxiety in the child? Any behaviour problems or parenting issues that might need addressing?

TOILETING At what age was [N] clean and dry? Has he or she had a period of six months with no ‘accidents’?

Does [N] sometimes have ‘accidents’ now? Wetting or soiling? Day or night? Could this affect the child’s social acceptability? Does he or she need referral for help with wetting or soiling (unrelated to being unable to ask to use the toilet)?

How much can [N] do for him or herself now? Can the child manage to be independent about going to the toilet? Do they shut the bathroom door at home? Any intense fears of germs and are these shared by the parent?

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FORM 1B

GROSS AND FINE MOTOR DEVELOPMENT

Look for any signs of general or specific motor problems. Dyspraxia? Problems with corestability? Could these account for a lack of independence or social confidence? Is an occupational therapy referral indicated?

When did [N] first sit? And walk?

How well can [N] manage buttons, laces and zips?

How well coordinated would you say [N] is?

How is [N]’s balance when kneeling, doing a handstand or a wheelbarrow?

4 SPEECH, LANGUAGE AND COMMUNICATION – DEVELOPMENT In the first year, what sort of a baby was [N]? Look at early communication. How curious, chatty or sociable was he or she as a baby?

At what age did [N] say his or her first words?

Continued

EXTENDED PARENT INTERVIEW form

Check ball skills, bike riding.

1b

If relevant, what language did he or she first speak?

When did [N] start to join words?

Has [N] always spoken clearly enough?

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1b EXTENDED PARENT INTERVIEW form

Continued

FORM 1B

Have you ever been worried about whether [N] can understand what you say? Are there signs of verbal comprehension problems?

How did [N]’s talking continue to develop?

Does [N] initiate communication generally, such as start conversations, ask questions, volunteer information, seek help?

Any concerns? Any teasing? Are there signs of early self-consciousness?

Has [N] ever seen a speech and language therapist? If yes, ask for details and the outcome. If no, or a long time ago, is a referral indicated now?

Have you ever been worried about [N]’s hearing? Ask about hearing tests, ENT investigations and procedures.

5 SPEECH, LANGUAGE AND COMMUNICATION – BILINGUALISM Which languages does [N] speak now and to whom? How competent is [N] in each language? How well does [N] understand the different languages spoken around him or her?

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FORM 1B

6 SPEAKING PATTERN – WITH DIFFERENT PEOPLE IN DIFFERENT SETTINGS

communication. Explore non-verbal communication, ability to initiate as well as respond, and conditions when the child does not talk fully and freely.

To whom does [N] speak fully and freely, and in what settings?

Does [N] speak a little to some people? Who? When? For what purposes?

If [N] is bilingual, are there situations where he or she is happy to use one language but not the other?

How does [N] communicate when he or she does not talk but wants to convey a message? How do other people react to this?

Does [N] speak in any groups or special activities after school or at the weekend? Whether Brownies or Cubs, ballet, kung fu or church, check the extent to which the child communicates in these settings. If not attending such activities, have they ever been thought about or tried? Check parents’ attitude.

Continued

EXTENDED PARENT INTERVIEW form

Start to gather information to give a baseline picture of the extent of the child’s

1b

To what extent do you think [N] is aware of the difficulties? What comments has [N] made? How much has the problem been discussed with the child? Does he or she want to be able to speak more comfortably?

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1b EXTENDED PARENT INTERVIEW form

Continued

FORM 1B

7 ATTACHMENT This section helps with the diagnosis – giving signs of anxiety, the onset and nature of the selective mutism and/or autistic features.

How easy was it for you to bond with [N] and when did you feel that happened?

How secure do you think [N] was as a young child? Did [N] have a predictable routine?

What was the pattern of child care and when did you first separate from [N]?

How did [N] cope with separating and going to nursery and school? Check early playgroup and school history regarding how the child separated and settled.

How many times have you and [N] been apart overnight, and for how long? Check when and how often mother and child have been separated, and how the child reacted. Any illnesses or accidents requiring the child to be in hospital?

How does [N] cope with you leaving now for any time?

How does [N] greet you after being away from you?

If [N] is upset, does [N] come to you for help and comfort?

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FORM 1B

8 TEMPERAMENT

Is this consistent with selective mutism? Are there signs of behaviour problems or autism?

How would you describe [N]’s character?

How does [N] adapt to new situations? And to new people?

Is [N] easily upset or does [N] get very angry? What happens? How does he or she show it? How long does it take [N] to calm down?

Does [N] generally do as he or she is told? Check how the child responds to discipline or are they used to having their own way?

Does [N] have any fears or other anxieties? Explore past and present fears. Triggered by specific incidents? Any night terrors?

9 PLAY AND PEER RELATIONSHIPS

Continued

EXTENDED PARENT INTERVIEW form

Again, these responses will help with diagnosis and when planning intervention.

1b

What and who does [N] like playing with?

Does [N] have a best friend? And/or a bigger group of friends? Check who the child confides in and spends time with on a regular basis. After school or at the weekends? Are the friends at school and/or living locally?

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1b EXTENDED PARENT INTERVIEW form

Continued

FORM 1B

Are there children living nearby of [N]’s age? Would you feel happy about [N] playing with them? Do parents actively encourage the child to be sociable?

What usually happens when [N] plays with other children? Is play harmonious? Can the child share? Can the child tolerate losing? Does the child usually lead or follow?

How does [N] get on with other children at school? Any teasing or bullying?

Were there any problems in the way [N] got on with other children before starting school?

10 SCHOOL LIFE Does [N] enjoy school and go there readily? Psychosomatic illness associated with return to school? Slow to dress or separate in the morning?

How well has [N] done in the past at nursery and school?

How has [N] got on with the teachers?

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Did anyone tell you there were any problems?

FORM 1B

Do you think [N] is doing as well as he or she should at school now?

Is child excluded from swimming, PE, etc because of anxiety or safety concerns? Does the child have or need any additional help with reading, language or other activities?

Has [N] missed much time at school? If yes, check the reasons. Illness? Anxiety?

Does [N] have any problem asking to go to, or using, the school toilets? If problems other than asking permission, go to ‘Toileting’ under ‘3 Developmental history’.

How do you get on with the head and the class teacher? Do staff members share your concerns about [N]?

11 SOCIAL HISTORY Can you tell me a bit about your home? Get an idea of the nature of the accommodation, garden or playing area and neighbourhood. Are there stresses and/or restrictions that might impinge on the child’s social interaction?

Continued

EXTENDED PARENT INTERVIEW form

If not, are there other reasons apart from the mutism?

1b

Has the family ever moved house? Get an impression of how often, when and where they lived, and the effect on the child.

Is there anything you think I need to know about your culture? Check cultural attitudes to silence and mutism.

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PRIMARY SCHOOL REPORT FORM

2a

FORM 2A

PRIMARY SCHOOL REPORT FORM Name ____________________________

Please complete and return the form to:

Date of birth_______________________

________________________________

Address ___________________________ ________________________________ ___________________________________ ________________________________ School ____________________________ Date of entry ______________________ Filled in by (if possible the teacher who knows the child best) Name (in capitals) ____________________ Signature ________________________ Position held ________________________ Date ____________________________ CONFIDENTIALITY: we sometimes find it helpful to discuss school report forms with parents and children. Please indicate, by marking distinctively, any parts of the report which you would not like to be discussed with the family. Your wishes can then be respected.

1 BACKGROUND INFORMATION Previous schools and dates Any previous records or reports about [N]

2 PRESENT SCHOOL What, if any, are your concerns about [N] now? Please write as fully as you want to about this child and any problems you perceive.

When were these concerns first noticed in the school?

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How have these problems changed over time?

FORM 2A

3 SPEECH, LANGUAGE AND COMMUNICATION

Does the child speak to anyone? In what way? In which settings? How adequate/inadequate is it with staff and children? Please give details.

