PHOTO CREDIT: Bjorem Publications
Episode 325
October is Selective Mutism Awareness Month! In this episode, speech-language pathologists Dr. Joleen Fernald, a DIR-Expert, and Lauren Kline of Bjorem Speech explain Selective Mutism and Situational Mutism and discuss Dr. Jo’s DIR®-SM card deck, a developmental approach to selective mutism.
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This Episode’s Guests
Understanding Selective Mutism and Situational Mutism
Dr. Jo explains that Selective Mutism is formally understood as an anxiety-based disorder. She describes how genetic predisposition, the brain’s threat-response system, and environmental factors can contribute to a freeze response that makes speaking inaccessible in certain situations. A child may speak comfortably and confidently at home but be unable to access their voice at school or in other social settings.
The word “selective” does not mean that children choose when or with whom to speak. Rather, their ability to speak can become inaccessible in particular settings or around particular people. Dr. Jo emphasizes this distinction so that families understand that the child is not being deliberately uncooperative, rude, or defiant.
Situational Mutism is a term that has gained traction within the autistic community to describe experiences in which autistic people cannot access their voice in certain social situations. Although it is not a formal medical diagnosis, Dr. Jo prefers the term because she feels it can more accurately reflect the person’s experience of being unable to speak in a particular situation.
Dr. Jo’s Personal Journey into This Work
Dr. Jo’s interest in selective mutism began when her eldest daughter was three years old. Although her daughter was exceptionally verbal and confident at home, she became withdrawn outside the home, hiding behind her mother, avoiding eye contact, and struggling to participate in preschool and social activities. Dr. Jo initially found it difficult to understand how her daughter could seem so different across environments.
After her daughter received a selective mutism diagnosis, Dr. Jo realized that, despite being a speech-language pathologist, she had received very little training on the subject. She had also understood the condition to be primarily trauma-based, which did not fit her daughter’s experience. This prompted her to investigate what was happening beneath the difficulty speaking, including the nervous system, sensory processing, and the body’s responses to stress.
The “Why” Behind the Difficulty Speaking
As Dr. Jo explored the underlying reasons her daughter struggled to speak in certain environments, she began learning about sensory processing and the nervous system’s fight, flight, freeze, fawn, fatigue, and flood responses. She also became interested in reflex integration and how it may influence sensory processing. Rather than focusing only on the visible symptom of not speaking, she began looking at her daughter as a whole child, seeking to understand what might be affecting her ability to communicate.
Dr. Jo found that supporting her daughter’s sensory needs and social communication helped her participate more successfully in situations outside the home. Recognizing that other families likely faced similar challenges, she established a multidisciplinary clinic bringing together occupational therapy, mental health services, and speech-language pathology. By combining these professional perspectives, Joleen’s team found that children could make progress that carried over into their everyday lives, including school and extracurricular activities, without needing therapy in every setting.
A Learning Journey
Joleen’s journey eventually connected with DIRFloortime®, which provided another way to understand children through their individual developmental profiles and relationships. Lauren shares that, before collaborating with Dr. Jo on the DIR®-SM card deck, she knew very little about selective or situational mutism, despite her own training as a speech-language pathologist. The project became an opportunity for her to learn.
Understanding the Child’s Experience and Respecting Their Communication
Dr. Jo explains that when a new client comes to her, she considers the child’s overall profile, including sensory differences, individual challenges, and whether the child appears to want to communicate in other settings. She distinguishes between selective mutism and experiences of situational mutism that may be associated with autism, emphasizing the importance of understanding the individual rather than assuming every child has the same needs.
She shares an example of a client she supported for several years who became comfortable speaking with her but did not generalize speaking to other people. After a change in their relationship, the child stopped speaking with Dr. Jo and began using augmentative and alternative communication (AAC) through her iPhone, converting typed messages into speech. Rather than insisting that the child speak aloud again before continuing therapy, Dr. Jo accepts this alternative means of communication. She highlights the importance of respecting the child’s autonomy and communication preferences, even when they differ from what caregivers or professionals initially hoped to achieve.
Communication Comes Before Speech
Dr. Jo emphasizes that her goal when supporting children with selective mutism is to support them to communicate, rather than focusing exclusively on spoken words. Communication might involve gestures, affect, body movements, or augmentative and alternative communication (AAC). Although caregivers may hope their child will eventually speak more comfortably in different settings, the priority is to support regulation, safety, and meaningful communication. Spoken language may develop as part of that process, but it should not be the condition for a child to participate or be understood, she stresses.
