Helping Children with selective mutism

Christopher A. Kearney's book, Helping Children with Selective Mutism and their Parents: A Guide for the School-Based Professionals, is a behaviorist's approach to dealing with selective mutism. The book does a great job of detailing typical causes of selective mutism and techniques for treating the various causes. One of the most important ideas is that selective mutism needs to be treated by the community- family, school, friends are all important components to the treatment plan. A therapist will experience most success by going into the child's comfort zone and slowly rewarding speech. The lower functioning a child, the longer the approach will take. While Shipon-Blum's book focuses on purely anxiety based causes, Kearney acknowledges that oppositional behaviors may contribute to the disorder.

Below is a graphic that summarizes the ideas in the text. The main causal factors are in the purple blobs in the center. They often occur in combinations. Kearney stresses that underlying issues need to be addressed prior to behavioral interventions. A child who has been taunted about stuttering is not likely going to be willing to speak until the taunting is eliminated and stuttering is reduced and/or normalized. A child who has been beaten for talking or making a noise will not talk until the threat is removed. Furthermore, children who do not speak English competently may be reluctant to speak around proficient speakers until their proficiency improves.

Kearney shares that treatment is often slow and progress gradual. Records of progress can keep the entire team motivated when plateaus occur.

Understanding Katie and Selective Mutism

I have a student on my caseload this year with selective mutism. Knowing virtually nothing about this disorder, I immediately began looking up information. One of the things I came across was the SMART center. I read and then ordered books. The first is a short one called the Supplement Treatment Guide to "Understanding Katie": For Parents, Teachers and Treating Professional: Understanding Selective Mutism and Social Anxiety by Elisa Shipon-Blum. The book could accompany a picture book called Understanding Katie, which I did not get. The guide both describes the picture book and gives lots of commentary and information about the disorder.

My takeaways:
Mental health aspects:  The anxiety is clearly overwhelming and needs to be treated. Medication may enable people to address the concerns. Desensitization to the phobic areas with a trained psychologist/psychiatrist is important. Focusing on getting the child to "talk" or "speak" may be counterproductive because it increases anxiety. Anxiety may be so severe that facial and vocal muscles are frozen. Treatment should include normalizing anxiety and the desire to be right/perfect while acknowledging how dysfunctional the mutism is and presenting strategies to deal with anxiety through other means. Professionals who wrap around different environments may be helpful with transitions. While some cases are caused by trauma, many cases do not involve any known trigger.

Behavioral aspects: Effort at communication and attempting hard things needs to be rewarded. Because of the anxiety, maladaptive behaviors may have been learned and these need to be changed. The idea that the silence becomes a habit needs to be addressed. Rewarding appropriate attempts rather than punishing inappropriate ones is helpful.

Educational aspects: These children are usually of average intelligence and want to learn and socialize. Reducing anxiety is important. Working with the family is essential. What the child may be able to do in one environment, he or she may not be able to do in another. Creative ways to assess learning may be required. Using the phrase, "has trouble getting the words out in school," rather than "doesn't talk" or "can't talk" is less anxiety producing.

Social aspects: The child needs to have structured opportunities to develop and maintain friendships, even if they are silent. Parallel play. Perhaps video games where individuals do not need to respond to each other but to the screen. Playgrounds where the expectation that talking is not essential. Comfortable adults or friends need to be available to facilitate transitions.

Stages of Communication Comfort Scale: This can be assessed in different environments with different people. Stages may change based on the surrounding circumstances.

• 0- non-communicative- nonverbal and verbal
• no response or initiation
• motionless, frozen, expressionless
• 1- nonverbal communication
• responding- pointing, nodding, writing, sign language,...
• initiating- get someone's attention, speak first, handing a note to someone
• 2- verbal communication
• responding- includes using a verbal intermediary, perhaps whispering to another who speaks on the child's behalf
• initiating- speaking, getting attention, making sounds

I am curious if anyone has any advice on strategies that have been successful with such individuals.

