July, 2012:

Why won’t my child speak when spoken to?

A couple years ago a mom approached me about her 4 year old twin daughters saying that she wondered why they wouldn’t speak to others outside of the family.  She explained that they were super verbal with each other and would talk to her and her husband, but as soon as they were outside in the community, at school, a playground, in a store, at a birthday party, they would never say a word.  I told her that there could be several reasons contributing to this type of concern, but more than likely given their age-appropriate speech & language skills, cognitive skills and also their apparent interest in being in social situations and not avoiding social contact with other children and family members, their silence could be connected to a fairly new disorder called Selective Mutism (SM).  Selective Mutism is defined as a disorder in which an individual cannot speak in specific situations where there is an expectation of conversational speech, according to the American Psychiatric Association, Diagnostic and Statistical manual of Mental Disorders, 4th Edition. According to Joleen Fernald, M.S., CCC/SLP and doctoral student, SM has been misconceived as being caused by trauma or abuse. “Research has found no causal link between the two, but rather concludes that family history of anxiety predisposes the child to SM, as well as the child’s individual temperament,” according to Fernald. Many children with SM having underlying challenges in the area of sensory procesing, speech and language, and executive functioning.  Fernald works at the Selective Mutism Clinic in Dover, NH.  This diagnostic and treatment clinic was founded based on the expertise of Fernald and the multidisciplinary team of professionals , including behavioral health, occupational therapy and speech-language pathology services.  Specialists working with children with SM use treatment approaches such as DIR/Floortime enables clinicians, parents and educators to construct a program tailored to the child’s unique challenges and strengths. This treatment approach incorporates problem-solving exercises and involves a multidisciplinary team of specialists.  Elisa Shipon-Blum developed the Social Communication Anxiety Therapy         (S-CAT), and implements this approach with children diagnosed with SM at the Selective Mutism Anxiety Research and Treatment Center (SMart Center) in Jenkintown, PA.  Families are finally able to find the help they need for their children whose speaking challenges fall into the diagnostic profile of SM.

Aphasia Treatment helping Gabby Giffords

It was January 8, 2011, in Tucson, Arizona, when Gabrielle “Gabby” Giffords was shot in a Safeway parking lot by Jared Lee Loughner.  Congresswoman Giffords captured the attention-and deep sympathy of our nation and beyond.  Her husband, Mark Kelly, contacted Nancy Helm-Estabrooks, CCC/SLP to help guide the direction of her ongoing rehabilitation to her damaged left hemisphere from the direct gunshot injury, which caused severe apahsia in Gabby.  She has made remarkable progess and speech & language pathologists have been instrumental specialists in her pathway to recovery.  Estabrooks was part of a team of specialists at the Boston Va Hospital back in 1972 when they discovered that a 48 yr. old patient at the VA who had left-hemisphere involvement after a stroke could finally get beyond her restricted ability of using repetitive productions of syllabic strings to mean a variety of intentions.  For example, “ni-ni-ni-na-na-na” could mean a question, or distress if used loudly, or to comment on someone’s fashion that was admired by this 48 year old woman. The team noticed that she could sing every word of the standards played by a pianist. This discovery led them to develop the treatment program called Melodic Intonation Therapy (MIT) after lots of work and trial and error to refine the method.  Gabby Giffords was exposed to this treatment approach early in her rehabilitation.  She was taught to separate words from a familiar tune and attach them to two rhythmically spaced, unassociated notes, while tapping out the syllables with her hand as she “sang” the notes.  For example, phrases with important meaning like “close the door” or “open the window”  or “I feel sick” could get communicated using this melodically intoning method.  Gabby showed great progress using melody and music in her early rehabilitation. In the summer of 2011, Helm-Estabrooks evaluated Gabby at Mark’s home in Texas.  She used a dynamic assessment approach and then hired three experienced speech-language pathologists to directly work with her.  Gabby continued to improve and a secure website was set up so Helm-Estabrooks could read her chart notes and make recommmendations & modifications if needed.  She then hired Marjorie Nicholas, CCC/SLP, a close colleague from Boston who now works at the MGH Institute for Health Professions, to come to Gabby in Texas and work for 70 hours during a 10 day span. Helm-Estabrooks and Marjorie Nicholas have been impressed with the many ways she has progressed across a variety of independent activities. This summer they are planning eight days of very intensive speech & language therapy in the Smoky Mtns. Gabby will receive day-long intensive language therapy.  One thing Helm-Estabrooks cautions about is the erroneous thinking that music therapy ALONE was the treatment that got Gabby to where she is now (some press accountants have intimated).  Her music therapy she received in Texas was also accompanied by lots of good language therapy that keeps up with her current skill level.  According to Helm-Estabrooks, “Gabby is on the road to a very good recovery and this is a testimony to the natural healing of the brain, good medical care, talented CCC/SLPs, OTs & PTs and rehabilitation medicine in general.” She continues, ” The issue, however, is that MOST people DO NOT GET as much therapy as Gabby. In most cases, the insurance of people with aphasia (if diagnosed) dries up quickly.”  Helm-Estabrooks sincerely hopes that Gabby’s progress secondary to all the services she has received, raises public awareness of the need for medical coverage of such services. 

(Some information & quotes taken from The ASHA LEADER, June 2012 issue).