Purpose: Selective mutism (SM) is the case that the individual knows the language spoken in society and can speak in other environments but cannot speak continuously in certain social environments (such as school). SM is an anxiety disorder that negatively affects the academic and professional success of the individual and disrupts the individual’s social communication. For the diagnosis of SM, the situation of the individual not speaking in certain social environments should last at least one month, but this one month should not be limited to the first month of the school year. Also, SM does not include nonspeech cases seen at other speech disorders (childhood stuttering, etc.) or autism, schizophrenia and other psychotic disorders (APA, 2013). Although the exact cause of SM is unknown, it is thought to be caused by the interaction of genetic, temperament, environment and developmental factors (Hua & Major, 2016; Muris & Ollendick, 2015). The studies on SM prevalence rates vary due to the diagnostic criteria used and the population differences studied. However, the prevalence rate is reported to be approximately 0.2-0.8% (Bergman et al., 2002; Kopp & Gillberg, 1997). This disorder is more common in girls (Kristensen, 2000; Steffenburg et al., 2018), and among bilingual and immigrant children (Elizur & Perednik, 2003; Hua & Major, 2016). Although SM is primarily an anxiety disorder, a significant proportion of children with this disorder also have social phobia (Hua & Major, 2016) and language delay or impairment (Kristensen, 2000; Steffenburg et al., 2018; Steinhausen & Juzi, 1996). SM starts at the age of 2-5 years, but the symptoms become evident when the child starts school (Black & Uhde, 1995; Cunningham et al., 2004). Recognizing the early signs of SM and performing appropriate interventions before the child starts school are very effective in preventing possible problems that children with SM may face in social communication and academic areas (Oerbeck et al., 2014). When the necessary interventions for SM are not conducted, this disorder may become chronic and continue in adulthood (Omdal & Galloway, 2007). Parents of the children who are suspected to have SM can also be referred to speech-language pathologists (SLPs) for information and therapy (Kovac & Furr, 2019). In cases where SM is accompanied with bilingualism, speech delay, language disorder, the children should also receive language and speech therapy (Bergman & Gonzalez, 2019; Toppelberg et al., 2005). SLPs also have an important place in the coordination of therapies for SM because of their knowledge and skills in therapies for communication skills (Schum, 2002). Thus, the SLPs’ awareness of SM is crucial, so that children with SM be directed to appropriate specialists and receive the correct intervention. In the limited number of studies in which SLPs’ knowledge and competencies on SM were examined; the SLPs stated that they should be involved in interventions for SM and that they encountered children with SM. However, those who participated in these studies also stated that their education on SM was insufficient and they did not feel competent enough when working with children with SM (Dorsey, 2017; Toland, 1998). Method: The study’s participants consisted of 92 SLPs working in private special education centres and private counselling centres. “Questionnaire to Determine the Awareness Level on Selective Mutism” was used to collect the data. In the first part of the questionnaire, there were questions about the participants’ gender, educational level, years of professional experience, and whether or not having worked with a child with SM. The second part of the questionnaire consisted of 22 statements on the basic information about SM. Two of the statements were related to the definition of SM, seven statements were about the characteristics of individuals with SM, three were on the prevalence of SM, two were related to the causes of SM, and eight were of the diagnosis-evaluation and therapy of SM. The participants were asked to answer these statements as “correct, incorrect, and I don’t know”. The participants of the study were contacted through the internet. The participants were informed about the study and the questionnaire was sent online to those who volunteered to participate in the study. Statistical Package for the Social Sciences (SPSS) 24 was used in the analysis of the data. First, the frequency and percentages of the answers given to the questions were calculated; then the correct answers given to the items were scored with “1”, the total scores received by the participants were calculated, and the total scores of the participants were examined according to their gender, educational status, years of experience, and whether or not having worked with children with SM. Results: The majority of the participants (92.4-39.1%) correctly answered 15 of 22 items. The first three items answered correctly by the majority were in the following respectively: “Although children with SM can speak, they do not speak in some social environments such as school.” (92.4%), “Reducing situations causing anxiety for students with SM in the classroom environment enables an increase in the verbal communication of these students.” (88.0%) and “Early therapy is possible for SM before starting school.” (82.6%). The three items that were mostly answered incorrectly by the participants were in the following respectively: “Before being directed to the intervention, children with SM should be observed for 2-3 months in order to be distinguished from shy children.” (67.4%), “Children with SM are more likely to have developmental delays or disorders.” (44.6%) and “Medication use can be effective in the treatment of SM.” (41.3%). The three items that were mostly stated by the participants as “I do not know” were in the following respectively: “SM is more common among men.” (68.5%), “SM is more common