If [N] speaks to anyone, is there any indication of difficulty or immaturity in his/her speech and language?

How does [N] communicate when he/she does not talk but needs to say something? Use of gesture? Eye contact? Touch? Written?

In the classroom does [N] seem to listen? Make eye contact?

If [N] wants something, how does he/she get it? Pointing, putting hand up, touching teacher or showing work, getting another child to communicate his/her needs; waiting to be noticed; making a noise; message via parent?

Continued

PRIMARY SCHOOL REPORT FORM

To what extent does [N] speak in school?

2a

What do you do when [N] needs to speak, eg to request a spelling, report illness or teasing?

What about answering the register? How does [N] respond compared with the other children?

How do you assess [N]’s reading ability?

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What happens in circle time?

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2a PRIMARY SCHOOL REPORT FORM

Continued

FORM 2A

What about going to the toilet? How does he/she ask to go? Does he/she require assistance?

Does [N] have any accidents? Wetting? Or soiling?

Does [N] initiate communication generally, eg ask a question, make a comment, seek help or report illness?

How have you tried to improve [N]’s communication?

Has there been any change in [N]’s communication over this school year?

4 SOCIAL INTERACTION, TEMPERAMENT AND BEHAVIOUR How would you describe [N]? Comment on temperament and behaviour. Happy? Anxious? Bossy? Shy? Other?

Does [N] have any particular fears, obsessions or mannerisms?

Do you think [N] is ever teased or bullied? How would [N] let you know?

Who does [N] mix with or sit with? Best friend(s), girls, boys, same or different children on different occasions?

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FORM 2A

Does [N] play with other children? Or watch them? In which settings?

Continued

How does [N] relate to you and to other teachers and adults? All the same? Any favourites?

5 ABILITY, ATTAINMENT AND INTERESTS Please indicate how you perceive [N]’s abilities by ticking the chart below. Below average

Average

Above average

Very high

Estimated general ability Level of attainment If available, please give details of any reading and spelling tests and attainment results.

Please comment on how [N] fares in the various subject areas, giving indications of strengths and weaknesses, particular talents and interests, and general attitude to work.

PRIMARY SCHOOL REPORT FORM

Please comment on free play at lunch-/breaktimes, as well as organised activities, and friends outside school if known.

Very low

2a

Does [N] attend any clubs or after-school activities?

6 ADDITIONAL ASSESSMENT AND HELP To what extent is the school Special Educational Needs Coordinator involved?

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2a PRIMARY SCHOOL REPORT FORM

Continued

FORM 2A

Are [N]’s special educational needs formally recognised? What formal education plans are in place and what are the current targets?

If no formal targets, what targets do you feel would be appropriate for [N]?

Does [N] receive any extra help with literacy, language, learning or behaviour in or outside school?

Is the educational psychologist aware of your concerns? Please describe extent of EP’s involvement.

Has [N] had psychological testing? If yes, please give details or attach report.

Has [N] had any other assessments outside school, such as speech and language or occupational therapy? If yes, please give details or attach report.

7 SIBLINGS Does [N] have any siblings at your school and how are they getting on? Any with special needs? How do the siblings interact with or support [N]? Please give details.

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FORM 2A

8 PARENTS

2a Continued

Please summarise your discussions with parents.

9 STAFF TRAINING AND EXPERIENCE Finally, what relevant experience or training have you and other key members of staff had with children who are silent or reluctant to speak?

PRIMARY SCHOOL REPORT FORM

Do school staff and [N]’s parents share the same concerns about [N]?

How do you feel we could support you?

Thank you very much for completing this form.

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SECONDARY SCHOOL REPORT FORM

2b

FORM 2B

SECONDARY SCHOOL REPORT FORM Name



Date of birth



Address



Please complete and return the form to:

_________________________________ School



Date of entry

Filled in by (if possible the teacher who knows the child best) Name (in capitals)

Signature

Position held

Date

CONFIDENTIALITY: we sometimes find it helpful to discuss school report forms with parents and children. Please indicate, by marking distinctively, any parts of the report which you would not like to be discussed with the family. Your wishes can then be respected.

1 BACKGROUND INFORMATION Previous schools and dates Any previous records or reports about [N]

2 PRESENT SCHOOL What, if any, are your concerns about [N] now? Please write as fully as you want to about this child and any problems you perceive.

When were these concerns first noticed in the school?

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How have these problems changed over time?

FORM 2B

3 SPEECH, LANGUAGE AND COMMUNICATION

Does the student speak to anyone? In what way? In which settings? How adequate or inadequate is it with staff and children? Please give details.

If [N] speaks to anyone, is there any indication of difficulty or immaturity in his/her speech and language?

How does [N] communicate when he/she does not talk but needs to say something? Use of gesture? Eye contact? Touch? Written?

During lessons, does [N] seem to listen? Make eye contact?

If [N] wants something, how does he/she get it or attract attention? Pointing, putting hand up, approaching teacher or showing work, getting another student to communicate his/her needs; waiting to be noticed; making a noise; sending message via parent?

Continued

SECONDARY SCHOOL REPORT FORM

To what extent does [N] speak in school?

2b

What do you do when [N] needs to speak? (eg to choose options, express opinions, explain absence)

What about answering the register?

How do you assess [N]’s abilities in oral tasks, such as reading or giving presentations?

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2b SECONDARY SCHOOL REPORT FORM

Continued

FORM 2B

Does [N] initiate communication generally, eg ask a question, make a comment, seek help or report illness?

How have you tried to improve [N]’s communication?

Has there been any change in [N]’s communication over this school year?

4 COPING WITH THE SCHOOL DAY Please comment on [N]’s attendance and punctuality.

Does [N] need any extra help in any way? (to get round the school, to organise self, other difficulties)

Does [N] use the school toilets?

Does [N] eat lunch with the other students?

5 SOCIAL INTERACTION AND TEMPERAMENT How would you describe this student? Comment on temperament and behaviour: happy, anxious, bossy, shy, other?

Does [N] have any particular fears, habits or obsessions?

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FORM 2B

Who does [N] mix with or sit with?

Continued

How does [N] interact with other students? In which settings? Please comment on interaction at lunch-/breaktimes, as well as in more structured activities.

Do you think [N] is teased or bullied? How would [N] let you know?

How does [N] relate to teachers and other adults? All the same? Any favourites?

6 ABILITY, ATTAINMENT AND INTERESTS Please indicate how you perceive [N]’s abilities by ticking the chart below. Below average

Average

Above average

Very high

Estimated general ability Level of attainment

SECONDARY SCHOOL REPORT FORM

Best friend(s), girls, boys, same or different students on different occasions?

Very low

2b

If available, please give or attach details of any tests and attainment results.

Please comment on how [N] fares in the various subject areas, giving indications of strengths and weaknesses, particular talents and interests, and general attitude to work.

Does [N] attend any clubs or after-school activities?

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2b SECONDARY SCHOOL REPORT FORM

Continued

FORM 2B

7 ADDITIONAL ASSESSMENT AND HELP To what extent is the school’s Special Educational Needs Coordinator (SENCo) involved?

Are [N]’s special educational needs formally recognised? What formal education plans are in place and what are the current targets?

If no formal targets, what targets do you feel would be appropriate for [N]?

Does [N] receive any extra help with literacy, language, learning or behaviour in or outside school?

Is the educational psychologist aware of your concerns? Please describe the extent of EP involvement.

Has [N] had psychological testing? If yes, please give details or attach report.

Has [N] had any other assessments outside school, such as speech and language, or occupational therapy? If yes, please give details or attach a report.

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FORM 2B

8 SIBLINGS

2b Continued

Any with special needs? How do the siblings interact with or support [N]? Please give details.

9 PARENTS Do school staff and [N]’s parents share the same concerns about [N]? Please summarise your discussions with the parents.

