Treatment for young children with selective mutism HAS TO TAKE PLACE in the SCHOOL or KINDERGARTEN!!!! If it takes place in a clinic, it might seem supremely successful, yet often have little impact on the child's real life!!! When the treatment itself takes place in the child's natural setting, any progress will affect him day in, day out! Treat the child in his natural setting! This has been my mantra for the last 30 years. This has to become the gold standard for SM treatment. Intensive interventions with key-workers in school are the way to go!
In our center, either a therapist or keyworker or parent comes to the school to implement treatment that was planned during clinic meetings with parents/keyworker/teachers. Usually, the therapist begins therapy with up to 4 home sessions, in which she enables the child to talk to her using gradual behavioral steps planned with the parent. This has engendered free speech in thousands of treatments carried out in my center. Then, the therapist transfers the treatment to the school setting, helping the child to continue speaking with her in a therapy room in the school, and gradually generalizing to include other students, and teachers, and then moving the therapy out of the room, into the yard, public space, and finally the classroom. Teachers and parents are also guided to implement interventions - I see teachers, parents, and therapists as potential therapeutic agents of change!
Here is an example of a teacher's intervention - Lanie's daily 3-minute, 4-week intervention that brought 5-year-old Jean from silence to speech: (Lanie is Jean's kindergarten teacher)
Jean prepared a talking album at home, in which alongside each photo, she recorded her narration. For example "this is me blowing bubbles" next to the photo below.
Jean's mom gave the album to Lanie, who listened with Jean to the talking album daily - powerful self-modeling, in that it is pretty close to direct speech. Lanie got used to hearing her voice in the teachers' presence.
During the 2nd week, the teacher continued to listen to the album, after which she asked Jean a "forced choice question" with 2 options – such as" did you blow the bubbles inside your house or outside?" Jean didn’t manage to answer out loud, but whispered in her ear.
During the 3rd week, they continued to listen to the album, after which Jean answered the forced choice questions out loud. By the 4th week, during each mini session they listened to the album, Jean answered questions, and they played go fish!! Way to go!!