Selective mutism is a social anxiety disorder where the child experiences fear and apprehension when in social situations. The child may be quite capable of speech but is unable to speak in certain situations. No single causes have been found for selective mutism, but most sufferers display similar traits. People who suffer from selective mutism describe symptoms such as a tight throat or paralysis when they have to talk in a certain situation. Selective mutism was formely described as elective mutism, indicating that individuals chose to to be silent in certain situations, while the truth is that they are forced by their extreme anxiety to remain silent. They want to speak, but just cannot get the words out.
Not all silent children have selective mutism
Some children that move to a new school, come to a new country, or start in a new classroom are often silent to begin with, especially if they do not speak the language or are shy. This is unlikely to be a selective mutism. To overcome these types of situations there are a number of things you can do to include the child and increase their confidence. It is important to keep trying to converse with the child even if they do not respond (accept non-verbal responses) and include them in small groups or pair them with a buddy. Other children choose not to speak to certain people or in certain environments. Again, this may not be mutism, rather a choice of the individual for whatever reason. However, if the duration of the silences continues for more than a month after measures have been taken to integrate the child, it is probably best to seek professional advice.
Characteristics of selective mutism
There are a number of characteristics that present with selective mutism:
- Consistent failure to speak in specific social situations or environments such as school or classroom, despite speaking in other situations. This has effects on progress at school, work and social situations.
- The failure to speak is not due to a lack of knowledge of the spoken language, autism, a communication disorder, or other psychiatric problem.
- At home where the child feels safe and confident to talk, he may be quite different and display moodiness, assertiveness, inflexibility, domination, extreme talkativeness, be easily upset and prone to crying.
- The child may be generally anxious, over sensetive and dislike crowds.
- The child may display blank facial expressions, lack eye contact and rarely smile.
- The child may have stiff or awkward body language.
Treatment and Therapy for Selective Mutism
Treatment and therapy will depend on the individual and the severity of the disorder. Forceful attempts, begging or bribery to make the child speak will not work and will possibly make the condition much worse. Selective mutism does not necessarily get better as the child gets older so it is important to try and treat the disorder from an early age. Through treatment and speech therapy the condition can improve. If left untreated the mutism can become more severe, and the people around the individual with mutism may develop an expectation of non-communication and stop initiating conversation because of the lack of response. A lack of treatment can also lead to depression, worsening anxiety and further withdrawal.
The goals of treatment for selective mutism are to reduce anxiety, increase self-esteem and increase confidence in communicative and social settings. The focus should not be about getting the child to talk, but reducing anxiety levels and developing confidence. If these processes can be achieved, verbalisation will eventually follow.
A common treatment for selective mutism is behaviour therapy through the use of stimulus fading. This involves a kind of de-sensitization of the individual in the presence of others. Initially the child will be brought to a controlled, safe environment with someone they are comfortable and can communicate with. Over time another person may be introduced. Small steps are taken over a period of time to allow the individual to slowly overcome their anxieties. Another form of desensitization is to allow the individual to contact someone through non-direct means intially (e.g. email, text message etc) prior to actually meeting them. Combining with stimulus or desensitization therapy with play therapy, psychotherapy or cognitive behavioural therapy can be effective. Parents may also need guidance to accept this disorder and learn how to react and respond.
Some practitioners advocate drug treatments such as anti-depressants to reduce anxiety, although this is quite a controversial area, with many differing views on the subject. However, some children with selective mutism have a biochemical imbalance and medication has been found to be successful. Prior to any treatment other causes should be investigated including hearing impairment, and other disorders such as autism should be rules out.
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