10 STAFF TRAINING AND EXPERIENCE Finally, what relevant experience or training have you and other key members of staff had with children who are silent or reluctant to speak?

SECONDARY SCHOOL REPORT FORM

Does [N] have any siblings at your school and how are they getting on?

How do you feel we could support you?

Thank you very much for completing this form.

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Suggested key: large tick = speaks at normal volume; small tick = quiet voice; w = whisper.

(eg staff in shops and restaurants, unknown visitors to house)

Strangers

Responds

Initiates

One-to-one, others in background (eg in shop, classroom or waiting room)

(eg teachers, peers, friends’ parents, youth group leader)

One-to-one, no one else around (eg at home, in empty classroom with no fear of interruption, deserted park) Responds Initiates

Date: _____________

Group conversation (eg family meal, car journey, class discussion, play activities) Responds Initiates

Name: _____________________ Age: ________

Regular contacts

Family and friends

PEOPLE

RECORD OF SPEAKING HABITS 

RECORD OF SPEAKING HABITS

3 FORM 3

FORM 4

Name of child or young person [N]: ……………………………...… Age: …….… Name of person completing checklist: …………………………..… Date: ……… Your relationship to [N] or staff position: ……………………………………….… NOTE Please identify as many situations below as possible, as some of them may be inadvertently contributing to N’s difficulty in speaking. Please tick if an item occurs occasionally (ü) or often (üü) Frequency and indicate occasion(s) or place(s) where this tends to happen

Context or example

EXAMPLE: N’s anxiety about talking is ignored or dismissed

Grandfather feels she’s being silly/stubborn

1

N’s anxiety about talking is ignored or dismissed

2

Adults or peers ask [N] questions and wait (unsuccessfully) for an answer

3

[N] is given their turn to talk (eg at circle time or registration) but remains silent

4

[N] is asked why they don’t talk, whether they can talk or when they will talk (by adults or peers)

5

[N] is told ‘I can’t help you unless you speak’

6

[N] is encouraged, requested, pressed or offered rewards to speak, but without success

7

[N] is asked if they have succeeded in talking to others or what progress they are making with talking

8

Talking targets or expectations have been set for [N] (eg in school report) but not achieved

9

[N] has been penalised, ignored, criticised, threatened or ridiculed for not talking

10

[N] hears adult(s) expressing concerns about their lack of speech

11

N talks when people insist but not comfortably

12

[N]’s speech has been corrected, laughed at or criticised

13

[N] or [N]’s peers have been told off too harshly for talking or making a noise

14

Parents or siblings are not always comfortable speaking so they model silence (eg prefer other family members to do the talking; do not answer phone; avoid social situations)

üü

(Continued )

Checklist of possible maintaining factors

CHECKLIST OF POSSIBLE MAINTAINING FACTORS

4

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Checklist of possible maintaining factors

Continued

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FORM 4

CHECKLIST OF POSSIBLE MAINTAINING FACTORS Please tick if an item occurs occasionally (ü) or often (üü) Frequency and indicate occasion(s) or place(s) where this tends to happen

Context or example

EXAMPLE: [N] has denied or tried to cover up speaking

‘Don’t tell my teacher I spoke at Kids Club’

ü

15 Attention is drawn to the fact that [N] has spoken 16 [N] has denied, or tried to cover up, speaking 17 [N] knows an audio/video recording of [N] talking was shared without their consent 18 [N] does not want their sibling/twin to speak or vice versa 19 [N] uses gesture, whispering, writing or pictures to communicate at school with no signs of progressing to speech 20 Different arrangements are made so that [N] does not become stressed 21 Fun activities, treats or comfort (as opposed to reassurance) are provided when [N] pulls away from an activity or has been excused from an activity 22 [N] uses gesture, whispering, writing or pictures to communicate with people they talk to comfortably at other times 23 [N] hears adults or peers warn others that [N] will not, cannot or may not be able to talk 24 Adults, siblings, friends or peers automatically speak for [N] 25 There is little need for [N] to speak at home 26 [N] is becoming more withdrawn and talking less within their usual comfort zone (eg at home) 27 People have stopped talking to [N] 28 It feels like there’s no coordinated plan in place to help N overcome their fear of speaking

Thank you for completing this form.

FORM 5

PICTURE THIS! Date:_____________

(a) School / college / work *

(* delete as appropriate)

Imagine a wonderful school/college/workplace* where you are happy, feel comfortable, have a good time and get on well. What happens there to make you feel good? (Write, draw or tell someone as appropriate.) 1 Things to do with getting on with other children / students / workmates* 2 Things to do with members of staff / supervisors / people in charge*

Picture this!

Name:_____________________

5

3 Things to do with class work and homework / your job* 4 T hings to do with lunch-times, break-times, after-school activities or clubs, or social gatherings at work* 5 Anything else you can think of

(b) Outside school / college / work * Imagine a really enjoyable weekend, evening or holiday. What happens to make you have a great time? 1 Things to do with friends or people the same age as you 2 Things to do with your family 3 T hings to do with clubs, sports or organised activities that are not related to school/ college/work* 4 Things to do with shopping, travel or being independent 5 Anything else you can think of

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YOUNG PERSON’S INTERVIEW FORM

6

FORM 6

YOUNG PERSON’S INTERVIEW FORM– PRIVATE AND CONFIDENTIAL Name: ___________________________________ Date of birth: _________________ CONFIDENTIALITY: the information the young person provides is subject to the same rules of confidentiality as any clinical information. However, it may help to discuss some points with the school, college or workplace. Explain this and ask the young person to let you know if there is any information that they do not want the school to know. Reassure them that their wishes will be respected, as long as it does not compromise their well-being.

1 STRENGTHS AND DIFFICULTIES Tell me about some things that you enjoy or are going well

What’s not going so well? What questions do you want answered?

2 FAMILY AND FRIENDS Who lives at home at the moment?

Which other family members do you have who don’t live at home?

Which people are most important to you in your immediate or extended family?

Is anyone in the family like you in any way?

Tell me a bit about your friends and the things you do together

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Do you attend any clubs/organised activities/gym/music lessons, etc?

FORM 6

3 GENERAL HEALTH AND LIFE SKILLS

a) eating? b) sleeping? c) coordination? d) learning? e) reading? f) independence? (taking care of yourself, going out alone, etc.) g) being seen in public?

4 SPEAKING When you are feeling comfortable, do you have any difficulty in: (a) understanding what people say to you? (b) finding words or ways to express yourself? (c) speaking clearly?

5 SPEAKING PATTERNS (a) Do you get very anxious about speaking to some people in some settings?

Continued

YOUNG PERSON’S INTERVIEW FORM

Do you have any difficulties around:

6

(b) Are there people you don’t speak to at all? Please say who. (c) Which of the following thoughts do you have most often when you worry about speaking? Tick (ü) any that apply. – I can’t think of anything to say – People will have a bad opinion of me – I won’t be able to get my words out – People will think it’s odd if I speak – Why can’t I talk? – Something else … (please explain)

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6

YOUNG PERSON’S INTERVIEW FORM

Continued

FORM 6

(d) Who can you speak easily to, and in what settings? (e) How do you communicate with other people in other settings? (f) Which situations or activities do you avoid as much as possible?

6 OTHER PEOPLE’S REACTIONS AND COMMENTS What do other people do or say that you find helpful or unhelpful as far as talking is concerned? (a) At home

(b) At school/college/workplace

(c) Out with friends

(d) In any other environment

7 WHAT STRATEGIES HAVE BEEN TRIED? What have you or anyone else tried in the past, or present, to help you speak more easily? Please indicate what worked well; what made things worse; and what made no difference.

8 TEMPERAMENT (a) How would you describe yourself? (b) Do you easily get upset? (c) What kind of things make you upset?

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(d) How often do you get angry?