Strategies for Teaching Boys and Girls

This year I am again placed in a building that has separate classes for middle school boys and girls. Years ago I purchased and read Strategies for Teaching Boys & Girls: Secondary Level by M. Gurian, K. Stevens and K. King (2008). In light of the fact that I would be co-teaching several of these classes, I decided to reread this text.  It is full of both the neuroscience and its implications for teaching. Although the book is several years old and the field of neuroscience has been exploding with research of late, I found the book to be helpful as I thought about how to approach these classes.

The book opens with a chapter on the basic neurological differences between boys and girls. While we would like to say that both are equal and the same, we all know that they are different, especially as they enter middle school and vastly large spreads in the onset of puberty highlight these differences. I have composed a chart summarizing the first chapter's insights. The codicil that the book includes that I did not recognize in the chart is that each child is unique, there are huge overlaps and while generalizations can help us anticipate types of responses, the individual child may not be well represented by the generalizations. This is especially true when it comes to designations of being right brained or left brained.

structure or chemical		what it does	gender differences
cerebral cortex		serious intellectual functioning- thinking, speaking, recalling, memory, voluntary motor behaviors, impulsivity, decision making, planning	females have more connections between neurons and it matures faster So… girls process and respond faster, multitask and access verbal information faster, are less apt to engage in high risk behavior, less impulsive
cerebellum		coordination of muscles and thinking; helps navigate both the physical and social world	larger in males Movement in the curriculum helps develop the skills of the cerebellum
corpus callosum		connects the hemispheres, increases in size during adolescence	denser in females- better cross brain “talk” Males need more time to process. Females may be hypersensitive and dramatic
Brain stem		“fight or flight” center	Very responsive to testosterone Boys tend to respond more readily to physical stressors and be more volatile
Limbic system and prefrontal cortex	Hippocampus	convert information from working memory to long-term memory	Larger in females so they have faster neural transmissions and increased emotional memory storage. Females attach more sensory details to events and remember them longer; may hold grudges longer. Music may change the brain state.
	amygdala	processing of emotions, deciding what to attend to and filtering out other stimuli (This is one of the areas of the brain that is permanently damaged by marijuana )	larger in males; may lead to more aggression when angry or threatened non-emotional tasks can help with calming down. Males need more processing time to understand emotions
blood flow		impacts processing speed, alertness	Up to 20% greater in the female brain. Females have quicker processing especially of verbal information, may not think before they act
language processing areas		males- centralized in left hemisphere females- multiple areas in both hemispheres	girls tend to have more areas available for language processing when they start school
spatial processing		testosterone influenced	males have increased area for spatial processing. Boys need more space to move and function Girls need more motivation to develop the skill
sensory system		Females tend to have stronger systems	girls include more sensory detail in responses
testosterone		male sex and aggression hormone	In males- levels rise when they win and decrease when they lose In females- levels remain relatively constant healthy competition tends to motivate boys and build self-confidence in girls
estrogen		group of hormones responsible for female sex functions, influence female aggression, impacted by seasons and body mass	overweight girls enter puberty earlier female puberty results in increased volatility and aggression
serotonin		“feel good” neurotransmitter impacts mood, anxiety, relaxation and cooling down after conflict	Girls have about 30% more than boys- more able to manage anger Responsive to environmental stimuli- kindness is calming
Dopamine		neurotransmitter that impacts motivation and pleasure and movement control Controls the flow of information between areas of the brain	increased stimulation tends to increase the stimulation more, spiraling out of control (self-inflating) need to balance the flow- enough to transmit information and learn, not too much to provide unmanageable enthusiasm
Oxytocin		“tend and befriend” hormone impacts social recognition and bonding, formation of trust, develop and maintain relationships	females have more than males so they need to build relationships and will act in ways to do so Males may not see the connections between their behavior and their relationships
left hemisphere		controls the right side of the body processes information sequentially and analytically generates spoken language recognizes spoken words and numbers responds more to external sensory information constructs memories does arithmetic functions seeks explanations for occurrences of events	preference more common in girls
right hemisphere		controls the left side of the body processes information abstractly and holistically interprets language nonverbally recognizes places, faces, objects, music fantasies abstraction (ex science-fiction) less detailed and more concrete in recall relation and mathematical functions organizes occurrences into spatial patterns	preference more common in boys

