Questionnaires and worksheets have been designed specifically for selective mutism. The Selective Mutism Questionnaire (SMQ) is an instrument that assesses a child’s willingness to speak to others in school, home/family, and public/social situations (Bergman, Keller, Piacentini, & Bergman, 2008). School items involve a child’s willingness to speak to peers, teachers, and others at school. Home/family items involve a child’s willingness to speak to family members when others are present or in unfamiliar situations, to extended family members and babysitters, and to people on the telephone. Public/social items involve a child’s willingness to speak to unfamiliar peers or others outside of school. Parents rate each item as never, seldom, often, or always. Other questions focus on degree of interference or distress associated with a child’s mutism. These items are rated as not at all, slightly, moderately, or extremely. Lower scores on the SMQ reflect lower frequency of speaking behavior. The measure has strong psychometric properties (Letamendi et al., 2008). The School Speech Questionnaire (SSQ), a supplemental measure, is an 8-item instrument completed by the teacher that involves school-based speaking behavior in different situations. Other researchers have used the Rating Scale for Elective Mutism, a 45-item measure of clinical and potential contextual ­factors surrounding failure to speak (Facon, Sahiri, & Riviere, 2008).

Questionnaires are good measures of the severity of a child’s selective mutism but do not supply information about a child’s daily fluctuations in speech, audibility, or anxiety. In our work with youths with selective mutism, we utilize daily monitoring forms for children, parents, and teachers. Table 3.3 contains our parent form. Parents record number of words spoken, mouthed, and whispered that day across several situations noted in the table, and other situations can be added as relevant. Parents also rate how audible a child’s speech was for words produced that day, if any. The scale also requires parents to record to whom the child spoke that day. Forms such as these are useful for monitoring daily fluctuations and progress in a child’s audibility and frequency of speech. Vecchio and Kearney (2009) found in a treatment outcome study that interrater reliability among child, parent, and teacher daily reports of number of words spoken was 86. Interrater reliability between children and parents was 92.

Other questionnaires may be relevant to cases of selective mutism. These include child self-report measures of internalizing problems such as general and social anxiety and depression (see later school refusal behavior section). Some children with selective mutism worry about negative consequences of speaking to others, so items related to worry should be given special consideration. Parent/teacher checklists for internalizing and externalizing behavior problems are also relevant in some cases where oppositional behavior is a key feature of a child’s selective mutism (Fisak, Oliveros, & Ehrenreich, 2006). Daily monitoring of oppositional problems such as noncompliance to parent commands to speak is often essential as well.

Behavioral observation is a time-intensive assessment strategy but one that can be quite useful for determining the parameters and function of a child’s selective mutism. Behavioral observations of a child at home, in a public situation, and at school provide not only information about the depth of a child’s failure to speak but also clues as to why the behavior continues to occur. Observations can also be done in a clinician’s office to some extent as well. A child who physically withdraws when someone tries to speak to him may have social anxiety, whereas a child who tantrums when asked to speak may be avoiding aversive directives from others. Audio or video recordings from home may also be useful in this regard (Jackson, Allen, Boothe, Nava, & Coates, 2005).

Behavioral observations in a child’s home are useful for gathering information about whether and how a child interacts with people she knows well and does not know well, whether other ­family members dominate conversations and give a child little room to speak, conflictive family communications, what language is spoken at home, communication problems a child may have, compensatory behaviors, and whether and how parents expect or command a child to speak (Toppelberg, Tabors, Coggins, Lum, & Burger, 2005). Observations at school can concentrate on peer–child and teacher–child interactions (or lack thereof), specific social or evaluative situations a child avoids, and the child’s performance in academic, social, music/art, and athletic tasks (Viana, Beidel, & Rabian, 2009). Observations should also be made in multiple school settings (e.g., playground, classroom, lunch).

Formal testing for children with selective mutism may be necessary if a clinician suspects that intellectual or communication problems overlap with failure to speak. Intellectual/achievement and speech/language assessment for youths with selective mutism is obviously a challenging task, but many measures contain nonverbal scales that allow for some assessment of a child’s cognitive and language ability (Fung, Manassis, Kenny, & Fiksenbaum, 2002). Examples include performance subscales on standardized intelligence tests (e.g., for perceptual reasoning, processing speed, and memory) as well as tests that allow for nonverbal responses (e.g., Kaufman Assessment Battery for Children-II, Peabody Individual Achievement Test-Revised, Raven’s Progressive Matrices, Test of Nonverbal Intelligence-3, Wide Range Achievement Test-Expanded).

Speech and language assessment may involve written narratives to evaluate writing skill, comprehension, syntax, and perception (McInnes, Fung, Manassis, Fiksenbaum, & Tannock, 2004). Nonverbal aspects of several tests of speech and language ability can also be helpful, including those from the Children’s Com­munication Checklist-2, Clinical Evaluation of Language Fundamentals-4, Lindamood Auditory Concept­ualization Test-3, Peabody Picture Vocabulary Test-III, Preschool Language Scale-4, Test of Auditory Comprehension of Language-3, Token Test for Children-2, and Utah Test of Language Development-4. Clinicians are also encouraged to review a child’s attendance, academic, and other school-based records to see whether selective mutism has resulted in additional problems. Some children with selective mutism have been administered standardized tests or placed in special education at school, so consultation with the school psychologist or with specialized teachers may be helpful (Dummit et al., 1997).

Assessment information is critical for determining which treatment direction should be taken regarding a case of selective mutism. Treatments for selective mutism are typically based on whether a child with selective mutism displays prominent symptoms of social anxiety, oppositional behavior, and/or communication problems. Detailed assessment information thus informs the development of exposure-based practice, parent-based contingency management, and speech and language training for this population. Vecchio and Kearney (2009), for example, utilized daily assessment information to inform the use of exposure-based practice and parent-based contingency management to successfully treat youths with selective mutism. Detailed assessment information is also crucial for understanding the scope, depth, and urgency of upcoming intervention.

Recall that school refusal behavior refers to refusal to attend school and/or difficulties remaining in classes for an entire day. School refusal behavior may be manifested as nonattendance problems that range from school-based distress or morning misbehaviors to extended absences from school. The problem is particularly upsetting to parents who must miss work, arrange child care, face legal and financial ramifications, and address ancillary problems such as a child’s school failure. The assessment of school refusal behavior is thus often a pressing issue. Like selective mutism, a behavioral assessment approach is emphasized for cases of school refusal behavior. Common assessment methods include interviews and consultations with school officials, questionnaires and daily monitoring, behavioral observations, and review of records.