La Salle faculty identify potential new treatment method for selective mutism

Evelyn Klein, Ph.D., CCC-SLP, BCS-CL ASHA Fellow, and Cesar Ruiz, SLP.D., CCC-SLP, BCS-S, found success in a case study with adolescents who received treatment with a new program, ECHO: A Vocal Language Program for Easing Anxiety in Conversation 

Cesar Ruiz, SLP.D., CCC-SLP, BCS-S and Evelyn Klein, Ph.D., CCC-SLP, BCS-CL ASHA Fellow, combined understanding of how the voice works with techniques for voice initiation, volume modification, pitch variation, and speech sound production along with pragmatic language skills in the treatment.

Faculty members in La Salle University’s Department of Communication Sciences and Disorders highlighted the benefit of a new approach to treatment for children and adolescents with selective mutism (SM), an anxiety disorder where children who can speak at home with family find themselves unable to talk with specific people in certain social situations, most commonly at school or in public places.  

The professors’ findings were published in a case study in a special edition of Behavioral Sciences: Approaches to Overcoming Selective Mutism in Children and Youths. The article is titled A Physiological Approach to Vocalization and Expanding Spoken Language for Adolescents with Selective Mutism. (Klein & Ruiz, 2025).

 Evelyn Klein, Ph.D., CCC-SLP, BCS-CL ASHA Fellow,  a professor, and Cesar Ruiz, SLP.D., CCC-SLP, BCS-S, a professor emeritus, in the department, measured the progress of two adolescents, referred to as GB and KD in the case study, who followed the treatment program to see if there was improvement speaking in situations that were previously not possible.  

Ruiz’ research at La Salle using surface electromyography (sEMG), a non-invasive technique to measure the electrical signals generated by muscles, identified laryngeal tension and the need for children with SM to learn vocal control for speech.  

“Children with SM require treatment to learn how to control their voice when initiating speech along with hierarchical guidance for expressing themselves in social situations,” Klein said. “This treatment method can make a real difference.” 

Klein and Ruiz combined understanding of how the voice works, the physiology of vocal production, with techniques for voice initiation, volume modification, pitch variation, and speech sound production along with pragmatic language skills, to treat the teens via teletherapy sessions.  

In the interactive sessions, activities included a therapy sequence to ensure that once voice initiation was more manageable, the children could build essential pragmatic language skills for adapting speech to various social contexts. This included turn-taking, topic maintenance, and conversational flexibility, to name a few. Twenty interactive games were used online to achieve specific goals.

At the end of their treatment programs, progress was reassessed on several measures including the Selective Mutism Questionnaire and the Social Communication Skills: Pragmatics Checklist, both of which were also completed at the start of the program for comparison.  

“The results were very promising. The first adolescent’s ability to speak in challenging situations, as measured by the Selective Mutism Questionnaire, increased from 35% to 86% and the second teen’s score rose from 25% to 55%,” Klein said. “In addition to talking more, both children also showed big improvements in their social pragmatic language skills (how they used language to interact with others). On the Social Communication Skills: Pragmatics Checklist, the first teen improved from 47% to 96%, and the second increased from 13% to 40%.” 

“The therapeutic journeys of GB and KD provide valuable insights into the effective treatment of SM. Their progress underscores the importance of therapy using an approach that integrates vocal control and pragmatic language,” Klein and Ruiz said in the case study. “By fostering confidence in speaking and enhancing social communication skills in sessions and through outreach work, therapy can improve the quality of life of children with SM.” 

Klein and Ruiz intend to continue treating children with SM using their vocal control and pragmatic language approach to support others and increase generalizability of their treatment method to a broader population.  

-Naomi Thomas

For citation: Klein, E. R., & Ruiz, C. E. (2025). A Physiological Approach to Vocalization and Expanding Spoken Language for Adolescents with Selective Mutism. Behavioral sciences (Basel, Switzerland), 15(8), 1013. https://doi.org/10.3390/bs15081013

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