Selective Mutism

Selective Mutism is a psychiatric disorder most commonly found in children, characterized by a persistent failure to speak in select settings which continues for more than 1 month. These children understand spoken language and have the ability to speak. In typical cases, they speak to their parents and a few selected others. Sometimes, they do not speak to certain individuals in the home. Most do not speak in school, and in other major social situations. Generally, most function normally in other ways, although some may have additional disabilities. Most learn age-appropriate skills and academics. Currently, SM is thought to be related to severe anxiety and social phobia. SM may be associated to a variety of things, but the exact cause is yet unknown.

These children may respond, or make their needs known, by nodding their heads, pointing, or by remaining expressionless or motionless until someone correctly guesses what they want. The majority of these children express a great desire to speak in all settings, but are unable to do so due to anxiety, fear, shyness and embarrassment. Many do participate in activities non-verbally. The withdrawn behavior is not usually disturbing until the child begins school. Sometimes, even then, the child is viewed as shy and is assumed that the shyness is temporary and will be outgrown. By the time SM is recognized (if it is recognized), the child has usually had at least 2 years in which non-verbalization has become a pattern. The behavior then becomes increasingly difficult to change because the child has found a way to avoid the anxiety of speaking.

The first symptoms of SM usually begins between the ages of 1 to 3 years. These symptoms may include shyness, a reluctance to speak in some settings, and a fear of people. Although onset is usually before age 5, the symptoms become noticeable when the child is requested to respond verbally in social situations, including preschool, elementary school and community environments.

Is Selective Mutism Caused by Abuse?

Unfortunately the lack of research has left much to speculate. Due to the misdiagnosis of the symptoms, some parents have been suspected or accused of child abuse. Sexual abuse has been suspected as well. The Selective Mutism Foundation, Inc. wishes to emphasize the vital need to clarify these unjust assumptions. The suspicion or accusation of parental child abuse is devastating and has caused tremendous grief and prevented many families from seeking help for their children. There is always a possibility that some children who have been abused do not not speak. However, the abuse may not be specific to immediate family members, but could occur from any adult, or even other children. We advise contacting the appropriate agencies only if there is a definite indication of abuse.

The cause has not yet been established. Current systematic research studies are under investigation for the possibility of a genetic influence or vulnerability for SM. The majority of families  have described either themselves or other family members as previously or currently experiencing SM, having extreme shyness, social phobia, or anxiety disorders.

The crucial diagnostic element is that the child has the ability to both comprehend spoken language and to speak, but fails to do so in select settings. These children will display reasonably appropriate verbal and interactive skills at home in the presence of a few individuals with whom they feel at ease. The term Selective Mutism should separate individuals who demonstrate a selectivity with whom they speak from individuals who speak to no one. A population which should be excluded are immigrants who speak another language, have no history of the disorder, and experience SM for a short period of time. In these cases the mutism is usually transient.

Associated behaviors may include no eye contact, no facial expression, immobility, or nervous fidgeting when confronted with general expectations in social situations. These symptoms do not indicate willfulness, but rather an attempt to control rising anxiety. Some may withdraw by pulling back when approached or touched and exhibit different forms of body language. In many cases the body language has been misinterpreted as abuse; however, we have found that these behaviors stem from anxiety. It is suspected that some children may have Obsessive-Compulsive Disorder (OCD) or Tourette Syndrome type symptoms, and a variety of phobias as well.

TREATMENT

Behavior management programs based on the treatment of phobias have proven to be successful. Techniques should be consistent, and should include desensitizing the child by providing short-term goals, positive reinforcement, and rewards to motivate the child to speak. Pressure, including punishment, bribery, or consequences are harmful. One word responses should be elicited at first, with gradual requests for more. After extensive treatment, some have been able to speak spontaneously in some, if not all, social situations. Anti-depressant drugs, known to be effective in treating adults with anxiety and/or social phobia have been effective for many children, usually in conjunction with behavioral treatment. Several articles can be found in major libraries which provide behavioral strategies.

Parents can help their child by providing every opportunity for socialization and for speaking. Behavioral techniques should be implemented in all social environments where verbalizing is difficult. Parents should consider contacting their teacher, principal, school psychologist, school counselor or social worker. These individuals can play a very important role in assisting families and implementing a consistent treatment plan in school.

Teachers play an integral part in helping students who are experiencing SM. By understanding that the symptoms are not intentional, teachers may reduce frustration and anger. Consistent behavioral strategies should and can be easily implemented in the classroom. Strategies should focus on encouraging, not forcing, the child to speak. Praise and rewards for speaking, and completion of classroom tasks (eg. monitor), will all contribute to lowering the anxiety, while helping the child to feel included, positive, and independent.

SOURCE: Selective Mutism Foundation

Published by

Dr. Gnap

Dr. Gnap is a family practice physician and behavioral medicine specialist in suburban Chicago.  Dr. Gnap developed the Inner Control™ Program in 1970 and has worked with thousands of people to improve and correct medical, emotional, behavioral and learning problems including performance.  He started the Inner Control program because so many patients asked, “what more can be done along with traditional treatment methods?”

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