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(e) How often do you feel lonely?

FORM 6

9 SCHOOL, COLLEGE OR WORK

– the work? – other students / teachers / work colleagues? (b) Does your communication difficulty hold you back in any way?

(c) Do you need or get any extra help at school / college / work?

(d) Do you have any other special help outside school / college / work?

10 THE FUTURE (a) Which of your interests or skills would you like to continue through further study, or employment or as a hobby?

(b) What would improve your life? List anything you would like to achieve or like to see happening.

Continued

YOUNG PERSON’S INTERVIEW FORM

Tell me a bit about what you are doing at school / college / work. (a) How are you getting on with:

6

(c) What would you like to be doing 5 years from now?

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4

ALL ABOUT ME

7

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FORM 7

ALL ABOUT ME Please answer the questions below as honestly as you can, and ask for help if there is anything you are unsure about or don’t understand. Circle a number from 0 to 3 to indicate how true the following statements are. 0 = definitely not true; 1 = slightly/occasionally true; 2 = mostly/usually true; 3 = definitely true. 1

I enjoy sports

0

1

2

3

2

I enjoy gymnastics

0

1

2

3

3

I enjoy dancing

0

1

2

3

4

I enjoy football

0

1

2

3

5

I enjoy social networking

0

1

2

3

6

I attend at least one school club or activity

0

1

2

3

7

I attend at least one club or activity outside school

0

1

2

3

8

I enjoy reading novels

0

1

2

3

9

I enjoy reading magazines

0

1

2

3

10

I prefer television to reading

0

1

2

3

11

I like going to the cinema

0

1

2

3

12

I am interested in computers

0

1

2

3

13

I am interested in horse-riding

0

1

2

3

14

I am interested in fashion

0

1

2

3

15

I am interested in music

0

1

2

3

16

I am interested in art

0

1

2

3

17

I like animals

0

1

2

3

18

I can play a musical instrument

0

1

2

3

19

I have no friends

0

1

2

3

20

I would like to have more friends

0

1

2

3

21

I have enough friends

0

1

2

3

22

I find it easy to make new friends

0

1

2

3

23

I find it easy to talk to strangers

0

1

2

3

24

People say I talk too much

0

1

2

3

25

I wish I was not so quiet

0

1

2

3

26

I think my voice sounds OK

0

1

2

3

27

People like me

0

1

2

3

28

Some people think I am silly

0

1

2

3

29

I like the way I am

0

1

2

3

30

I would like to be different

0

1

2

3

Thank you!

FORM 8A

PRIMARY COMMUNICATION RATING SCALE How easy or difficult are the following situations for you? Please circle a number from 0 to 4 on the scale. 0 = very easy (no anxiety); 1 = fairly easy (a little anxiety); 2 = quite difficult (definitely some anxiety); 3 = difficult (more anxiety); 4 = very difficult (high anxiety).

Tick (ü) the box if you can talk in these situations q 0 1 2 3 4

1

Talking to close family members at home

2

Talking to close family members in a shop or restaurant where other people might hear you

q 0 1 2

3

4

3

Talking to other relatives at home

q 0 1 2

3

4

4

Talking to strangers

q 0 1 2

3

4

5

Talking to your class teacher on your own

q 0 1 2

3

4

6

Talking to your class teacher in front of other children in your class

q 0 1 2

3

4

7

Talking to other teachers or adults in the school

q 0 1 2

3

4

Name: ___________________

q 0 1 2

3

4

Name: ___________________

q 0 1 2

3

4

Name: ___________________

q 0 1 2

3

4

Name: ___________________

q 0 1 2

3

4

8

Putting your hand up in class to ask a question

q 0 1 2

3

4

9

Joining in a class discussion (giving your own opinion or ideas)

q 0 1 2

3

4

10

Answering the register

q 0 1 2

3

4

11

Joining in circle time

q 0 1 2

3

4

12

Asking if you may go to the toilet

q 0 1 2

3

4

13

Asking for help if you are not sure what to do

q 0 1 2

3

4

14

Reading to your class teacher on your own

q 0 1 2

3

4

15

Reading aloud in front of the class

q 0 1 2

3

4

16

Approaching other children to talk and be friendly

q 0 1 2

3

4

17

Answering other children if they talk to you

q 0 1 2

3

4

18

Telling other children they are annoying you

q 0 1 2

3

4

19

Telling a grown-up you think they have made a mistake

q 0 1 2

3

4

20

Talking to an adult when you may be in trouble

q 0 1 2

3

4

21

Telling an adult at school that you feel ill

q 0 1 2

3

4

22

Telling an adult at school that someone has upset you

q 0 1 2

3

4

23

Talking to a new teacher for the first time on your own

q 0 1 2

3

4

24

Talking to a new teacher for the first time in front of other children in your class

q 0 1 2

3

4

25

Talking to a new boy or girl at school for the first time

q 0 1 2

3

4

Thank you!

PRIMARY COMMUNICATION RATING SCALE

Name: ______________________________________ Date: ___________________

8a

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SECONDARY COMMUNICATION RATING SCALE

8b

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FORM 8B

SECONDARY COMMUNICATION RATING SCALE Name: __________________________________________ Date: _______________ How easy or difficult are the following situations for you? Please circle a number from 0 to 4 on the scale. 0 = very easy (no anxiety); 1 = fairly easy (a little anxiety); 2 = quite difficult (definitely some anxiety); 3 = difficult (more anxiety); 4 = very difficult (high anxiety)

Tick (ü) the box if you can talk in these situations

1 2

q 0 1 2 q 0 1 2

3 4 5 6 7 8 9 10

11 12 13 14 15 16 17 18 19 20 21

Talking to close family members at home Talking to close family members in a shop or restaurant where other people might hear Talking to other relatives at home Ordering a meal or drink in a takeaway or fast food outlet Asking for a bus or train ticket Talking to a shop assistant Answering a stranger in the street (eg they ask you for directions) Talking to your form tutor on your own Talking to your form tutor in front of other students Talking to other teachers or adults in the school or college Name and position: _______________________________ Name and position: _______________________________ Name and position: _______________________________ Name and position: _______________________________ Putting your hand up in class to ask a question Joining in a class discussion (giving your own opinion or ideas) Answering the register Joining in circle time or activities where everyone has to speak in turn Asking if you may go to the toilet Asking for help if you are not sure what to do Reading aloud to a member of staff when no one else is listening Reading aloud in class Giving a presentation to the class Approaching other students to talk and be friendly Answering other students if they talk to you

3 3

4 4

q q q q q

0 0 0 0 0

1 1 1 1 1

2 2 2 2 2

3 3 3 3 3

4 4 4 4 4

q q q q q q q q q q q

0 0 0 0 0 0 0 0 0 0 0

1 1 1 1 1 1 1 1 1 1 1

2 2 2 2 2 2 2 2 2 2 2

3 3 3 3 3 3 3 3 3 3 3

4 4 4 4 4 4 4 4 4 4 4

q 0 1 2 q 0 1 2 q 0 1 2

3 3 3

4 4 4

3 3 3 3

4 4 4 4

q q q q

0 0 0 0

1 1 1 1

2 2 2 2

(Continued )

FORM 8B

SECONDARY COMMUNICATION RATING SCALE

Continued

22 23 24 25 26 27 24 25 26 27 28 29 30 31 32 33 34 35

Telling other students they are annoying you Telling an adult you think they have made a mistake Talking to an adult when you may be in trouble Telling an adult at school or college that you feel ill Telling an adult at school that someone has upset you Talking to a new teacher for the first time on your own Talking to an adult when you may be in trouble Telling an adult at school or college that you feel ill Telling an adult at school that someone has upset you Talking to a new teacher for the first time on your own Talking to a new teacher for the first time in front of other students in your class Talking to a new boy or girl at school or college for the first time Making a phone call in private Making a phone call where other people can hear you Answering the home phone Texting friends Texting or emailing school staff Social networking, e.g. Facebook Thank you!

