Where to find help?

HOW DO I FIND HELP?

Recognising symptoms of mutism in kindergarten or school is important, even if a child is not officially diagnosed.

Many children may be silent or speak little when they begin in a new kindergarten or school. However, if a child remains silent or speaks only to certain people for 1 to 3 months after beginning in a new kindergarten or school, it is worth considering how the child could be actively supported in kindergarten or school. The sooner a child receives understanding and support, the better. Consequently, staff of kindergarten and school should be given information and practical tools on basics principles of how to behave when they encounter a silent or little-speaking child.

If symptoms of silence continue, it is worthwhile to refer a child to further diagnosis and care. Help is most easily found from general health services, that is, maternity/ early childhood health care, family counselling, or school health care. From these services, a child can be referred to a psychologist and/ or speech therapist if needed.

DIAGNOSIS AND CARE

In Finland, a doctor always makes diagnoses. A diagnosis can be made by a doctor in healthcare or maternity/early childhood services, or school. If needed, a doctor can refer a child for assessment by a child psychiatrist, according to local practice. Plans for the child can include rehabilitation with a speech therapist or psychologist. Rehabilitation usually begins by municipal financial commitment. Financial support for further rehabilitation can be applied for via Kela, especially if a child has many symptoms or symptoms of mutism have strong negative effects on a child’s performance.

If an evaluation by basic health services raises concerns about a child’s growth, development or mental wellbeing and/ or the offered care does not alleviate a child’s symptoms within approx. 6 months, the child can be referred to specialized care assessment.

Specialized care aims to 1) holistically map a child’s symptoms, strengths and weaknesses in his or her own daily environment at home, kindergarten/ school and hobbies and 2) plan care according to a child’s current needs. As situational difficulties in speaking, that is selective mutism, has many and various background factors, children need different types of care and support in kindergarten and school.

SITUATIONAL DIFFICULTY IN SPEAKING/ SELECTIVE MUTISM REQUIRES PROFESSIONAL ORIENTATION

Sometimes, family therapy can be a useful approach, because a child who does not speak needs a lot of support and understanding from their parents and family. Also important is that people working with the child and their family receives in-house training and information about care regarding situational difficulties in speaking/ selective mutism.

Professional healthcare training regarding selective mutism does not yet exist in Finland. However, speech therapist Maggie Johnson has many trainings regarding treatment for selective mutism and many workers, psychologists and especially speech therapists have participated in these trainings. It is also possible to become familiar with the field through literature or other international treatment models.

Sometimes, it is difficult to find somebody with relevant knowledge or experience where you live. Having an interest in becoming familiar with the issue is already a good and important start. Holistically understanding symptoms of mutism will help to plan therapeutic care and rehabilitation for a child for the maximum benefit of the child.

Experiences of families regarding referral to care and receiving help vary greatly. Symptoms of selective mutism are not very well known and are not always recognized. Symptoms of mutism can cause confusion and worry in kindergarten, school and health care or social services. Consequently, attempts to help a child may in fact increase anxiety for the child and their family, and actually make the situation worse. Information and understanding will help to target care and support for the benefit of both the child and their family

Regional differences may exist in how to apply for and receive help. Below are two examples from different regions regarding access to care.

PIRKANMAA

Access to care happens by addressing the issue of difficulties in speaking in maternity/ early childhood services, family counselling or school health care. From here, referrals will be made to health care speech therapists or psychologists. Usually before the rehabilitation period begins, cases are evaluated by a psychologist and speech therapist, sometimes also by a child psychiatrist. A diagnosis is usually given before rehabilitation begins, although sometimes, it can be given after a short rehabilitation period. Rehabilitation payments are covered by the municipality (periods of 10 to 20 sessions); longer periods are covered by Kela. Usually, rehabilitation payments begin through the municipality and if needed, continued through Kela.

THE OULU REGION

Access to treatment requires addressing the issue of difficulties in speaking in maternity/ early childhood services, family counselling or school health care. From here, evaluations can be made by health care speech therapists or psychologists. If selective mutism is suspected, the child will be referred by a speech therapist or psychologist to child psychiatric services in the child’s own community. In vicinities of Oulu, referral can be made according to need to Oys child psychiatric services, either through family counselling or consultative child psychiatry. If phoniatrics or pediatric neurology suspect selective mutism or make a diagnosis, a child will be referred to child psychiatric services by request for consultation or referral to Oys child psychiatric services. Longer periods of speech therapy in Oys are available via Kela if other related challenges and language difficulties exist.