Selective mutism (SM), is defined as a disorder of childhood characterized by an inability to speak in certain settings (e.g., at school, in public
places) despite speaking in other settings (e.g., at home with family). SM is associated with anxiety and may be an extreme form of social phobia.
The prevalence of SM is perhaps much more than one might expect. 1 in every 143 children are being diagnosed with SM. Usually the difference in speaking is noticed when children are attending kindergarten or first
grade as this is typically their first significant social experience outside of the house. There are often co-morbid (or co-existing) disorders that are commonly seen with SM such as social anxiety disorders or sensory integration disorders. Thus, when providing treatment for SM, a multidisciplinary approach is often very effective. Anti-anxiety medication in combination with therapies has also been shown to help achieve the desired results more quickly.
In working with many children who have a diagnosis of SM, one thing that has really stood out to me is the importance of not placing pressure on the child to speak. It can be difficult for parents and caregivers not to place pressure on the child to speak as it is expected in many situations. It also can be difficult to not "jump in" for the child and speak for them. The advice that I usually give around this is to give the child a few moments to try to respond on their own, and then explain that your child sometimes gets nervous. Most people are used to this to some degree, and will ideally shift their attention away.
The other common misconception is that the failure to speak in certain settings is a willful defiance or behavioral problem. While some children who have a diagnosis of SM have strong-willed personality types, the most significant reason for their not speaking is a result of a paralyzing anxiety. Research into some of the neurological reasons for SM has suggested that children who have the disorder have an overly active amygdala. The amygdala is a region of the brain that has a primary role in the processing of memory and emotions. When this limbic area of the brain is put on "alert," it sends out a signal to the rest of the body. This can affect breathing, movement, and emotional responses. The so-called "fight or flight" response is enacted. Thus, situations that are to some people essentially non-threatening (being out side the home, coming into contact with unfamiliar people, etc.) are viewed as a threat to one's well-being.
It is imperative that treatment for SM begin as soon as there is any evidence of its symptoms. Often the recognition happens around the time of the child first school-age experience. As children get older, the symptoms become more ingrained and the disorder is more difficult to treat.
If you have questions around SM, feel free to contact me.
BOOKS Helping Your Child With Selective Mutism: Steps to Overcome a Fear of Speaking By Charles E. Cunningham, Ph. D,
Melanie K. Vanier Why Dylan Doesn't Talk: A Real-Life Look at Selective Mutism Through the Eyes of a Child. By Carrie Bryson
Photo courtsey of sheknows.com
Stephen Quinlan is a Licensed Independent Clinical Social Worker who practices in Dover, NH