The Overlap Between Autism and Selective Mutism
Dr. Jo explains that research is increasingly recognizing an overlap between autism and selective mutism. Although the two were historically treated as mutually exclusive in diagnostic criteria, she notes that dual diagnoses are now possible. Sensory differences and the way a child processes incoming information may provide important clues when exploring their developmental profile, she explains. However, sensory differences alone do not establish that a child is autistic. She stresses that a diagnosis tells us relatively little about an individual child. Understanding where communication becomes difficult and why it happens is far more informative than relying on a diagnostic label alone.
Creating Inclusive, Practical Resources
Lauren describes how her experience as a speech-language pathologist working in a middle-school language-based program led her to Bjorem Speech materials. She appreciates the company’s commitment to collaborating with subject-matter experts to develop resources in specialized areas. The materials are designed to include engaging, representative illustrations and to be accessible to children, families, clinicians, and educators. The goal is to make high-quality resources practical to use, even for professionals who are new to a particular area.
Developing the DIR®-SM Card Deck
The idea for the DIR®-SM card deck emerged when Bjorem Speech founder Jenny Bjorem learned about Dr. Jo’s relationship-based, developmental approach to supporting children with selective mutism. Rather than relying on behavioural techniques such as rewarding children for speaking, Dr. Jo focused on helping children feel comfortable and building the foundations for communication. The challenge was to translate her extensive clinical experience into a resource other professionals could use while preserving the individualized nature of DIRFloortime®.
Developing the deck took more than a year and required careful collaboration between Dr. Jo, Lauren, and the illustration team. They worked to organize the material around DIR’s three central elements: Functional Emotional Developmental Capacities (FEDCs), individual differences, and relationships. Because children have different developmental profiles and needs, the cards were designed as a flexible framework rather than a rigid sequence of steps that every child must follow.
Making the Cards Accessible
Lauren explains that the deck was developed with two audiences in mind: professionals who need to understand the DIR® approach and selective mutism, and children who need clear, accessible explanations of the activities themselves. For example, an instruction such as stomping your feet may seem straightforward to an adult, but a professional may need to break down the action into understandable steps for a particular child.
The deck includes an accompanying guide that explains the research and provides background information to help speech-language pathologists understand both the developmental approach and how to use the cards. The activities can be selected according to the child’s abilities and needs, without requiring clinicians to follow every card in a prescribed order.
Starting With Movement and Regulation
Dr. Jo explains that the freeze response associated with selective mutism may affect more than a child’s voice. Some children experience a whole-body freeze that makes it difficult to move, engage, or communicate. The deck therefore begins with simple body movements that produce sound, such as stomping feet, clapping hands, tapping knees, or snapping fingers. These activities offer opportunities for movement and sensory input while helping children become more comfortable using their bodies.
The activities are embedded in playful, meaningful interactions rather than demands to speak. For example, while a child is on a swing, Joleen might offer different ways to move the swing and invite the child to communicate a preference by stomping their feet or making another sound. This creates a natural back-and-forth exchange in which the child’s actions have a communicative purpose, without the pressure of being told to say a particular word.
Connecting the FEDCs With Speaking Stages
Dr. Jo organized the deck around DIR’s functional emotional developmental capacities (FEDCs) 1 to 4, aligning these with stages in the progression toward speaking for children with selective mutism. At FEDC 1, which focuses on regulation and shared attention to the environment, a child may be so frozen that they struggle even to engage or connect. The initial activities therefore emphasize sensory experiences that can help the child become more regulated and available for interaction.
The cards also identify whether activities provide vestibular or proprioceptive input. Vestibular input relates to the body’s sense of movement and balance, while proprioceptive input comes from the muscles and joints and helps us sense our body’s position and movement. This information makes it easier for professionals to select activities that may be supportive for an individual child’s sensory needs and to collaborate with occupational therapists. Examples include swinging, using a scooter board, and jumping on a trampoline, which can provide movement-related sensory input while creating opportunities for shared enjoyment and communication.
