Sunday, February 9, 2014

Literacy Instruction and The Selective Mutism Student

 boy talking

If you have been around my blog for awhile, you know that I have a passion not only for promoting literacy, but for bringing awareness to Selective Mutism, a childhood anxiety disorder.  The child with S.M. is not able to speak in certain social situations, usually at school or school-like environments (Sunday School, Scouts, sports teams, music lessons) because of intense anxiety. My own child was diagnosed three and half years ago at the age of three.  Since that time he has progressed to whispering in a school environment.  A few weeks ago, I withdrew him from his public school to bring him home to learn since his extreme anxiety was causing him much distress at school and at home.

His performance in school has always been a concern of mine since he was in a three year old preschool class.  However, despite his silence, he has done remarkably well and is on or above grade level in most subjects.  What has been a bit of a challenge is assessing him.  In fact, this is a challenge with any S.M. child that will not talk in school.   How do you assess a child's strengths and weaknesses?  How do you measure growth?  How do you administer a Running Record?  How do you assess phonemic awareness, segmentation, and comprehension with a child who will not talk? What unique challenges does a child with Selective Mutism have when it comes to learning to read and write?

 In this two-part article, I will share from my experiences and what the research says in the hopes of helping you teach your S.M. child or student.


  

Research Says...
Dr. Elisa Shipon-Blum, a premiere expert and researcher in the field of Selective Mutism and President and Director of the SMart Center, suggests than an experienced evaluator assess the student with Selective Mutism.  This is especially critical when any type of cognitive testing is administered.  Shipon-Blum suggests that the evaluator build rapport first with the child before beginning testing.  I can speak of how important this is first hand. 

 I have had doctors, therapists, and counselors who have spent extensive time making my child feel comfortable without the expectation that they will speak. Eventually, my child did whisper or talk out loud to them.  The professionals that jumped right into testing or instruction without taking time to do this did not have the same results.  For many with S.M., first impressions are everything.  If the professional expects, demands, bribes, or places any type of pressure on the child to speak during the initial meeting, the child may associate the professional with anxious and fearful thoughts and may never speak.

One common thread in the research is that it is not the teacher's job to make the child speak.  In fact, it is not anyone's job.  Any person that comes in contact or that works with the child must have as first priority to make the child feel comfortable and to reduce their stress and anxiety levels.


 
Tips for Literacy Instruction

It wasn't until I began homeschooling my child that I realized how much his inability to speak at school had affected his literacy skills.  Although he is reading above grade level, his writing skills, specifically his spelling, is below grade level.  In a school setting, he has relied on his visual and auditory skills to learn and to master content.  He was able to memorize easily, and so he did well on the weekly spelling tests.  However, there was little to no transfer of knowledge in his writing.  When decoding and encoding words, he often struggles with unfamiliar words which makes me suspicious that he has memorized and is able to recognize many words, but has little knowledge of phonics and spelling rules and patterns.

 boy book happy

And then it hit me.  Besides the reading he does at home, this child has never read out loud, never sounded out a word, never stretched a word to hear the sounds when writing, and at most has only ever whispered when engaged in any verbal activity.  Therefore, he has very limited practice with oral reading.  And comprehension?  He is not used to thinking out loud, has never participated in group discussions about his reading, and rarely asked questions in class. And when he did, it was in a whisper.

Like assessments, effective literacy instruction will be effective and successful when parents are involved in the process.  Having parents involved offers security and eases the child's anxiety.  From there, the research suggests that the teacher work on building a trusting relationship with the child by working with them individually as much as possible.  This means working with the child in small groups in the classroom and working with the child when the other students are not present.  What this means is that the teacher works with the child alone when no other students are present.  This may be before school, after school, during recess (many S.M. kids feel very uncomfortable during unstructured times such as recess because they often are alone and do not know to interact with other children), or in lieu of a special.  