Tick (ü) the box if you can talk in these situations 1 1 1 1 1 1 1 1 1 1 1

2 2 2 2 2 2 2 2 2 2 2

3 3 3 3 3 3 3 3 3 3 3

4 4 4 4 4 4 4 4 4 4 4

q 0 1

2

3

4

0 0 0 0 0 0

2 2 2 2 2 2

3 3 3 3 3 3

4 4 4 4 4 4

q q q q q q q q q q q

q q q q q q

0 0 0 0 0 0 0 0 0 0 0

1 1 1 1 1 1

SECONDARY COMMUNICATION RATING SCALE

Name: __________________________________________ Date: _______________ How easy or difficult are the following situations for you? Please circle a number from 0 to 4 on the scale. 0 = very easy (no anxiety); 1 = fairly easy (a little anxiety); 2 = quite difficult (definitely some anxiety); 3 = difficult (more anxiety); 4 = very difficult (high anxiety)

8b

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Worrying thoughts

9

FORM 9

WORRYING THOUGHTS Name of person completing the form: ……………………................................ Age or date of birth: ……….… Date: …………. Here is a list of thoughts you might have in situations where you need to talk. 1. Read through them to see if any of them match your own thoughts. If you have any other worrying thoughts about talking, you can add them to the list. 2. How often do you have these thoughts? Score each one here 0 = never or hardly ever 1 = occasionally 2 = quite often 3 = a lot 4 = almost constantly 3. Which of these thoughts bother you the most? Identify one or two dominant thoughts and tick here 4. Try to give an example of a situation where you have that thought, for thoughts rated 2 or above Worrying thoughts with examples of when you have the thought, eg When people say hello to me 1. I mustn’t draw attention to myself or I might be expected to talk 2. What I say won’t be good enough – people will have a bad opinion of me or say something humiliating 3. I want to talk but … I can’t get the words out – my throat feels blocked 4.  People won’t be interested in what I have to say 5. I can’t think of anything to say or My mind will go blank 6.  I don’t understand why I can’t talk 7. When I do speak, I seem to end up embarrassing myself 8. I don’t want people to know I sometimes have difficulty talking 9. People won’t be able to hear me or People won’t be able to understand me 10. People will be surprised if I speak – I’m worried about their reaction 11.

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12.

These worry me the most

How often? (0–4)

FORM 9

WORRYING THOUGHTS The information obtained by using this form cannot be used to make a diagnosis of selective mutism (SM) or social anxiety disorder (SAD); but it may contribute to a battery of assessments, interviews and observations, referral to another agency or treatment planning. Individuals who meet the DSM-5 criteria for SM typically record high scores for 1, 3 and 6. If they have been silent with the same group of people for several years, a high score for 10 is common. The dominant thought could be any of these. If they manage to speak under duress (low-profile SM), 9 may also have a high score. If they are trying to make a fresh start with new friends or associates, and afraid their ‘secret’ will be discovered, it may be 8. When thoughts 1 or 8 dominate, they represent considerable inner turmoil and conflict – that is, how to fit in and be invisible at the same time? As self-esteem decreases, individuals with SM will in addition record high scores in other areas such as 2 and 4. Individuals with SAD who have difficulty speaking in certain situations will typically have high scores for 2, 4, 5, 7 and possibly 8 or 9. The form may also be used to investigate worrying thoughts around speech, language or autism spectrum disorders. These individuals may focus on items 2, 5 (‘can’t think of anything to say’ is very typical for ASD) or 9, or 1, 3 and 7 for fluency disorders. Clinicians may add or change items at their discretion to shift the emphasis from anxiety disorders to disorders of communication and interaction. Examples: I won’t be able to find the right words It will help if I try to get my words out as quickly as possible People will get bored waiting for me to finish I’m not interested in what other people talk about I must avoid certain words

Worrying thoughts: INTERPRETATION

Notes on interpretation for the assessor

9

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(Continued)

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9

Worrying thoughts: INTERPRETATION

Continued

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FORM 9

Some considerations when addressing worrying thoughts Is further reflection necessary? For example, item 7 (‘I don’t want people to know I sometimes have difficulty talking’) could be a practical issue – knowledge could bring unwanted attention and questions, leading to increased pressure to talk – or it could be linked to a sense of shame about the difficulty and/or fears of rejection if they are found out. Different thoughts require a different focus when looking for ways to move forward. Is this within my remit? Practitioners need to be comfortable that the thoughts relate to issues within their area of expertise, and clear when liaison with, or referral to, other agencies is indicated. Is there a practical solution or a different way to think about this? Anxious individuals need help to unpick problems methodically, challenge their perceptions and look for solutions and coping strategies. When individuals appear to be stuck in patterns of unhelpful thinking, and logic has little effect in turning this around, advice should be sought from mental health practitioners or counsellors who are skilled in cognitive reframing therapies such as cognitive behavioural therapy (CBT).

FORM 10

Name of person completing the form: ……………………...........................… Age or date of birth: …….….… Please tick if an item occurs occasionally (ü) or often (üü) and rate how much this bothers you from 0 – 5 (0 = not at all, 5 = a lot). If you like, you can give an example. If something never happens, leave that line blank. Example: My anxiety about talking is ignored or dismissed 1

My anxiety about talking is ignored or dismissed

2

Adults or peers ask me questions and wait longer for an

Date: ………………

How often this happens

üü

J 0–5 L 5 - Mum jokes about it & I feel really embarrassed.

answer than I find comfortable 3

I’m given a turn to talk (eg answering the register or at circle time) but can’t say anything

4

People ask me why I don’t talk, if I can talk or when I will talk

5

People say things like ‘How can I help if you don’t tell me what’s wrong?’

6

People try to get me to talk more (any sort of encouragement, pressure or persuasion)

7

People ask me if I’ve spoken yet or what progress I’m making with talking

8

Talking targets or expectations have been set for me that are too difficult

9

I’ve been penalised, ignored, criticised, threatened or ridiculed for not talking

10

I know people worry that I don’t talk

11

Some people insist that I talk and they don’t give up until I do

12

My speech has been corrected, laughed at or criticised

13

I’ve been told off unfairly for talking or making a noise

14

People tell me other people are worse off than me but this doesn’t make me feel any better

REACTIONS OF FAMILY/FRIENDS/STAFF

REACTIONS OF FAMILY/FRIENDS/ STAFF

10

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10 REACTIONS OF FAMILY/FRIENDS/STAFF

Continued

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FORM 10

REACTIONS OF FAMILY/FRIENDS/ STAFF Please tick if an item occurs occasionally (ü) or often (üü) and rate how much this bothers you from 0 – 5 (0 = not at all, 5 = a lot). If you like, you can give an example. If something never happens, leave that line blank. Example: I get scared to speak in case people will make too big a deal about it 15

I get scared to speak in case people will make too big a deal about it

16

I worry that if people hear me speak, they’ll expect me to do it more than I can manage

17

I worry that someone will share a voice or video recording of me without my consent

18

Some of my family prefer other people to do the talking, or are embarrassed that they don’t speak a language very well

19

Some of my family avoid things like answering the phone, opening the front door, going to meetings and socialising.

20

My brother or sister gets me to agree not to talk to other people or vice versa.

21

I prefer to use gesture, whispering, writing or pictures to communicate at school

22

I’m allowed to be excused certain activities at home or school

23

When I’m excused an activity, I get to do something I really enjoy

24

I use gesture, whispering, writing or pictures to communicate with people who I can also talk to

25

I hear people telling other people I find it hard to talk

26

Other people answer for me when someone talks to me

27

My family don’t spend much time with me

28

I keep out of people’s way to avoid getting stressed

29

People have stopped talking to me

30

It feels like there’s no coordinated plan in place to help make talking easier for me

Thank you!

