Dr. LulaiRebecca (Becky) Lulai, M.A., CCC-SLP is Director of Clinical Programs in Speech-Language Pathology at the University of Minnesota, Minneapolis. She has been with the University of Minnesota since 2006. She has worked with graduate students in speech-language pathology as a clinical supervisor, instructor, and now as director of clinical programs. Prior to working at the university she worked with children and adults with communication disorders in various settings including schools, hospitals, clinics and skilled nursing. When she isn’t working she enjoys spending time with her family and curling up with a good book.

 


How did you become interested in treating selective mutism?

I first became interested in selective mutism when it became a concern in my own family. I was attending a presentation at a national conference, watching videos of children with selective mutism and realized that one of our family members was exhibiting these same behaviors. I had heard of selective mutism but did not fully understand the underlying cause and how a SLP can help. It was initially while helping this family member that I realized how much of the things we do with other children (with other diagnoses) could be helpful for those with selective mutism. From there I began learning as much as I could about it, eventually consulting and presenting to other SLPs. At the Julia M. Davis Speech-Language-Hearing Center at the University of Minnesota we now offer individual speech and language intervention for children with selective mutism.

 

What are some of the challenges of treating selective mutism?

I think the biggest challenge is a lack of understanding. There are a lot of professionals that do not understand this condition and even more parents and teachers that do not understand.  It is most commonly viewed as an act of defiance from the child. However, selective mutism begins with the brain shutting down in response to intense anxiety or fear.

Another challenging factor is that children with selective mutism are usually very intense and highly sensitive. The techniques that work for most children often don’t work to motivate children with selective mutism. This condition is so much more than motivating a child to speak. The smallest change in the child’s environment or the people in the room can cause a flood of anxiety that prevents a child from speaking. The harder we try to make the anxiety around speaking go away, the stronger it gets.

 

What are parents’ most common questions when they learn their child has selective mutism?

I think that as a parent you so desperately want to help your child when you see them struggle. Parents want to know anything they can do to help, but parents of children with anxiety and selective mutism have a constant struggle between rescuing their child and pushing them to reach their full potential. Helping parents understand that this is a dynamic condition with a cycle of successes and setbacks makes it easier to keep advocating for their children on those tough days.

 

How has our understanding of selective mutism and the way we treat it changed over the years?

As we learn more about mental health and anxiety in general, we realize that a team approach is the most effective. SLPs can work alongside social workers, counselors, psychologists, teachers, and parents to provide consistent support for children in all environments.  Selective mutism is a social-communication impairment and can be effectively treated. There is a growing body of evidence demonstrating that many children with selective mutism also have one or more other communication disorders. Those disorders can include but are not limited to fluency, receptive and expressive language disorders, voice disorders, and speech sound disorders. It is imperative that a SLP is involved in the assessment and treatment process for these children.

 

Does the average SLP receive enough instruction on selective mutism to properly treat it?

Graduate programs provide students with foundational knowledge and skills. A lot of what is learned regarding intervention for other diagnoses is useful with this population as well. It is always important for SLPS to continue learning about disorder areas that are less common. There are more and more opportunities for continuing education about anxiety and communication. As mental health concerns become more prevalent in our communities it is important for SLPs to seek out information and skills to treat this population.

 

What are some of the challenges to effectively supervising graduate students?

I love working with students! The energy and enthusiasm that they bring to the therapy room is infectious. This type of work does require a student to really understand the nature of the disorder before entering the room. That can be difficult when students are learning so much already and maybe experiencing some anxiety of their own. I love it when the student is able to break through the child’s anxiety and make a child smile or laugh. That is the beginning of a success story for that child.

 

What aspect of your work are you most proud of?

The impact of treatment on individual children living with this condition is very rewarding. However, I think the most impactful work is to educate graduate students, other SLPs, and parents to understand this condition and share that information with others. The more people that understand anxiety and related conditions, the easier it will be to find appropriate intervention services.

 

What is your advice for speech pathology graduate students?

Never stop learning! If you encounter someone on your caseload with a diagnosis you are not familiar with, it’s ok. Do what you can to learn about it. You are not expected to know all of this as a student, nor as a CF. All of us are learning new things about our field and our clients every day. When working with children with selective mutism, it is especially important to remember that your training has prepared you for improving communication no matter what stands in its way. Use your resources and don’t stop learning!


Note: You should consult with your doctor or speech pathologist for recommendations on treatment. The views and opinions expressed in this article are those of Professor Lulai and do not necessarily reflect the official policy or position of SpeechPathologyMastersPrograms.com