New Selective Mutism Therapy Program

Clinical instructors Katherine Mendez and Justine Steele are initiating a new clinical endeavor involving the evaluation and treatment of selective mutism at Memphis Speech and Hearing Center (MSHC). Selective mutism is typically associated with an anxiety disorder that causes a child to be unable to speak or communicate in certain settings. The two clinicians anticipate that there is a significant need in the community for the evaluation and treatment of children with suspected selective mutism since no one else in the Midsouth area appears to offer these services. Steele and Mendez are acting to address this need.

Steele explained, “you might have a child at your house, and they are talking openly with you, using a loud voice, and you can understand everything. But when they go to school, people think that they don’t, or can’t, talk. They will just be silent.”

Recent research shows that approximately 81% of children with selective mutism also present with a speech, language, voice, or fluency disorder. This places speech-language pathologists in a unique and primary role of treating children with selective mutism.

Steele described selective mutism as an “iceberg” with deeper challenges underneath the surface.  There may be an underlying communication disorder (in voice, fluency, speech, or language) or another cause that manifests as selective mutism. “All you see is someone who is not talking,” Steele further noted, “if we take only a behavioral approach and just address what is on the outside, we may be missing the actual cause.” Because of the wide variety of specialized faculty and clinical services at the University of Memphis, the MSHC is a great resource for evaluating and treating these clients. For example, if the underlying disorder is stuttering, Julie Marshall can assist in therapy. If vocal tension is the cause, Dr. van Mersbergen can lend her expertise. 

The inspiration for this project began with the previous experience Steele and Mendez had in Shelby County Schools. When performing evaluations, especially with Spanish-speaking, bilingual children, Mendez noticed more and more children presenting with selective mutism. After transitioning to the MSHC, Mendez and Steele joined forces to develop a program specifically for children with selective mutism. 

Modeled on a program developed at LaSalle University, the UofM clinicians plan to carry out these unique evaluations with the help of the parents. Experience has shown that if the clinicians are in the room, the child will likely not speak or only produce whispers and one-word utterances. The clinicians will observe the parent and child through a one-way mirror. The parent will wear an earpiece through which the clinicians can direct and guide the parent through the assessment. The idea behind this evaluation method is to replicate the preferred communication environment of the child as much as possible, while the language and communication experts gain the clearest picture possible of the child’s speech and language abilities.

Now that a plan for these evaluations is established, Steele reported that the next steps involve getting the word out to the community so that parents, speech-language pathologists, and psychologists will know where they can bring/refer their children/clients for an evaluation. Currently, these evaluations are only available in person and not through telehealth.

This project is an exciting new endeavor at the MSHC that will serve the community and provide a unique, collaborative experience for clinicians, students, and families.