The Commitee

The National Selective Mutism CEN was founded in October 2016.

Here are the current Committee members.

ChairmanAnita McKiernan. Highly Specialist Independent Speech and Language Therapist based in London (member of RCSLT and ASLTIP).

Anita is also the RCSLT advisor on selective mutism and she works as a tutor and visiting lecturer for City University of London, where her teaching includes lectures on selective mutism and mental health.

Specialisms: selective mutism

Committee member since October 2016

 

28279177_192352521526756_8368474379922657658_nSecretary and Treasurer: Anna Biavati-Smith. Highly Specialist Independent Speech and Language Therapist based in Edinburgh (member of RCSLT and ASLTIP)

Anna is based in Edinburgh and graduated from Queen Margaret University in Edinburgh as a Speech & Language Therapist in 2002 and also completed an MSc in Science of Education in 1996. Working for 13 years for the NHS, managing a speech and language therapy clinic, she started her independent practice in the Edinburgh area in 2014. She has been working with children with SM since 2008, has a large caseload of children with SM. She is also a blogger (both in her website and youtube). She is also a trainer in this field and has set up the Scottish Selective Mutism Group.

Specialisms: Bilingualism, Selective Mutism, DLD and severe phonological disorders.

Committee member since October 2016

 

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Charlotte Firth, Specialist Independent Speech and Language Therapist based in York.

Charlotte qualified as a Speech and Language Therapist in 1989. She has been developing her specialism in Selective Mutism for over 15 years.

Charlotte developed NHS SLT pathways for Selective Mutism. Also, a large range of information and advice sheets to enhance ‘Selective Mutism friendly practice’ carried out by therapists, parents/carers and school staff.
The care pathway work led to Charlotte co-authoring a chapter regarding this topic,  in ‘Tackling Selective Mutism’ (Jessica Kingsley 2014).
Charlotte continues to have a wide range of clinical interests in addition to SM, particularly phonological disorder, DLD and language disorder within the Autism Spectrum.

Specialisms: Selective Mutism, phonological disorder, DLD and language disorder within the Autism Spectrum, ASD and SM- differential diagnosis and co-morbidity.

Committee member since October 2016
Libby-Hill-Image-300x277Libby Hill Highly Specialist Independent Speech and Language Therapist based in (member of RCSLT and ASLTIP), qualified as a speech and language therapist from the prestigious University College, London in 1986.

Specialisms: Autistic Spectrum Disorder and Selective Mutism.

Libby set up Small Talk Speech and language therapy in 2007 which has grown to include speech and language therapists, SLT assistants, early years practitioners and councellors with access to Clinical Psychology and Educational Psychology.

Committee member since August 2018.

 

Judith Chidgey Principal Speech and Language Therapist based in South East Wales
(Member of RCSLT and registered with HCPC).
Judith graduated from CIHE (now known as Cardiff Metropolitan University) in
1995. She has worked for the NHS for 23 years supporting children with speech,
language and communication needs.
Judith manages a community paediatric service.She supports children / young people with selective mutism and their families and provides training to other agencies including schools and members of the wider multi-disciplinary team.

Specialisms: Selective Mutism

Committee member since November 2017.

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Selective Mutism

Characteristics
Selective Mutism (SM) is an Anxiety Disorder (Diagnostic and Statistical Manual-5; APA 2013), whereby;
• The child speaks happily and freely in some situations, but not in others.
• This varied speech pattern has been apparent for a month or more
• The disorder is not better accounted for by another communication or language learning difficulty
• The inability to speak in certain situations is limiting academic or social functioning.

The term ‘Elective Mutism’ has been used previously, but this is no longer favoured.

SM is perhaps best thought of as a ‘speech phobia’. The child can become fearful of vocalising in other ways too, for instance to cough or laugh.

The child with SM may withdraw more generally and then fear other means of communication, such as writing or pointing. She or he may become ‘frozen’ and then find it difficult to point to indicate or use gesture. Eye to eye gaze and facial expression may also diminish.

High profile SM
High profile SM is the most obvious manifestation of the disorder, whereby the child is totally silent with certain people in certain situations.

Low profile
Children with LP SM may manage to speak a little when this is absolutely necessary and when the fear of disapproval outweighs the fear of talking. There is usually no spontaneous communication with adults however.

Aetiology and factors contributing to the SM
There is no single cause of this complex anxiety disorder.

Contributing factors (Johnson & Wintgens 2001)
 Predisposing, e.g. SLCN, anxiety, sensitivity in the child
 Precipitating (triggers)- a pronounced reaction to what are usually everyday events e.g. starting school
 Perpetuating (maintaining) e.g. over acceptance of the SM, lack of appropriate management

Traumatic Mutism
SM should not be confused with Traumatic (also known as Reactive) Mutism. This is a usually short lived loss of speech across all situations, following a very stressful event (Goodman and Scott 1997) and would be managed by Child and Adolescent Mental Health Services.

Shyness
Shy and/or quiet children are at risk of SM, but SM is not shyness.
Underlying the SM, the child could be shy, but conversely may be outgoing and this will only be revealed in all situations, once the fear of speaking is no longer having an effect.

Vulnerability and risk issues
• Lack of understanding of the true nature of SM
• May be incorrectly perceived as being ‘wilful’, ‘stubborn’ or as ‘liking control’
• Lack of recognition of the fear of speaking, especially in cases of low profile SM
• Children with SM are socially anxious and some may have a diagnosable Social Anxiety Disorder.
• Misinterpretation of the presenting features as another communication disorder, e.g. ASD (due to lack of engagement, reduced eye contact and little facial expression)
• Underlying SLCN are overlooked/undiagnosed, as the SM is ‘in the way’
• Difficulties in carrying out other functions, e.g. using public toilets or eating in certain places.
• Lack of professionals willing to diagnose SM
• Lack of multi or trans-disciplinary input
• Families may not know who to go to for support or find it difficult to find professionals with experience of SM.
• Inappropriate interventions, due to misinterpretation of the SM
• Interventions are not put in place for any underlying SLCN
• Lack of SM specific transition planning e.g. to another school year or teacher
• Lack of understanding of the need for consistency in interventions
• Adaptations are not put in place to give the child access to the curriculum where possible
• Reduced school attendance or school refusal
“Children with Selective Mutism are a vulnerable group, as the condition is not the remit of any one professional group” (Keen, Fonseca and Wintgens 2008).
“..the potential for (SM) children to fall between the cracks of different services is enormous” (Jean Gross, 2014)
“…we would like to see multi-agency care pathways in place so every child is steered without delay towards appropriate support, regardless of where the child lives and whom the family first approaches for advice” (Johnson, Firth and Jemmett 2015, in Tackling Selective Mutism, Smith et al).

Welcome to the Selective Mutism Cen

Processed by: Helicon Filter;  KONICA MINOLTA DIGITAL CAMERA
Processed by: Helicon Filter; KONICA MINOLTA DIGITAL CAMERA

Clinical Excellence Networks (CENs) have developed from the needs of individual clinicians to share information and developments within particular areas and settings within speech and language therapy. Supported by the RCSLT, they’re an essential and accessible channel for continuing professional development, producing and disseminating the evidence base. CENs promote good practice and will inform about new developments. (RCSLT aug 2015)

The specialism covered in this CEN is Selective Mutism(SM). Selective mutism is defined as the ‘Consistent failure to speak in specific social situations in which there is an expectation for speaking (e.g. at school), despite speaking in other situations. DSM-5 (APA, 2013).

One of our aim is to share good practice in relation to the identification and management of selective mutism.

This site will provide information about all our past and future meetings and an opportunity for professionals to talk about SM.