Individualizing Sensory Support
Dr. Jo emphasizes that sensory activities must be selected according to each child’s individual differences rather than assuming that the same type of input will help everyone. The DIR®-SM card deck includes information about the sensory systems involved in each activity, making it easier for professionals and caregivers to understand the options and collaborate across disciplines. The resource is designed for use at home, in schools, and in therapy settings, with guidance accessible to people who have different levels of prior knowledge.
From Body Movements to Gestures and Play
As children become more regulated and available for interaction, Joleen explains that the activities progress toward gestures and purposeful communication. Dr. Jo connects the early DIR® developmental capacities with activities such as yoga poses, pretending to be animals, and engaging in playful interactions. These experiences can support children to calm their nervous systems, move their bodies, and communicate with others through actions such as pointing, nodding, or shaking their heads. Joleen emphasizes building engagement and communication gradually, rather than expecting speech before the child is ready.
Making Sounds Through Play
Next, Joleen explores making sounds with the children’s bodies and mouths. Rather than directly asking a child to produce a particular speech sound, she uses imaginative play to make the experience enjoyable and less threatening. For example, a child might pretend to be a dragon breathing fire or the Big Bad Wolf blowing down the pigs’ houses. While playing, the child may naturally produce a sound such as “H” without being explicitly told to practice speech.
Dr. Jo explains that the cards distinguish between voiced and voiceless sounds because some children may find it easier to produce sounds that do not require activating their voice (e.g., “P” versus “B” sounds). She uses child-friendly language, such as describing the voice as a motor that can be turned on, and adapts activities to each child’s interests. Once children become more comfortable making sounds, those sounds can gradually be connected to letters and speech, without introducing formal speech demands too early, she explains.
Building Toward Words in Manageable Steps
As children become more comfortable with sounds, Dr. Jo describes gradually combining them into words and using those words in meaningful interactions. For example, a child might begin by producing a simple sound and eventually blend it into “yes.” The process is individualized, with small steps that help build confidence and make speaking feel more accessible. The aim is not simply to practice speech in a therapy session, but to support the child’s ability to access communication in everyday situations.
Supporting Success Beyond the Therapy Room
Dr. Jo explains that the skills children develop through the DIR®-SM approach can be carried into other environments without necessarily requiring a therapist to accompany them to every setting. Caregivers can help children practice familiar activities in meaningful situations, such as choosing what to eat at a restaurant. If speaking is not accessible in that moment, the child might use gestures or picture choices from the card deck instead.
These alternatives provide a bridge to communication while allowing children to participate in experiences that might otherwise feel overwhelming. Successfully navigating a stressful situation can help a child feel more regulated and confident, increasing the likelihood of future success. Dr. Jo also recommends incorporating playful sensory opportunities into school days, where children can engage at the developmental capacity currently accessible to them.
Preserving Autonomy and Meaningful Communication
Joleen discusses the importance of helping children communicate their preferences, connect with friends, and participate in social experiences. Many children with selective mutism want to speak and may feel frustrated by missing out on sleepovers, birthday parties, and other childhood experiences. Their difficulty speaking can increase anxiety and make social situations feel even more overwhelming.
I asked Joleen about this and how much harder self-advocacy, including being able to say no, express disagreement, and communicate personal boundaries is. Dr. Jo notes that these needs can become especially important during adolescence, when young people encounter dating, college, and other situations that require greater independence. She acknowledges that supporting older adolescents involves additional considerations beyond the primary age range for which she developed her card deck and therapy model.
Feedback on the DIR-SM Card Deck
Lauren shares that the response to the DIR®-SM card deck has been very positive, particularly because of its comprehensiveness. The resource offers guidance for both experienced speech-language pathologists and professionals who are newer to selective mutism. The accompanying information helps users understand the developmental approach, select appropriate activities, and adapt them to individual children rather than following a rigid program.
This episode’s PRACTICE TIP:
Let’s reflect on interactions we may have with individuals whose capacities vary depending on the environment.
For example: Do we assume that because a child may speak in one environment should also be able to speak in one where they are anxious? Let’s always stay curious and wonder about an individual’s profile.
Thank you to Dr. Joleen Fernald and Lauren Kline for giving us so much information about Selective/Situational Mutism and Dr. Jo’s DIR-SM® card deck. If you found this episode enjoyable, please share it on social media!
Until next time, here’s to choosing play and experiencing joy every day!
* Thank you to Toronto recording artist Ayria for the song permissions.