By working with the child in such a manner, the teacher can first develop a  relationship with the student.  Once the child feels comfortable, baby steps can be taken to encourage whispering. loud whispering, and uttering a few words out loud.  It is in this setting that an assessment can be given instead of in a classroom with other students present.  Many times, the S.M. student is terrified to speak in front of his/her peers.  A Running Record, IRI, benchmark, or screening test can be given one-on-one. For some students, it may be beneficial for the parent or parents to be present as well.  Having Mom or Dad in the room eases the anxiety and the fears that the child may have.  Some evaluators even assess in the child's home where they feel the most comfortable.  I realize that this is not feasible for many teachers, but inviting the parent or parents into the classroom is a good plan.  From there, the teacher and parents can work together to slowly fade the parental presence.



So, to summarize, this is what often works for the student with Selective Mutism:

1.  One person in the school setting (teacher, guidance counselor, special education teacher, SLP, etc.) should strive to develop a close and trusting relationship with the student. Work with the child in a one-to-one setting as much as possible.

2.  Remember that the goal is not to make the child speak, but to reduce his/her anxiety and make them feel comfortable. During the initial meeting play games, encourage gesturing such as pointing and nodding of the head, or use picture cards.  Keep it light, fun, and do not draw attention to their silence.  If the child is extremely anxious, this may take several sessions.  Once the child is visibly comfortable the child will most likely begin to gesture, smile, whisper, or talk out loud (albeit, this can take years to occur).  Then, you begin your work of assessing or instructing.

3.  Involve parents as much as possible.  Think outside the box and be as flexible as possible.  Have a parent be present after school when you must administer the required benchmark or Running Record.  If you feel comfortable doing so and if your administration will permit, visit the child's home and perhaps even assess the child in this setting.

4.  Selective Mutism is part of the DSM-5, within the Anxiety Disorders category.  Once diagnosed, students can get an IEP for classroom and testing accommodations.

In the second part of this series, I will share specific tips for literacy instruction.

Together, can we work to help these little learners who suffer in silence.



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10 comments:

  1. Thank you for taking the time to write such a detailed post. The teacher across the hall from me has a little girl who rarely speaks and when she does it is in a whisper - I am going to pass this information onto her. I did not realize she may be eligible for an IEP. Do not be too concerned that your son has learned to read, but does not know or possibly just not use phonics and spelling patterns. I have many first graders in this same boat. I believe this is part of why the DIEBELS has become used in schools. We are now finding those children who avoid using phonics to read early and addressing it, before it becomes a problem usually in third grade where the words are too long to simply memorize. He will learn quickly from you with some direct phonics instruction and then some application. He is very lucky to have you as a mom! Maria

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    1. Thank you, Maria! Yes, if a child has diagnostic assessments completed by a psychologist or similar professional, they are entitled to an IEP. We took our son to the Kennedy Krieger Institute in Baltimore where they have many doctors and therapists that work with S.M. children. I also thank you for your advice with the phonics. My son did learn to read early in kindergarten and interestingly, I was a very similar reader as he is: I internalized the phonics at an early age without really knowing the rules. Please let me know if you or your colleague have any questions. :-) Lauren

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  2. Lauren-this is just so beautifully written. Thank you for the information. We've had a few (1-2 students through the years with selective mutism), and I'm very glad to learn about it.

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    1. Thank you, Carla! This is a subject that I am just so passionate about. :-) Lauren

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  3. I just wanted to say thank you for writing such an articulate article. My own 2nd grade son has selective mutism and non-specific anxiety disorder. He is doing well in school now, but you never know when he might slip back into the old ways. I am fortunate to work at the same school he attends and could not agree with you more about the need to develop and focus on the relationship and not making a child speak. For years, I have sat and listened to teachers talk about their frustrations with students they knew had the ability to speak, but didn't. If only it was a matter of the child making a choice. I wish you the best with home schooling. abqgreene@gmail.com

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    1. Thank you for your kind words. I have had several teachers and professionals who deemed by child to be "just stubborn or controlling". You are so right- to not speak is not a choice; these children want to, but are so paralyzed by fear that they cannot. I worked at the same school that my son attended for three years and that really helped a lot to ease his anxiety. I wish you all the best! :-) Lauren