How often this happens

üü

J 0–5 L 3 It would be weird if I spoke at school now

FORM 11

Name: Date:

ASSESSMENT SUMMARY Parent interview carried out? or Extended parent interview? and/or Young person’s interview? School Report Form completed? Input from child or young person? eg All About Me The Primary Communication Rating Scale The Secondary Communication Rating Scale The Miracle Question Picture This! Other Speaking Habits noted:

at home?

at school?

Diagnosis: pure SM?

or additional difficulties?

ASSESSMENT SUMMARY

SELECTIVE MUTISM: ASSESSMENT AND MANAGEMENT CHECKLIST

11

in the community?

High/low profile? Progressive? Any speech, language, literacy difficulties, or exposed to more than one language)? Any other developmental, medical or learning difficulties? Any other anxieties or obsessions? Possible reasons/causes/triggers for initial onset ★ temperament / family history of SM, anxiety, etc ★ life events Maintaining factors identified?

Discussion about diagnosis and possible causes with parents? person?

And young

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11 MANAGEMENT SUMMARY

Continued

FORM 11

MANAGEMENT SUMMARY Education on SM: to parents?

to school?

to relatives?

Any need for further awareness-raising or training?

Information on national and local support organisations given to: Home? School ? SLT/other? Is there a role for a facilitative book? eg Can I tell you about selective mutism? My friend Daniel doesn’t talk Can’t talk? Want to talk! Pep Talk to child / young person by: close family keyworker teacher SLT/other

Who?

When?

Anyone in child’s or young person’s comfort zone who can assist with the programme in any way? (eg someone to help the transition to a new setting)

People involved in the programme: Coordinator? Keyworker?

Others?

Targets and management strategies agreed and documented? Targets set for school? For parents? For child / young person? Where documented? Action plan distributed?

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SM programme review dates: 1 2 3 4

FORM 12

Ensuring an anxiety-free environment for children and young people who have selective mutism Student’s name [N]:_______________________

Date of birth:___________

Setting:_______________________________

Year group: ____________

Completed by:_________________________ Purpose:  to help identify and eliminate possible causes of anxiety which could be adversely affecting [N]’s self-esteem and progress in communication. Aim:  for staff and family to make appropriate adjustments, where necessary, in order to agree with each statement (ü). Communication

Date

Review date

Using non-verbal, written or verbal means (eg talking through a friend), [N] has a way of:

Gaining attention/acknowledgment



Protesting/indicating dislikes



Expressing need to go to the toilet



Obtaining help/clarification for homework/course work



Obtaining general help/clarification during the school day



Making a lunch selection



Reporting teasing/bullying/illness

EDUCATIONAL ENVIRONMENT

ENVIRONMENTAL CHECKLISTFOR EDUCATIONAL SETTINGS

12

Natural alternative forms of communication are encouraged (eg gesture, pointing to words/pictures/symbols, writing) rather than an unfamiliar alternative communication system Participation Using either verbal or alternative forms of communication, [N] is routinely able to participate in (add/delete as appropriate): Registration/roll-call

Circle time or ‘bring and share’ activities



Reading activities



Writing/spelling activities



Class assembly



PE sessions



Drama sessions



School trips/work experience

P

Staff do not do things for [N] but with [N], giving whatever support [N] needs in order to manage part of the activity or make some contribution

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12 EDUCATIONAL ENVIRONMENT

Continued

FORM 12

Name of student [N]: Social relationships and self-esteem Staff involve [N] in usual greetings/conversation/banter by using commentary-style talk, rather than asking questions [N] is befriended by others in class and is included in class/team activities [N] spends break/lunch-times with other students [N] routinely gains success/acknowledgement through realistic targets and desirable behaviour (eg kindness/taking the lead/physical activity/ responsibility/ participation) [N]’s strengths/special interests are recognised/valued by classmates Teasing/bullying occurs rarely, if at all, and is addressed to everyone’s satisfaction Support Staff have reassured [N] that he/she will be able to talk in time but there is no rush; meanwhile, there are other ways to participate and have fun Peers know they can best help by including [N] in all they do, waiting patiently, not trying to make [N] talk and not saying that [N] can’t talk [N] has good rapport with at least one adult in the educational setting who is able to offer regular encouragement/support [N] is given 1:1 time for curriculum differentiation, rapport building and communication goals, as appropriate (ie little and often, rather than once a week) [N] knows that staff members will not single out [N] to talk in class but wait for [N] to volunteer information (until [N] is more comfortable with talking) If [N] speaks, staff members are primed to respond warmly but without direct praise or comment (this does not include planned programme targets) School/home is in regular contact through a liaison book or email to communicate [N]’s successes/news/concerns/queries/strategies, etc. General points [N] separates from the parent willingly and is confident about collection arrangements; or can travel to/from school independently Apart from rare occasions, [N] smiles frequently (and genuinely – not a fixed smile) and looks relaxed throughout the day The seating position allows [N] to observe other people and not feel scrutinised [N] eats lunch with his or her peers [N] uses the school toilet [N] is not given extra attention/privileges for silence/opting out (apart from the 1:1 support necessary to address needs and move forward) [N] is allowed to experience some disappointment/frustration as a result of not speaking (eg occasionally misses out) and maintains incentive to change Staff members have access to a support network for further information about selective mutism and as a sounding board for their ideas

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2

A plan is in place to address [N]’s speech anxiety, which has been agreed with student and parent(s)

Date

Review date

FORM 13

Ensuring an anxiety-free environment for children and young people who have selective mutism Child or young person’s name [N]:_______________________ Completed by:_______________________________________ Purpose:  to help identify and eliminate possible causes of anxiety which could be adversely affecting [N]’s self-esteem and progress in communication. Aim:  for the family to make appropriate adjustments, where necessary, so that family members and relevant professionals agree with each statement (ü). Home and community

Date

Review

HOME ENVIRONMENT

ENVIRONMENTAL CHECKLIST FOR HOME SETTING

13

Talking outside the home is culturally/socially acceptable; if not, permission has been actively given for appropriate settings Socialising is modelled and encouraged within the family and [N] is enabled to participate comfortably in social activities with and without parents present SM is explained to and/or discussed with [N], rather than in front of [N] [N]’s difficulty talking is openly acknowledged by parent(s) and reassurance has been given that it will not last Friends, family and members of the community in regular contact with [N] have been educated about SM and have modified their behaviour accordingly [N] does not experience distress as a result of teasing or bullying [N] is not pressed to talk when clearly uncomfortable but, rather than opting out completely, is helped to participate in other ways [N] does not use inappropriate non-verbal communication or whispering when alone with parent(s) because they have learned from parent that it is ineffective Parents do not answer for [N] [N] gets ready for their educational setting willingly, and travels there either independently or with a parent/peer/sibling, as appropriate to their age [N] has the opportunity to play/share activities or communicate with peers out of school hours (includes email, texting, online messaging) [N] gets more attention/physical contact when they are succeeding/ participating/playing/helping than when they are anxious/shy/opting out [N] has a regular physical outlet and gets enough sleep [N] has skills, interests or talents to focus on, enjoy and be proud of If clear speech is an issue, it is encouraged through modelling, rather than correction [N] is self-motivated to improve through the experience and enjoyment of success; in contrast to opting out to avoid failure/correction/criticism [N] experiences normal disappointment/frustration as a result of not speaking (eg occasionally misses out) and expresses their desire to talk Parent(s) have access to a support network of other parents with experience of selective mutism A plan is in place to address [N]’s speech anxiety, and this has been agreed with [N] and their educational setting

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Age:_______  Planning meeting held on:_____________  at:__________________

