(Name has been changed)
Of all the various disorders and syndromes that affect children in our community, I wonder if any is as misunderstood or puzzling as “selective mutism.” Until very recently, professionals and educators just assumed that children with selective mutism were actually being silent “on purpose.” It is only within the last year or two that we have discovered that it’s really not under the child’s control.
But I’m getting ahead of myself. First, let me describe what selective mutism is, by telling you about Chava, a 7-year-old child I am currently working with. Charming and bright, Chava seemed to be a confident and happy child as she was growing up. Her mother describes her as a “chatterbox” at home, and frankly relates that she is the “loudest” of all her six siblings. The problem began when Chava started school. That’s when Chava suddenly stopped talking. In class, she remained silent. During recess, she did not utter a word. Yet, strangely enough, when she came home at the end of the day, she was her old vivacious self all over again.
Selective mutism, therefore, refers to children who have normal verbal skills but do not talk in certain social settings. Most commonly, but not always, this means in school. In a 2002 study, Lendsey, Piacentini, and McCracken estimated that about seven of 1,000 children are experiencing selective mutism. Another study by Steinhausen and Juzi (1996) found that that the disorder generally begins in preschool and is more common in girls than boys.
What’s confusing about selective mutism is the fact that these children are fully capable of speaking and they understand language just as well as other kids do. Yet somehow they fail to speak in certain situations where it is expected of them. It’s as if they’ve suddenly become “frozen” into being unresponsive. Or, as Chava once described it to me, “It’s like the words got stuck in my toes.”
Since these children do speak up when they’re in a more relaxed environment, we have a tendency to think that they are just acting out or putting on a show. As if this was their way of making a statement. I assure you this isn’t true. I know Chava well and I’ve worked with her for quite some time now. She’s not being stubborn or chutzpadik or rude. She honestly is too frightened to speak.
Even the experts originally thought that these children were actually “choosing” to be silent in certain situations; hence they named the disorder “elective” mutism. The truth, however, is that they are forced by their extreme anxiety to remain silent and, despite their will to speak, just cannot come up with a voice. It was as recently as in 1994 that the name was changed to “selective mutism.”
How do you know if your child has this disorder or if she is just shy or withdrawn? The experts have presented us with these guidelines :
1. Does the child consistently fail to speak in specific social situations despite speaking in other situations?
2. Does the disturbance interfere with educational achievement or with social communication?
3. Has the situation lasted for at least one month or longer?
4. Are we sure that the failure to speak is not due to a lack of knowledge or comfort with the spoken language? (For example, is the child possibly silent because she has suddenly been placed in a Yiddish-speaking preschool environment while at home she speaks only English?)
5. Have we ruled out the possibility that the child is not suffering from any other language or communication disorder such as stuttering, which would naturally embarrass her enough to keep her silent?
If you’ve answered “yes” to all of these, then it might be a good idea to discuss the situation with a special educator or a child development expert. Be advised that this condition is often misdiagnosed and confused with other disorders such as autism or Asperger’s syndrome. So make sure you see someone who is familiar with selective mutism and has seen it often enough to recognize it.
Once selective mutism has been diagnosed, what next? Frankly, treatment approaches vary. They depend on the child, her age, her personality, her intelligence, and the specific nature of the disorder. Parents should be patient and tolerant, because progress is usually a slow process. But it can and does happen. Eventually, the child can learn to find her voice.
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Getting back to Chava, if I may, I’ll tell you what worked for her. First, I took Chava into my office and allowed her to play to her heart’s content. It was important to build up a sense of trust in order to advance to the next level. Once I felt Chava was really comfortable, I started chatting with her. It was more like a monologue, but I persisted, never stopping to ask her direct questions or to seek some kind of verbal response. I wanted it to come naturally. Apparently, Chava felt comfortable enough after a few weeks to begin speaking on her own. But I never challenged her or demanded cooperation. Chava couldn’t be coaxed. She had to “let go” on her own.
Chava’s sessions lasted most of the summer. In September, it was decided that it would be best if she would begin to attend a new school. All of us felt that she was ready for a fresh start. We were fearful that plunging her back in to her old anxiety-provoking environment would be like taking two steps backward. We had come too far for that.
We all held our collective breaths the day that Chava bravely boarded the school bus to her new Bais Yaakov, but Baruch Hashem she did well. Of course, we alerted her teachers about the situation ahead of time, cautioning them not to demand too much communication from Chava and to handle her gently. After the first day of school, Chava’s teacher called us to say that – while she was definitely silent during the first part of the day (after all, she was entering a new school ) – by the time lunch came around she was hungry and made it quite clear to her Morah that she wanted tuna rather than peanut butter sandwiches. She did this by telling her.
Chava’s success is heartening but not every child responds as well as she did. There are other techniques that have been effectively used to encourage these children. In some cases, encouraging the child to sing or to whisper instead of speaking may be helpful.
Using hand puppets where it appears that the puppet is speaking and not the child, has also been proven to be effective. Any sort of verbal response, no matter how slight, should be warmly praised.
It’s important not to create a scene by applauding any signs of progress. Making a major announcement like, “Look kinderlach, Chava is asking a question for the first time by exclaiming “Yaaayy, Chava,” will only draw attention to the original problem and may prove to be counterproductive.
Contrary to popular expectations, children suffering from selective mutism don’t necessarily grow out of it or improve as they get older. That’s why diagnosing and treating this condition early on is so important. Also, as time goes on, the selective mutism tends to become self-reinforcing. Meaning that after a while, most people come to expect the child not to speak. They get used to it. Eventually, they stop initiating conversations and refrain from verbal contact. This makes the prospect of change even more difficult.
As parents, here’s how you can help. First of all, get help – the sooner the better. Also, never try to force a child with selective mutism to talk. This will result in greater levels of anxiety, which means it will only be harder to treat the condition. On the other hand, you don’t have to stand on the sidelines like helpless bystanders. There are certain things you can do to speed the recovery process.
Number one, establish a safe and secure home environment for your child. Express warmth, support, and encouragement whenever possible. This will help lower the anxiety and allows your child to build confidence and trust.
Also, do some detective work. Search for clues on which settings and situations are the most difficult and which are easier. For example, maybe your daughter feels more at ease when sitting on a certain favorite chair in school or when a specific adult (perhaps a parent) is present in the room. Does she seem more relaxed when there is soft music playing or when she has a beloved doll in her arms? These are clues that, together with therapy, can help your child achieve her goals.
We’ve come a long way from the days when we thought that children who were silent in school were just being obstinate or annoying. We don’t blame them or accuse them of being uncooperative, any more than we would blame a child for having any type of medical or psychological condition. Instead, we deal with it.
The good news is that we are living in a time when extensive research on children’s social and academic behavior constantly offers us new and significant insights into their development. With Siyata D’Shmaya, and the right shliach to guide you, your child can learn to talk no matter where she is and where she goes.
Mrs. Rifka Schonfeld founded, and directs the widely acclaimed educational program, SOS, servicing all grade levels in secular as well as Hebrew studies. She is a well known and highly regarded educator, having served the community for close to 30 years. As a kriyah and reading specialist, she has successfully set up reading labs in many schools and yeshivas. In addition to her diversified teaching career, she offers teacher training and educational consulting services and evaluations. She has extensive expertise in the field of social skills training and focuses on working with the whole child. She can be reached at 718-382-5437 (KIDS).