Regarding Ways to Help CHILD OPEN UP, Acknowledge Anxiety and Mutism and Create Lowered

Suggestions for How To Help a Child with SM “OPEN UP” By: Dr. Elisa Shipon-Blum President and Director SMart Center Founder & Director Emeritus: Selective Mutism Group (SMG) Director: Selective Mutism Research Institute (SMRI)

Children with Selective Mutism are notorious for their inability to ‘express’ their feelings and thoughts. As a result, many of our children tend to deny or ignore their mutism, which causes worsening anxiety. Avoidant behavior is classic in children with SM. Not only do they AVOID social situations where verbalization is expected, they also often avoid acknowledging that their mutism even exists!

Children with SM cannot begin to OVERCOME their anxiety until they ADMIT that they become MUTE when they are uncomfortable.

The first and MAIN step in the treatment process needs to be to find ways to help our children OPEN UP and express their feelings of being uncomfortable, scared, etc.

Children use different words to express their emotions based on their age and experiences with language. The words the child with SM uses to express how s/he feels when the ‘words won’t come out’ will vary from child to child. Below are some of the common ways children express how they feel when they are in social situations where they typically become mute:

 Feeling scared or afraid  Feeling uncomfortable  Feeling nervous  Feeling that it is HARD to get the words out

It does not matter what word(s) the child uses to describe his/her feelings, as long as they are expressing their feelings! The child with SM must first ACKNOWLEDGE that s/he cannot speak and how it feels; then the journey to recovery can begin.

Tools for Expressing Feelings

The most effective tools for children to use are tools they have helped develop. This helps the children feel that they have some power and control in their treatment process. It also increases their belief in what they are doing and builds enthusiasm.

Feelings Journal or Diary

Children can draw pictures and ‘write’ about their inner most thoughts and concerns. This should be encouraged on a daily basis. The child’s ability to open up will take time. It is important that no one dismiss the child’s feelings by saying things like “That’s not scary.”, “But you see her all the time.”, “But you like him.”

The feelings expressed are the child’s feelings. Adults should not make value judgments about them. Often children are overwhelmed when presented with a blank page and asked to write how they feel. You and your treating professional may need to suggest things the child might want to write or draw about. For example:

 What was your favorite/least favorite part of the day and why?  What did you do during recess?  What did the teacher talk about during circle? Did you have anything you wanted to share? How did you feel?  What made you the happiest today and why?  What made you sad today and why?

Comfort Rating Scales

A Comfort Rating Scale does just what its name implies…it depicts how comfortable a child is in different situations and/or with different people. The child uses this tool to indicate how scared or uncomfortable s/he is in various settings. It is used to help the child confront and understand his or her FEELINGS on an on-going basis. This is again an area where the child’s age and interest is critically important in establishing the “scale” to be used. If the child has helped determine the scale, s/he will be more likely to understand it and have more enthusiasm about using it.

This method of accessing fear or discomfort is critically important for the child. It enables the child to gain control over his/her feelings and ultimately the anxiety.

Some children have used:

Stacks of blocks or logos

For each scenario being discussed, the child builds a stack to represent his/her level of fear or discomfort. For example: Being at home with a friend maybe three legos high, being at school with the same friend may be 7 legos high, answering the phone may be 9 legos high, giving an order in a restaurant may be 6 legos high.

Different height towers or people

Level of scaredness

100 80 60 40 20 0 5 4 3 2 1 0 . Note: From left to right represents HIGHEST to LOWEST level of being afraid/scared/uncomfortable. 5-0

Below is an example of a 6 year old girl’s interpretation of how she rated her level of ‘uncomfortableness’ and ‘being scared’ in social situations

. A lot can be learned from having the child rank the level of fear experienced in various situations. Parents and treating professionals need to take their cues from these rankings and develop the treatment plan based on this information. For example:

1. Your child indicates that riding the bus to school is a level 1 (comfortable) but circle time is a level 5 (very uncomfortable). This tells you that you don’t need to work on increasing comfort with riding the bus, but you do need to work on circle time strategies.

2. Your child indicates that responding to a friend in school is a level 4 but speaking to the same friend during recess is a level 1. This would suggest that you should work on strategies with that friend to increase comfort in the classroom. You do not need to work on merely getting your child more comfortable with that particular friend. The increased level of anxiety is situational, not related specifically to the friend.

Note: Enlisting the aid of a friend in treatment can be very effective. Friends can be asked to do some things that might not be typical. For example, having a play date in the school instead of at your home. Or you might invite a friend along on a routine errand like going to the grocery just so your child will have the opportunity to increase the number of people s/he is willing to speak to in that particular setting.

The point of using a comfort rating scale is that we are allowing the CHILD to be an active participant in his or her treatment. Through creating the scale the child is acknowledging the degree of anxiety experienced in various situations.

Being able to ASSESS anxiety gives the child a sense of CONTROL that is empowering and will ultimately help LOWER ANXIETY.

Keep in mind:

Every child is different, how one child communicates the feeling of anxiety may be different than ways used by another child. Using the words SCARED, AFRAID, UNCOMFORTABLE, etc. are all examples of what children may relate to. For example, one child may say they feel scared, but another may associate being scared to ‘scary monsters and the dark.’ Therefore s/he may describe the anxious feeling as being uncomfortable or uneasy.

Your goal is to figure out how your child can express the level of anxiety and then apply that to the above feelings chart and other ways. You will need to dig deep and determine the child’s ultimate feelings about a situation. S/he is mute for a reason. Whether it is called being scared, uncomfortable, having the words get stuck, etc., those are the words that they child will relate too.

NOW WHAT?

With the information gained from the child being able to acknowledge and understand his/her feelings in various situations, it is time to work with the child to ‘figure out’ what they can and cannot handle as far as expectations go. Asking the child how s/he feels in the particular settings that they are involved in will help determine whether or not the child is ready to be ‘gently nudged’ to accomplish various tasks.

With the help of a treating professional who understands the anxious Selectively Mute child, goals should be set to help reduce the child’s anxiety in various situations…one step at a time. With patience, understanding, and acceptance children with SM will slowly emerge into the confident speakers they are capable of becoming.

215-887-5748 ~ [email protected] www.selectivemutismcenter.org

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