Creating Communication Confidence
This is a treatment programme best described by Maggie Johnson and Alison Wintgens in The Selective Mutism Resource Manual (SMRM). It involves breaking down speaking activities into small manageable steps starting with a step that the individual feels comfortable to do.
Before starting any treatment programme it is essential that those in the individuals environment know what to do to support the child’s confidence, reduce their anxieties and how to eliminate any factors maintaining the mutism. This can be achieved through collaboration with school and others using training/information sessions and more personalised resources such as those in the resources sections of this site.
In the SMRM they describe the processes of “Informal Sliding-in” and “Formal Sliding-In – these are stimulus fading approaches where a new person is gradually faded into a talking activity.
Informal Sliding In – more useful for younger clients and those with reluctant speaking behaviours who can warm up to talking. This typically involves the adult gradually moving towards the child and joining in communication activities that the child is already doing.
Formal Sliding In – This involves a more structured process whereby small steps are made (in agreement with the individual) to work up towards and through a range of talking activities. Typically it involves the individual speaking with someone whom they feel comfortable with in a comfortable environment and then gradually introducing a new element e.g. a new person or place.
Similar strategies that can be used within or in the absence of one of the stimulus fading treatment approaches above include:
Shaping – this involves changing the speech element with a new conversation partner e.g. starting with noises or single sounds and gradually increasing spoken output to speech and larger sentences.
Desensitisation – this involves the individual gradually getting used to the thought of talking before doing it with new conversation partners. This can also involve the use of video or sound recordings as a transition to speech.
I have typically found the use of a formal sliding in approach in conjunction with all the strategies above to be most successful. I have found the use of reward systems integral to the use of these programmes to support motivation for the individual to complete the programme.
The length of a programme is totally dependent on the individual and their needs. Individuals with more complex SM e.g. additional difficulties with anxiety, language, social communication and/or more entrenched mutism will most probably require longer programmes with smaller steps. It is important that all of the individual’s difficulties are considered and addressed if true gains are to be made.
The Selective Mutism Resource Manual (Johnson and Wintgens, 2016) is an essential tool if starting a sliding in programme. It provides all the information you need to get started and trouble shooting advice for during a programme.
Selective Mutism: Planning and Managing Interventions with Small-Steps Programmes. This handout is available on the SMIRA website and gives a comprehensive overview of how to run a programme.
Building Communication Confidence – This handout is also available on the SMIRS website and Facebook page and is a programme for use with adolescents and adults which utilises a telephone programme. It can be self directed or supported by an adult.
Transferring Speech to the Classroom and Generalisation in the School Environment – This is available on the SMIRA facebook page and website and gives examples of steps for use within a programme.
Helping Your Child with Selective Mutism: Practical Steps to Overcome a Fear of Speaking (McHolm et al, 2005). This book has some easy to read hints and tips for a sliding in programme however it is recommended more for use when you already have a health professionals support.