Selective Mutism in a High School Student

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I agree that working with a high school student who has not spoken in school since kindergarten is a task that requires a team, including psychology. Although we are certainly a part of that team, there are surely issues beyond speech-language pathology. It's hard to imagine that there is not a history of assessment and intervention that would be important to know about also.

I contacted Dr. Robert Thompson, who has worked with close to 250 patients who present Selective Mutism over 16 years as director of SLP/A services and primary diagnostician and therapist at a psychiatric hospital for children. He currently consults with a variety of agencies, including Children's Medical Center, Indian Health Service, University of Oklahoma Health Science Center, public school programs. He currently has 4 children with this diagnosis on his caseload. He has worked with teens who present the problem -- primarily in conjunction with psychology.

In regard to the need to "consult with a cognitive behavioral therapist to be successful, " he suggested that most professionals know little about management of this population. If the cognitive behavioral therapist has experience and something to offer, that would be useful, but it may be hard to find someone who has such experience.

I am quoting Dr. Thompson's excellent experience and advice below:

I'm assuming that the observation is not for the purpose of diagnosis, but to provide support in meeting his needs. You might want to observe his or her Associated Features (e.g., flat affect, hesitant and reserved movement, limited eye contact, etc.), and the reaction of teacher and peers to the student.

In working with teens, my goals were

1. To remove pressure often exerted by family members, teachers and therapists, and peers in regard to the child's silence. We will all accept the silence. This means counseling sessions with parents and staff, and defusing peers comments.
   
   
2. To help the patient to communicate as he or she feels comfortable - gesture, write, pantomime, etc. I never ask them to talk and certainly don't set this as a goal - long term or short term. Why set an impossible goal?
   
   
3. To build a relationship with the patient through play therapy sessions - yes, I did play therapy with 15- and 16-year -old students. You wouldn't believe what a terrific pool player and pac-man expert I am! And, it worked with a 16 year old boy - after 3 months of daily play therapy he added me on to his small circle of family members that he talked to. And I never asked him to talk - rather, I worked to decrease his anxiety and opposition.

I dealt with another family for about 10 years (yes, 10) and their son resolved at age 17 years and went on to college and worked as a waiter at Dennys. But, don't expect similar results with most teens.