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Vocal Control in Selective Mutism: A Promising New Approach

07/16/2015 02:21pm ET | Updated July 15, 2016
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In my last article, I describe selective mutism as a condition in which a child fails to speak in public despite the ability to communicate with ease at home. For most children with SM, it is thought to be driven by a fear of talking. Therefore, prompted by anxiety, these children avoid situations and encounters in which they are expected to communicate. In my experience with SM, I was comfortable being surrounded by others, but the possibility of having to speak terrified me. Due to the tension that arose in my throat, I had difficulty using my voice despite knowing what I wanted to say. Once I gained vocal control I no longer avoided speaking.

In her book, "Freeing the Natural Voice," Kristin Linklater, a renowned acting coach, says, "to free the voice is to free the person." When one experiences vocal tension, it inhibits speech. As I sought ways to overcome my selective mutism, I came across Linklater's book. The exercises I found therein focused on speech sounds and articulation. They also stressed the use of imagery to draw awareness to and to control parts of the vocal mechanism within the larynx that we use without conscious effort. "Freeing the Natural Voice" was originally developed to help actors who needed to project their voices in theatre and film. Through Kristin Linklater's technique of freeing the natural voice, I learned to compensate for my vocal tension by producing the voiceless velar phoneme /k/. It is speculated that, when tense, my larynx elevated and my vocal folds felt as if they became temporarily closed, thereby preventing the necessary airflow needed to initiate vibration and produce sound. Therefore, the Linklater technique lowered the larynx, decreased laryngeal tension, and allowed for more airflow. I also reduced vocal tension by relearning natural breathing and exploring the free range of sound-making, which helped my ability to speak and eventually participate in conversations. Voicing became easier.

This was all uncovered by Dr. Cesar Ruiz and Dr. Evelyn Klein, two speech-language pathologists, during an interview and voice evaluation at La Salle University during my visit to their clinic in Philadelphia. After I gave them a historical account of my vocal symptoms and strategies that aided my recovery from selective mutism, Dr. Ruiz developed an approach that I will present here.

The new approach focuses on vocalizing rather than verbalizing, gaining vocal control in non-speech tasks, and being introduced to speech tasks only when one feels comfortable. As a pilot study, the Vocal Control approach was used with four children diagnosed with selective mutism. They were asked to play with two Apps, BLA-BLA-BLA and the Magic Voice. These Apps required the children to use their voices to make changes to animation scenes, such as sustaining a vowel in order to inflate a balloon until it pops. During the observation, a surface electromyography (sEMG) was utilized to assess laryngeal tension and anxiety in the children. Outcome: The clinician reported increased laryngeal tension in the children when they were asked to phonate or speak, which tends to support the tension and anxiety I mentioned. By the end of the half hour session, three of the children initiated speech when helped to free their voices.

Dr. Ruiz has shared these findings with many health and education professionals at conferences and has provided recommendations for helping children with selective mutism. Here is a summary of his conclusions on vocal control in selective mutism. He recommends:

  • Gaining vocal control and moving into verbalization for spontaneous speech production (previously limited by anxiety and poor vocal control when initiating speech).

  • Beginning with humming as it is one of the easiest ways to produce voice because sound is directed through the nose and focused away from the larynx, initially.
  • Once vocalization is obtained, lengthier productions follow in a systematic way toward meaningful verbalizations.
  • As a person who gained his full use of voice, I hope that once children can vocalize, they can express themselves with ease in schools, playgrounds and other settings where they should feel free.