Strategies needed to achieve this shortterm target

Person(s) responsible for Date to be this action achieved by

The above actions were agreed by: __________________________________________________ Review date: ______________________________

What is happening now/ What we would like to current situation see happening

Desired long-term outcome(s): _________________________________________________________________________________

Name:___________________________

TARGET SHEET AND ACTION PLAN

Target Sheet and Action Plan

14 FORM 14

FORM 15

Name: __________________________________ Date: _________ Please complete section 1 plus one other area that is important to you. Rate each situation in those sections from 0 to 5 to show how easy or difficult you would find it (0 = easy/no anxiety, 5 = very difficult/high anxiety or panic). SITUATIONS 1 General independence Go out alone – you might pass strangers or people you know on the way (eg post a letter, walk the dog, go to a friend’s house) Use your phone in a public place where people might see you talking Wait on your own in a public place (eg outside school gates for a lift, in a café while friend goes to the toilet, train station) Answer the front door and take in mail or sign for a delivery Phone to order food for home delivery or collection (eg pizza) Approach a stranger on the street to ask a question or for directions (you could be alone or with a friend)

0–5

ü if you ever do this

Talking to strangers

TALKING TO STRANGERS (FOR OLDER CHILDREN AND TEENAGERS)

15

2 Going out with friends or family Order food or drink at a counter (eg ice-cream van, fish-and-chip shop, fast-food restaurant, cinema) Order food or drink at your table (in a café or restaurant) Go back for, or request, an extra item (eg sauce, serviette, something you forgot) Buy a ticket from a cashier (eg cinema, swimming pool, bowling alley) 3 Shopping independently Buy an item where you can hand it over and pay without talking (eg magazine, sweets, drink, DVD, clothes) Go through a staffed supermarket check-out and pay for shopping (no need to talk but the cashier might say ‘Hello’, etc) Look round a place where an assistant might ask if they can help you (eg browse in a shop or at a market stall for clothes, music, etc) Get an item at a shop, bank or post office where you need to ask (eg stamps, a reserved magazine, shoes in your size, currency) Ask an assistant for an item you cannot find (eg library book, supermarket item, DVD) 4 Travelling independently Buy a travel ticket at the ticket office Buy a travel ticket on a bus or train Travel alone Travel with a friend or sibling (not parent)

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15 TALKING TO STRANGERS: DISCUSSION POINTS

Continued

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FORM 15

Accompanying discussion pointsand activities for individual or group sessions, or homework 1. Being able to talk to strangers gives you independence and freedom. Can you think of anything you would really like to do if you had this independence? For example, join a club, make friends, go to college, apply for a job. The items on this form are smaller steps towards achieving the goals that matter to you. Consider how you achieve these things at the moment. Do you depend on parents, or friends, or the internet? Are there times when you go without or have to put up with something you don’t want? These are all good reasons to make a start on understanding and overcoming the anxiety which is getting in the way of you enjoying your life to the full. 2. Working within your chosen area, identify specific examples of activities that would be particularly useful to you if you could do them with little or no anxiety. For example, places where you like to eat and food you would like to order; shops you’d like to go to and things you’d like to buy; journeys that you’d like to make. Choose one activity to work on. 3. Consider the factors which make an activity more or less difficult. For example: the number of people present in the background or in the queue seeing people you know versus seeing strangers doing it alone or accompanied the size of the building or the length of the walk the time of day the number of items to order or purchase buying tickets in advance or when needed whether the stranger is a man or a woman. 4. Break down the chosen item into smaller steps, starting with the steps you would find easier: For example: phone a ‘robot’ about a ticket (automated voice-recognition) ask a real person about a ticket on the phone buy a ticket from the ticket office at a quiet time of day buy a ticket from the ticket office at a busy time of day buy a ticket on the train. 5. Work through these ‘assignments’, adding smaller steps if necessary. Repeat each one you achieve immediately or soon afterwards, until you can do it with little or no anxiety. Then move on to the next step. There are no rules about how often you tackle a new assignment but the more often you do it, the faster your anxiety will disappear! Go back to the original list when you are ready to select another item. 6. Be proud of your achievements! What may seem like small steps to other people are massive steps towards overcoming a phobia, and each takes courage.

FORM 16

Date:___________

Thank you for your help in reviewing the progress of this student ____________________ 1 Please give your name _________________________ and the nature of your involvement (eg art teacher, club organiser) ________________________________ 2 Has this student spoken to you or other children more/less/the same in the time you have known them?

3 To what extent have you observed this student talking? (eg roll-call, specific activities, interactions with peers and adults, volunteers answers, requests help)

STAFF QUESTIONNAIRE

STAFF QUESTIONNAIRE

16

4 To what extent have you observed this student using writing or non-verbal communication (eg nodding, gesture) to participate or communicate with other people?

5 Generally speaking, how would you rate this student’s communication (please underline): (a) inadequate (b) adequate, but minimal (c) adequate

6 To what do you attribute any lack of participation or reluctance to speak?

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16 STAFF QUESTIONNAIRE

Continued

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FORM 16

7 Please describe this student’s general behaviour this term, including any unusual mannerisms. Have these increased or decreased in the time you have known this student?

8 What adjustments (if any) are in place to support this student’s inclusion in your setting?

9 What speech and/or behaviour targets (if any) do you feel would be appropriate?

10 Please state help or advice you would like from this service and any other suggestions you would like to make.

Keyworker:

ü

= with supporting adult,

ü = without supporting adult.

Start date:

ONE-TO-ONE INTERACTION

Note:. where cells are split,

* See reverse for the key to stages of one-to-one interaction. Tick and date each box as each stage is achieved.

8

7

6

5

4

3

2

1

People and stage*

Name:

ONE-TO-ONE INTERACTIONWITH A RANGE OF PEOPLE

PROGRESS CHART 1

1

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2 Frozen Unable to relax with them Participation Willing to join in silently but no communication

Non-verbal and written communication Happy to communicate by nodding, shaking head, pointing, miming, writing, etc

Talks through parent or other talking partner (eg answers a question repeated by parent; talks in Sliding-in Technique turn-taking circle with talking partner’s support)

Uses voice (eg laughs aloud; makes a communicative sound such as ‘mm’, ‘uh?’; letter sounds; sings in unison; reads aloud – competent readers)

Single words (eg answers an ‘X or Y?’ question; names a picture; uses single words in a structured game without talking partner’s support)

Sentences4 (eg answers a ‘Where?’ or ‘When?’ question; uses sentences in a structured game without talking partner’s support)

Conversation (eg answers several questions in a row about a shared topic; instructs adult how to play a game)

Confident talking (eg initiates a conversation; asks for help; talks in front of whole class; copes with unexpected question)

2

3

4*

5*

6

7

8

8+

How child behaves towards each person

List the family and contacts in all settings that ___________ talks to easily in certain situations. Transfer stage 8 people to this list if starting a new chart.

Talking partners

Name: ____________________________

1

Stage

* If they are feeling very comfortable, children may bypass stage 4 and/or 5. Stage 7 can be achieved relatively quickly. Stages 8 and 8+ take longer, depending on individual relationships and circumstances.



Key to Progress chart 1: One-to-one interaction with a range of people

ONE-TO-ONE INTERACTION

Continued

1 PROGRESS CHART 1

PROGRESS CHART 2

(people who are not part of the child’s group or activity but may hear or see the child speak)

Place

Number of bystanders 0 1 few many

Notes (eg examples and date)

TALKING IN PUBLIC

TALKING IN PUBLIC WITH INCREASING NUMBERS OF BYSTANDERS

2

} Complete the boxes using the key below to indicate how much the child talks in each situation. Whispers or says nothing

Sentences (mainly in response to questions)

Single words (mainly in response to questions) Talks freely

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Record of individual/group sessions

3

PROGRESS CHART 3

RECORD OF INDIVIDUAL/GROUP SESSIONS Aim: To enable ______________ to speak freely to a range of people in a range of settings Term objective(s):

Date

Activity

Stage* Comments

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* Working towards stages 2–8 of ‘Confident speaking: one-to-one interaction’. Add a plus sign for generalisation activities, eg ‘6+’ = single-word activity with an extra person in group; 8+ = unplanned conversation.

