1. Management of Children with Selective Mutism – Pathway and Outcomes
Judith Saunders
Principal Speech and Language Therapist
20th October 2016

2. Learner Objectives Information about selective mutism (SM)
Impact of SM on a child and their family
Local pathway for SM in CTUHB
Outcomes of intervention
Barriers to effectiveness of intervention
What next……….

3. Article 12 of the UN Convention on the Rights of the Child (1989) states: ‘Parties shall assure to the child who is capable of forming his or her own views the right to express those views freely in all matters affecting the child, the views of the child being given due weight in accordance with the age and maturity of the child’.

4. Background to Selective Mutism
DSM-5 (2013): Anxiety Disorder
‘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’
1:150 children
3 times more common in bilingual children
Girls more likely to be affected than boys
Usually begins under the age of 5:0
Selective mutism is not a choice

5. So What? Why does SM Matter?
IMPACT
EDUCATION AND LEARNING
SOCIAL / FRIENDSHIPS
CAREERS AND JOBS
WORRYING FOR FAMILY
EXPRESSING NEEDS AND FEELINGS
WELLBEING

6. Comments From Parents (SMIRA)
LEFT UNTREATED, SM STEALS HOPES, DREAMS, ASPIATIONS AND FUTURES
TREATMENT IS A POSTCODE LOTTERY
‘SM HAS ROBBED MY DAUGHTER OF HER CHILDHOOD’
THE QUIET ONES GET LEFT ON THE SIDELINES AS THEY’RE NO BOTHER

7. Identification and Intervention
‘Together for Mental Health’ (Wales 2012) 1 in 10 children between the ages of 5 and 16 have a mental health problem.
Early identification and intervention is crucial
Services not taking responsibility, cuts in funding and pressures on CAMHS  frustration for parents, lack of support for children
Intervention can be lead by a SM educated parent/ school or with support from SM trained SLT / psych worker (SMIRA).

8. Local Situation in CTUHB
Increase in new referrals and re-referrals for older children 7;0 years + (2012)
Entrenched difficulties and minimal progress
Previous intervention limited or ineffective
No local pathway in place
Meetings with partners: CAMHS, LSS, EP
Draft pathway developed
SLT learning / training needs identified

9. FACILITATE PARENTS AND SCHOOLS TO WORK TOGETHER
What Do We Do in CTUHB?
CONSULTATIVE ROLE
ASSESS AND DIAGNOSE
EDUCATE
FACILITATE PARENTS AND SCHOOLS TO WORK TOGETHER
INDIRECT WORK
MONITOR + ADVISE

10. Selective Mutism Pathway

12. CTUHB SM Referrals Jan 2013 – July 2016 According to Language of the School

13. Outcomes – Assessment to Treatment Complete

14. Outcomes – Treatment Length

15. Barriers to Effectiveness of Intervention
Lack of knowledge and understanding
Poor communication with key people
Giving up too soon
Expecting too much too soon
Moving too quickly and not at child’s pace
Not involving child as an active partner
Environment

16. It’s lovely that my daughter is no longer known as ‘the one who doesn’t talk

17. What Next? TOMS Increase awareness of selective mutism
Improve early identification of SM
Training to early years settings including FS staff – early intervention
Up-Skilling of band 5 SLT with interest in SM

18. Resources / Information
SMIRA
The Selective Mutism Resource Manual 2nd Edition, Maggie Johnson and Alison Wintgens (2016)
Tackling Selective Mutism: Guide for Professionals and Parents. B Rae Smith and A Sluckin (2015)
National CEN for Selective Mutism

19. Thank you for listening.