When my son was about 3 we went to the dentist. Knowing his proclivity for anxiety and tantrums, I went to the library and took out every picture book about going to the dentist I could find. (My graduate program included a class that emphasized bibliotheraphy for children, a fact for which I am ever so grateful.) For four weeks we read stories about the dentist every day. There was a wonderful Mr. Rodgers one that had photos of the chair and equipment. There was Dr. Seuss' Tooth Book, H.A. Rey's Curious George Goes to the Dentist and I think a William Steig one, too. He still had to have his first and second visits done while sitting in my lap. There were tears and not a lot of dental work. At the end of the second visit, I brought my camera and we took pictures of him in the chair, waiting room, and on the walk going into the building- no not three pictures, probably about 15 as we went through all the stages of the physical environment. After that, the dentist became no big deal. We looked at the pictures before the visit, read one story and that was enough. Angela E. McHolm, Charles Cunningham, and Melanie K. Vanier's book, Helping Your Child with Selective Mutism: Practice Steps to Overcome a Fear of Speaking, shares that photos are a useful way to help children with selective mutism deal with anxiety related to new places or events as well.
One thing I liked about this book is chapter 11: Factors that may influence progress. They indicate that shy or anxious temperament, duration of the mutism, severity of the mutism, poor peer connections between school and home, challenges related to maintaining momentum, age and developmental level all will influence progress. So my homeschooled teenage student who has not spoken a word in nearly three years, interacts with no peers and has anxiety issues, will be extremely difficult to break out of the mutism cycle. Unfortunately, they do not offer tips on how to deal with a confluence of features that make the disorder difficult to treat.
The point I do think the book offers as a critical take away is the maintenance of a journal for the parents. If parents are the key to getting over mutism, they need their role acknowledged and reinforced. A notebook offers them the opportunity to record progress, set backs and thoughts. It enables them to keep a record of what is going on. This could be especially useful for those dark moments when it seems like the tunnel is a bottomless pit and you are not getting anywhere but the center of the earth. It also allows for a set record of interventions, especially when providers change. The notebook or record file is an essential piece of any parent's special education file, it is doubly true if parents are directing the treatment plan.
Similar to Helping Your Anxious Child, the authors describe creating a ladder of progressively difficult steps for the child to master. These steps must address the people, location and activity involved and only one must be changed at a time. They emphasize the importance of creating achievable challenges in which children are unlikely to fail to communicate because failure is likely to result in backsliding not perseverance at a difficult skill. I liked the idea of creating situations where a reward can be given, not for speaking, but for a task in which the child speaks. For example, reward for reading out loud not for speaking or play a game of TV tag where the child must say a TV show to be unfrozen. The event includes speaking, but it is not the speaking that receives the reward, but the reading or the game play. Crafting situations that are authentic and are not seen as rewarding communication per say may take some thought, but it can be done. In my math instruction, I am not getting excited about communication, but I do reward pointing to a yes or no icon after a
question is asked with support in solving the problem the child is flummoxed by.
I am increasingly amazed at the complexity of this disorder and the apparent lack of professional medical support available to this family. Actual centers exist for the treatment of selective mutism. Sadly, there is not one here locally.