A Speech Language Pathologist on Selective Mutism, Pathological Demand Avoidance and So Much More | Ep. 162

I speak with Stephanie Harrigan, a certified speech language pathologist with nearly fifteen years of experience working with the neurodiverse population, to talk about selective mutism, feeding therapy and more.Stephanie brings a regulation-first, child-led approach to all of her work, and this conversation is full of concrete examples from her practice, including what feeding therapy actually looks like when it follows the child's lead, how she has worked with selectively mute children, and what she has seen happen to communication when behavioral pressure is removed.We also talk about how to advocate effectively with a school team and what research Stephanie uses when making the case for a non-behavioral approach.Stephanie can be reached at Inclusive Minds Educational Consulting via inclusivemindsllc@gmail.com.She also shared some links to research and resources:https://scerts.com/https://www.ted.com/talks/amy_laurent_compliance_is_not_the_goal_letting_go_of_control_and_rethinking_support_for_autistic_individualshttps://tiltparenting.com/2025/01/21/episode-424-creating-neurodiversity-affirming-schools-with-amanda-morin-emily-kircher-morris/https://pmc.ncbi.nlm.nih.gov/articles/PMC9601143/https://pmc.ncbi.nlm.nih.gov/articles/PMC4515208/https://aane.org/autism-info-faqs/library/restoring-the-autistic-nervous-system-a-gentle-path-to-regulation/Key TakeawaysRegulation Before Skills, Always | 00:07:00 Stephanie describes how her approach across all of her work, whether feeding, Augmentative and Alternative Communication (AAC) speech therapy, or selective mutism, starts with regulation. She references her time at the Center for Discovery, where the entire program was built on the belief that sensory and emotional regulation is the foundation. Without it, she says, everything else crumbles. She uses the analogy of a house: regulation is the foundation, and speech and communication goals sit on top of it. What Child-Led Feeding Therapy Looks Like | 00:18:32 Stephanie gives two concrete examples from her feeding therapy work. One student only ate hot dogs at age sixteen. Rather than introducing new foods directly, she used the student's interest in small figurines to interact playfully with food. Another student loved baking but would not eat what they made, so they baked together and delivered food across campus. Stephanie explains that child-led feeding therapy means finding the child's special interest and embedding it into the work, with no timeline for progress and no pressure toward any specific outcome. Selective Mutism and the Role of Safety | 00:24:28 Stephanie describes working with a kindergarten student who was described by staff as someone who never spoke. In her first session with him, he spoke immediately. She attributes this to the felt safety she worked to establish before anything else. She describes how she uses a total communication approach, honors every form of communication including grunting and hissing, and matches the child's energy rather than bringing high excitement.AAC Is Not a Last Resort | 00:30:29 Stephanie explains what AAC is and pushes back on the common concern that using a device will prevent a child from learning to speak. She draws a parallel to what Casey describes with PDA children more broadly: the issue is often not that the child lacks the ability, but that at times stress and sensory dysregulation are blocking access to that ability. She describes seeing communication expand when sensory needs were addressed first, and frames AAC as one tool in a total communication approach rather than a replacement for speech.How to Work With a School Team as a PDA Parent | 00:48:57