Treatment Protocol for Selective Mutism

Treatment Protocol for Selective Mutism

Treatment Protocol for Selective Mutism

Developed by Lisa McDonald & Lydia Rodriquez

Orange County Public Schools

  1. This training has been empirically validated on elementary age children. It may not be appropriate for older children or pre-school age children.
  2. Selective Mutism is an anxiety disorder. It includes the ability to communicate orally but the failure to do so in certain settings or situations.
  3. Of the OCPS children identified as having this disorder, 80-90% are bilingual.
  4. Parents should request a “504 Plan” at school if the child is mute at school. This plan requires the school system to provide “accommodations” for the child, such as written tests instead of oral, or tape recorded speeches at home instead of in from of the class. All students have to have a way to communicate the need to go to the bathroom and that they are sick, so the school needs to have a nonverbal method for these children to communicate these two situations.
  5. Implementation of this plan requires daily sessions of about 15 minutes. It can be implemented by school personnel, once they are trained in the protocol.
  6. Throughout the training sessions, the child should receive frequent reinforcement (e.g., small edibles, stickers, etc.), at first for just being willing to be in the sessions, and then for any improvements made. Praise should be delivered in a calm, matter-of-fact manner, with smiles, but NOT excitable or too enthusiastic, as this may increase the child’s anxiety.
  7. In the beginning stages of training, sit in close proximity to the child and touch him/her frequently to desensitize him/her to your presence.
  8. Say the sounds for each item as a model for the child, until he/she begins saying them him/herself.
  9. On the last page of the packet, explain this to the child: “You can’t speak because you have the ‘scared’ in you. It starts in your feet, but as you get a little more comfortable, it moves up to your knees. As you get closer to being able to talk, the ‘scared’ moves up higher to your stomach. It keeps moving up as you get more comfortable with the idea of talking, until finally it comes out of your mouth, and you are talking. Where is the ‘scared’ right now?
  10. Training should begin in 1:1 setting away from the classroom, preferably beginning in the most comfortable setting (usually the home). After the child is speaking with the therapist in this setting, begin fading in elements of the more anxiety-provoking setting (e.g., move sessions to a private office in the school)
  11. As the child becomes comfortable speaking in the new setting, continue changing elements of the training setting to become a closer approximation of the goal setting. The goal setting is usually in the classroom, sitting in the middle of the other students. Examples of changing elements include bringing a peer from the classroom into the training room, opening the door to the training room, movingtraining to a hallway or secluded area in the back of the classroom, having the child talk to the peer in one of these settings, etc.
  12. Go through the whole packet at every training session, even if the child gives no oral response. The process of going through the packet is desensitizing, even if the child does not speak.
  13. Have a variety of colors of pens or pencils. Have the child pick the color for you to use to record their responses. Record the child’s responses in the cells next to each item, to keep track of progress.

Coding: 1=no attempt; 2=mouthing; 3=whisper; 4=speaking; 5=loud speaking

Child’s Name:______

Dates:_____,_____,_____,_____,_____,_____,_____,_____,_____

Show me your…

  1. hands
  2. head
  3. hair
  4. ears
  5. eyebrows
  6. eyes
  7. nose
  8. lips
  9. teeth
  10. tongue

Blow bubbles or blow out candle

Say the sound that each letter makes.

AN

BO

CP

DQ

ER

FS

GT

HU

IV

JW

KX

LY

MZ

Say the sound that each group of letters makes.

blst

brfl

chfr

cring

drong

glung

grsw

plan

prin

quon

spat

smen

snun

shum
Pick one of these word endings and say it with each of the beginning letters.

aneninonun

b

d

f

g

h

j

k

l

m

n

p

r

s

t

v
Pick one of these vowels and say it with each of the beginning letters in both columns.

aeiou

mpl

nsm

bbl

vsn

cbr

xcr

zdr

lfl

kfr

jgr

hgl

gpr

fst

dsh

ssp

Read each of these words aloud.

CATNO

DOG MY

FATPLAY

STOPSTAY

SHEROOM

MOP CUT

POTSIT

TOPCHAIR

CANEAT

MANFOOD

MADLUNCH

GLADTHE

SADO.K.

COOKIEMAYBE

YESLATER

Read each of these words aloud.

go homework

nobathroom

stophurt

hellohit

mommyscared

daddybother

teacherdon’t know

summersister

schoolfamily

pictureprincipal

babybrother

pencilspeak

libraryspoke

dinnerlaugh

pizzamovie

Read the beginning of the sentence and finish the sentence with anything you like.

  1. My name is ______.
  2. My mother is ______.
  3. My father is ______.
  4. I have _____ sisters.
  5. I have _____ brothers.
  6. My school is ______.
  7. My teacher is ______.
  8. I am _____ years old.
  9. My birthday is ______.
  10. Today is ______.
  11. I want to go to ______.
  12. I feel ______.
  13. I like ______.
  14. My favorite color is _____.
  15. I like to play with ______.
  16. My favorite food is ______.

Write your answers then say the list aloud.

People I speak to:

1. ______

2. ______

3. ______

4. ______

5. ______

6. ______

7. ______

8. ______

9. ______

10. ______

11. ______

12. ______

13. ______

14. ______

15. ______


Add anything you like to this person (example: eyes, nose, mouth,hair, clothes) and color it, if you like.

Where is the “scared” right now?