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  4. Thank you for all of the information about SM! I am a kindergarten teacher and will have a student with SM this year. I am trying to do as much research as I can to prepare myself for the school year. I am currently taking a grad class right now and have choose to write my final research paper on SM. It is very true, that unfortunately there is not a lot of resources out there and many of my coworkers are puzzled as well. Can you recommend a great resource that could better prepare me in how to instruct this student in the fall? Thank you!! : )

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  5. Hi Tammy- Kudos to you for being so passionate about SM and for doing everything you can to prepare for this student. The SMart Center has a lot of research-based information and a unique treatment program. The site is here- http://www.selectivemutismcenter.org/home/home

    The owner of the site has a book titled Easing School Jitters for the Selectively Mute Child by Dr. Elisa Shipon-Blum. I purchased it on Amazon a few years ago. It is a little book that is crammed full of helpful information for parents and teachers.
    I always remind teachers that their first priority is to make the child feel comfortable and to reduce anxiety. Never set out with the goal of trying to make the child speak. Because S.M. is an anxiety disorder, there are numerous behavior mod and desensitization skills that the child can learn and that you can reinforce. Not sure if the child has an IEP or 504 plan, but if they do that is a good starting point and should have specific goals.

    If you can meet with the family before school starts, that would be a great way for the child to meet you, see the room, and the school. Even if he/she attended the school last year, meeting you alone when there are no other students around can really put them at ease. when my son started a new school 2 yrs ago, we visited the school several times over the summer to play on the playground, to tour the school with the secretary, and to see his classroom.

    Another great site that even has an archive of webinars is the Child Mind Institute- http://www.childmind.org/
    Just do a search for Selective Mutism.

    You can also search on my blog and you can see all the posts I wrote about SM

    There is so much more I can share! Please feel free to email me if you have any questions and I will be happy to help! teachermomof3@comcast.net

    All the Best, Lauren

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  6. I am an SLP and am consulting on a case for a KN student with selective mutism. The team is looking for information on how we can assess his reading skills. DIBELS is a district wide mandate and obviously this student is not being assessed with any validity. Any suggestions on how we can better assess him on reading skills, such as first sound fluency and phoneme segmentation?

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    1. Hi! Thank you for stopping by and for sharing your important question. I'm not sure if you saw these two posts that I wrote about literacy instruction and the S.M. child. They may be of some help:
      http://literacyteachermomof3.blogspot.com/2014/02/literacy-tips-for-teaching-child-with.html
      http://literacyteachermomof3.blogspot.com/2014/02/more-literacy-tips-for-child-with.html

      Does the child whisper, or is he/she nonverbal? My own child was whispering in kindergarten through grade 2 (he is now homeschooled). Although, not ideal, it is a start on the progress continuum to whisper before speaking aloud. There were some gaps in what could be assessed, but it gave them the data they needed.

      Some psychologists and other doctors have a one-way mirror and can videotape the child. When my son was 3, his psychologist left us alone in a room to play so she could videotape him and use the tape to assess his behavior and speech. If the child is in therapy with a professional who has access to such equipment,this could be an option. If not, it can be done at home, but both options would require the parent to administer the assessments. My son would shut down and not talk at home if he knew he was being recorded. Many children with S.M. are embarrassed by their voices and are frightened of having their teachers hear them speak, even on audio or video recordings, so it makes it very tricky.

      Some have had success with the teacher visiting the child's home (where the child is most likely to feel comfortable speaking). After a few visits, the child may feel less anxious and may speak, thus allowing the teacher to give the assessment.

      Does the child have an IEP or 504 plan? I'm not sure of your district policies, but many times the assessments used have to be altered for children with S.M. Unfortunately, the child with S.M. grows increasingly more anxious with the expectation to talk, especially within a testing situation.

      Something else that can give you some information is to have the student point to a correct answer instead of verbalizing the answer. I know that this can be used with some portions of the DIBELS, but not all. An example is, which picture begins with a /k/ sound? Or, which picture stands for a word that begins with the sound letter k makes?

      I hope that I have given you some options that you can explore. The best bet for a student who is nonverbal at school, is to allow the assessment (or some similar tool) to be given at home by the parent.

      If you have other questions, feel free to email me at teachermomof3 AT comcast DOT NET.
      I wish you all the best! Lauren

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