PROGRESS CHART 4

Stage of one-to-one interaction* with the new person and individual target milestones

Date achieved

Talking Bridge

Talk when alone with parent/other talking partner (eg keyworker) in a quiet room with no interruptions. New person is not involved. Take turns counting to 20 with talking partner [P] and say other rote sequences, eg the days of the week/months of the year/alphabet. Take turns counting with [P], knowing that the new person [N] is a short distance away. [P] starts the counting. Take turns counting with [P] with [N] outside the closed door. Take turns counting with [P] with [N] outside and the door not shut properly. Take turns counting with [P] with [N] outside and continue when [N] opens the door about 15cm towards the end of counting. Take turns counting with [P] with [N] outside and the door open 15cm. 4

Take turns counting with [P] and [N]; [N] stays outside and the door is open 15cm.

4

Take turns counting with [P] and [N]; [N] enters the room while counting and (a) stands by the door, (b) approaches the table, (c) sits at the table.

4

Take turns counting with [P] and [N], starting with [N] inside the room: (a) standing by the door; (b) sitting at the table.

4

Participate in turn-taking sequences in both directions for counting, days of the week and possibly months of the year or the alphabet with [P] and [N] at the table: (a) takes turn after [P]; (b) takes turn after [N].

4

Participate in structured single-word turn-taking games or activities with [P] and [N], in both directions.

4

Participate in structured sentence-level turn-taking games or activities with [P] and [N], in both directions: (a) gives clues; (b) asks questions; (c) gives instructions.

6 and 7

Participate in structured single-word or sentence-level games or activities with [N], while [P] waits: (a) across the room; (b) outside the room.

7

Participate in structured sentence-level games or activities with [N]: (a) [P] joins in at the end of the session; (b) [P] doesn’t attend the session.

8

Use connected speech with [N] to: (a) give instructions; (b) ask questions; (c) continue a conversation.

Note: The student’s voice may be quiet but must not be whispered or strained. Each target is broken down into smaller steps, as necessary, to reduce anxiety and ensure success. Whole targets, or steps within targets, may be bypassed for fewer steps. Several targets may be completed in the same session. Generalisation to other people may start at stage 7. * ‘Model of confident talking: stages of one-to-one interaction’ (Johnson & Wintgens, 2016, page 74)

SLIDING-IN A NEW PERSON

TALKING TO A NEW PERSON USING THE SLIDING-IN TECHNIQUE

4

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GENERALISING SPEECH FROM ONE-TOONE INTERACTIONS TO THE CLASSROOM

B Structured activities in settings where student may be overheard

A Sliding in new peers and staff to group activities (no one else present)

Part 1

C Preparation for transfer to class

GENERALISING SPEECH TO THE CLASSROOM

5

PROGRESS CHART 5

Summary of individual targets (Sections A, B and C may be done in tandem) Talk to keyworker in structured sentence-level activities on a one-to-one basis (in a private room outside the classroom or in the classroom, with no one else present). Talk to keyworker plus a peer of student’s choice, working from single word to sentence-level activities. Adding one peer at a time, talk to keyworker and up to five peers of student’s choice in a structured sentence-level group activity. Repeat group activities without keyworker support. Talk to keyworker plus teacher, working from single-word to sentence-level activities. Complete a sentence-level activity with teacher; keyworker is not present. Complete a sentence-level activity with keyworker, teacher and up to five peers. Start with a low-risk activity (eg reading aloud). Repeat group activities with different peers (keyworker and student take turns choosing next peer) and/or work in different locations (see section B) until at least half the class has heard the student talking. Include classroom-related topics or activities in the group session.

Date achieved

Repeat individual or group activities in other settings where the student is unlikely to be overheard, including the student’s classroom (eg empty classroom at lunch-time, playground during lessons, vacated assembly hall). Repeat individual or group activities in settings where the student may be overheard by a few people (eg original room with the door open, original room with peer(s) or adult(s) working separately at another table, dining room before lunch, corridor during lessons, table outside own classroom, corner of playground). Repeat individual or group activities in settings where student may be overheard by many people (eg dining room at lunch-time, corridor between lessons, in a museum during school trip, centre of playground). The student has been reassured that they won’t be picked to answer a question or read aloud in front of the class unless they volunteer. Practise roll-call in small group sessions. Half the class has heard the student talking outside the classroom or the whole class has heard a recording of their voice and/or the student and the teacher are confident that peers will not comment when the student talks.

Notes If the student reverts to a whisper or strained voice at any point, repeat the activity or make the target easier to regain voice. For students making a ‘fresh start’, omit Sections A and B.

PROGRESS CHART 5

D Transfer to classroom setting

Part 2

Summary of individual targets Date (Sections A, B and/or C complete) achieved Consider the student’s positioning for the first three items, as they will not want the rest of the class to see their lips moving initially; . With the rest of the class occupied, talk to the keyworker at own table or work station during class time: (a) on a one to one basis (b) with peers* seated at same table. With the rest of the class occupied, talk to peers* during class-time: (a) in a paired activity (b) in a group activity With the rest of the class occupied, talk or read to the teacher at the student’s table or work station or at the teacher’s desk: (a) on a one-to-one basis (b) with peers* seated nearby. As the student gains confidence talking to individuals and small groups in the classroom, move on to the final section where they talk in front of the whole class (flexible order). Keyworker practises class activities in advance with the student or allows the student to check their answer with them first, to give the student the confidence to put up their hand to answer a question or take their turn for a prearranged question. Take turns in a low-risk whole-class activity involving a familiar rote sequence or reading aloud (eg go round the class counting in twos, fives or tens; take part in a play reading; read aloud from a PowerPoint presentation). Participate verbally in roll-call (can be made easier if students call out their number in the register, rather than ‘Good morning’, etc). Participate verbally in circle-time when given warning or preparation time for topic or activity. Volunteer an answer without checking with keyworker. Participate verbally in circle-time without warning of topic, or answer unplanned question. Note any other contribution to class discussion, either prompted or voluntary:

E Talking in public places

Have lunch and chat with peers*. Participate in class assembly by singing or speaking in unison. Read aloud in a class assembly which includes a warm-up activity such as singing or speaking in unison. Work on a class assignment outside the classroom with peers* (eg collect leaves and name as many different trees as possible). Show a new or younger student around the school. Talk to peers* at after-school club or other organised activity (eg on coach during school trip, in swimming pool changing room). * Refers to peers who the student has spoken to comfortably in previous small group sessions.

Continued

GENERALISING SPEECH TO THE CLASSROOM

GENERALISING SPEECH FROM ONE-TOONE INTERACTIONS TO THE CLASSROOM

5

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RECORD OF INDEPENDENT SOCIAL FUNCTIONING AND ASSERTIVENESS PLANNED ACTIVITIES LANGUAGE IS USED TO:

Structured/ semi-structured

Unstructured

UNPLANNED/ SPONTANEOUS

Request item Instruct/ direct/ teach Seek help

CHILD-INITIATED

Volunteer information Get adult’s attention Ask for clarification Report illness Report incident Contradict/ correct Initiate social contact Share personal information unknown to listener EMOTIVE CONTENT

RECORD OF INDEPENDENT SOCIAL

6

PROGRESS CHART 6

Share likes/ dislikes Answer, even though unsure if correct Express opinion Speak, even though unsure of consequences

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Tick and date as each type of interaction is achieved or observed. If there is no evidence of spontaneous use, consider building skills and confidence through planned activities.