These differences are only the beginning. The true test and the area where training can make or break a single sex class is in implementation of strategies to best meet the needs of the students. One of the games suggested I modified to use in the all boy science class review. We had a Koosh(T) ball that was to be passed around- thrown with the left hand, underhand. The students were to repeat the last fact given and then answer a question given to them. It involved body movement, listening, using notes for help, and recall. Some of the boys loved it. One was unable to follow the rules. I think if I were to play this again, I might split the class into kids who wanted to play a review game and students who wanted to just take the test.  I do know that the biggest lesson I need to remember is that they need more time and movement. If we slow things down with increased wait time and increase the movement, our boys should do better.

Bringing grammar to life

The Common Core State Standards include a number of standards related to both understanding language and word use by authors and producing written material by the students themselves. Below is a sampling of the objectives that reflect such learning:
CCSS.ELA-Literacy.CCRA.R.2.1 Read closely to determine what the text says explicitly and to make logical inferences from it; cite specific textual evidence when writing or speaking to support conclusions drawn from the text.

·         CCSS.ELA-Literacy.CCRA.SL.3 Evaluate a speaker’s point of view, reasoning, and use of evidence and rhetoric.

·         CCSS.ELA-Literacy.CCRA.SL.4 Present information, findings, and supporting evidence such that listeners can follow the line of reasoning and the organization, development, and style are appropriate to task, purpose, and audience.

CCSS.ELA-Literacy.CCRA.L.2.1 Demonstrate command of the conventions of standard English grammar and usage when writing or speaking.CCSS.ELA-Literacy.CCRA.L.2 Demonstrate command of the conventions of standard English capitalization, punctuation, and spelling when writing.
CCSS.ELA-Literacy.CCRA.L.3 Apply knowledge of language to understand how language functions in different contexts, to make effective choices for meaning or style, and to comprehend more fully when reading or listening.

·         CCSS.ELA-Literacy.CCRA.L.5 Demonstrate understanding of figurative language, word relationships, and nuances in word meanings.

Although Deborah Dean's book, Bringing Grammar to Life, was written before the publication of the CCSS, her book is aligned with these goals in that she sees grammar instruction an arm of language instruction that needs to be incorporated throughout ELA instruction. Her book delves into secondary English instruction and teaching grammar in the context of teaching reading and writing. She analyzes the writer's craft as she discusses passages in the readings, looking at devices, what makes them effective and trying other ways of writing sentences and deciding which the students like better and why. I particularly like the idea of having students write sentences in multiple ways, and discussing why some of them are more effective than others. She guides students to notice things about writing and then asks them to implement the techniques discussed. 

As teachers moved away from teaching grammar in isolation because it did not improve reading or writing skills, many of them dropped grammar instruction all together. While teaching grammar in context is slower and requires more time, it does result in greater learning for students. How do you ensure that all the concepts get coverage if you are teaching in context? Whole language reading instruction showed the dangers of just sending teachers off without a scope and sequence, hoping that they would understand the acquisition of reading skills and how to pass those on to students without strict guidelines. Many students never learned phonic rules and struggled with reading. In order to prevent a hurly-burly approach, Dean's recommendation is that different aspects are targets each month/unit. For example, focus on using appositives and adjectives effectively this month and prepositional phrases, their punctuation and different writing registers next. Pages 142-3 of her book detail grammar focuses for the book To Kill a Mockingbird. Beautiful examples of literary devices, grammar and language should not be ignored as you come across them, but you can briefly comment and move on. This promotes the idea that in reading we need students to analyze the effect of grammar and language on meaning.

Elementary teachers might not find this text as useful. All the examples are solidly secondary. There is an assumption that students know the meaning of a sentence and have some familiarity with definition of major parts of speech. Preparing this background is the purview of the elementary classroom. The techniques could, however be adapted to lower level classes. Since so much focus in the elementary classroom is on language development, many teachers already incorporate some elements into their instruction.

The book has a rich array of resources for learning grammar yourself, picture books that illustrate examples of grammar and using mentor texts to teach grammar and language. These resources allow teachers to supplement their skills and provide guidance on where to go for examples.