among bilingual and immigrant children” (54.3%) and “SM can be heritable.” (53.3%). The distribution of the awareness scores of the participants was examined according to gender, educational status, and years of professional experience, and the distribution was seen to be normal in all variables. The results of the Independent Samples t-Test showed that the awareness scores regarding SM did not change according to these variables. When the participants’ awareness scores on SM were analyzed according to whether or not having worked with a child with SM, it was observed that the awareness scores of the pathologists having worked with children with SM were significantly higher than the scores of those who did not work with children with SM, and the effect size related to the difference between the groups was high (t(90)= 4.03 , p=0.00, d=0.88). Conclusion: When the frequency and percentage of the participants’ answers to the questionnaire items were examined, it was not surprising that the first item was answered correctly with high accuracy, since it is related to the definition of SM. The second item is about the effect of the arrangements to be made in the classroom environment during the intervention for SM. SLPs being aware of the effectiveness of the classroom arrangements in increasing the verbal communication behaviours of children with SM is highly important for the counselling service that they give to the teachers. The SLPs’ awareness about the early intervention for SM is important in terms of knowing that SM is not a disorder that starts with starting school and that the problem can be prevented from being chronic with early intervention. The three items that the participants answered incorrectly mostly were in the following respectively: “Before being directed to the intervention, children with SM should be observed for 2-3 months in order to be distinguished from shy children.”, “Children with SM are more likely to have developmental delays or disorders.” and “Medication use can be effective in the treatment of SM.”. It is important for children with SM to receive intervention as early as possible so that mutism and its effects do not become chronic. For a child who is suspected to have SM, waiting for 2-3 months without any guidance is a serious waste of time, except for the first month of the school year. It is necessary for SLPs to be aware of this situation and to raise awareness on this issue in order to prevent losing time. It is also important for SLPs to know that children with SM are more likely to have developmental delay or disorder, so that the child is evaluated in terms of all development areas and supported as needed by all relevant specialists. Although it is also important that SLPs, who are involved in the intervention for SM when necessary, know about the effects of medication use which plays an important role in the intervention, it was observed in this study that the SLPs had incorrect information about the issue. The three items that were stated by the participants mostly as “I do not know” were in the following respectively: “SM is more common among men.”, “SM is more common among bilingual and immigrant children” and “SM can be heritable.” The first two of these items are related to the prevalence of the disorder and the groups at risk. For the preventative practices, it is highly necessary that SLPs know the groups that the disorder is likely to be common. Especially after the civil war in Syria, the number of refugee/immigrant and bilingual children in schools in Turkey has increased substantially (United Nations International Children’s Emergency Fund, 2016). Therefore, it has particular importance that SLPs have knowledge about this disorder which is more likely to be seen in immigrant and bilingual children, and carry out necessary informative and preventive practices. Besides, it is necessary that the SLPs know that SM is a hereditary disorder, so that the children and siblings of individuals with SM are evaluated, monitored and treated with early intervention in order to prevent the possible problems. The total awareness scores of the participants were examined according to gender, educational status, years of experience, and whether or not having worked with a child with SM. The findings showed that the awareness score varied only according to whether or not having worked with a child with SM, the participants who had experience with children with SM had higher scores, and the effect size was high. This shows that these participants have gained awareness by working with children with SM. However, the ideal is to increase the awareness of SLPs about this topic during their education and to have a high level of knowledge before working with children with SM. In conclusion, the importance of SLPs in the intervention for SM is revealed by the fact that SM can be accompanied with language and speech disorders, children with SM are more likely to have developmental delay and/or disorder, the prevalence of SM is high among bilingual and immigrant children whose population is quite a lot in Turkey, and SLPs are among the most important professionals who work in the relevant areas. However, it was revealed in the study that the SLPs lacked knowledge on SM at a serious level. These findings are also consistent with the results of the previous studies on the topic (Dorsey, 2017; Toland, 1998). Based on the findings and related literature, it is important to include the relevant content in the education programs for SLPs and to organize in-service training programs for graduates. In subsequent studies, the effectiveness of in-service training programs about SM on SLPs’ knowledge levels can be studied and the therapy practices of SLPs working with children with SM can be examined in depth.
Keywords
selective mutism, anxiety disorder, awareness, speech disorder.
References
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