What is Selective Mutism?
It is a beautiful little 4-year-old who loves to talk to her dolls… But she cannot speak outside the home.
It is an adorable 6-year-old boy who runs around boisterously in his backyard… but stands expressionless, staring into space, when he enters his classroom.
It is a 11-year-old little girl who sings and writes beautiful songs at home… but cannot verbalize a sound tin front of her teacher and classmates.
It is a 15-year-old boy who loves computers, roughhousing and joking with his best friend… but cannot talk to this friend at school or other social events.
It is a sensitive and perceptive little 5-year-old girl who tells her parents all the exciting and fun things she wants to do at her birthday party… but has never spoken a word to anyone outside the home.
It is a comical 6-year-old girl who dances and sings in the entertainment room while her family proudly watches on… but, stands motionless, and cannot utter a sound when her class rehearses for the school musical.
It is a 9-year-old boy cheering loudly and intensely as he watches his favorite hockey team score a goal… but sits alone at a party and sadly turns away when another child approaches him.
It is an artistic 7-year-old girl who prides herself on showing off her artwork to her family and two best friends… but cannot talk to these friends at school.
What is Selective Mutism? It is a child suffering in silence.
Dr. Elisa Shipon-Blum wrote the above poem for her daughter who suffers from selective mutism. As identified and explained in the Diagnostic and Statistical Manual of Mental Disorders, while children with this condition are fully capable of speech and understand language, they have an innate anxiety that fills them with fear and actually restrains them from speaking in public situations where they feel uncomfortable. Studies have shown that there are three primary factors that will visibly affect the ability of such children to express themselves verbally. The first is location, meaning that children with selective mutism are most likely to speak at home, less likely to speak outside of the home (such as at the grocery store), and least likely to speak at school (documented in two research studies – Black and Uhde 1995 and Cunningham et al. 2004). These children find the school environment, where they are expected to speak on a regular basis, to be particularly anxiety-provoking. The second primary factor is people, meaning that a selectively mute child will likely be more comfortable speaking to other children than to adults. The third factor is activities – children with this disorder will tend to more readily engage in conversation while participating in activities that they enjoy.
How can a parent be almost certain that their child has selective mutism? In addition to displaying this selective form of communication, the child will have behaved this way for at least one month; will often have one or more of other types of anxieties, including social phobia, separation anxiety from his or her parents, perfectionist or obsessive tendencies, and oppositional behavior; and may also have certain speech or language problems, learning difficulties, or even impaired hearing.
While scientists do not yet know exactly what causes selective mutism, clinical investigations have determined there are several contributing factors to the onset of this condition. These include a child with a naturally shy or anxious temperament; a family history of shyness or anxiety; speech or language difficulties or a history of delayed language development (documented by Kristensen in 2000 and reported in the Journal of the American Academy of Child and Adolescent Psychiatry); the presence of Sensory Integration Dysfunction, wherein the child has trouble processing some sensory information, thereby becoming anxious and literally unable to speak; adjustment to a new culture, which would apply to children who have recently immigrated from another country (study by Elizur and Perednik in 2003); and limited socializing with school peers outside of school, due to the fact that the family is geographically or socially isolated from the families of the child’s classmates.
What should parents do to enable their child to overcome the condition? According to leading professionals with extensive experience, there are several approaches to treatment of the disorder. Barbara Markway, Ph.D., a psychologist who serves as the director of the Anxiety and Stress Management Center of Mid-Missouri, recommends Cognitive Restructuring as one helpful approach. “It’s important to help the selectively mute child change his or her distorted thinking patterns,” she says. “In Cognitive Restructuring, a therapist works with the child to get him to stop believing that those around him, such as fellow students, will belittle him if they speak publicly.” Markway also finds that teaching such a child basic relaxation techniques will help lower his overall anxiety level and give him coping skills to handle stress-inducing situations.
The experts concur that the most effective form of treatment is the behavioral approach, wherein exposure and transfer are utilized. Dr. Angela McHolm, a clinical psychologist who serves as the director of the Selective Mutism Service at McMaster Children’s Hospital in Ontario, Canada, explains that in order to reduce fear and the avoidance of fearful situations, a person must be exposed to the feared situation in a manner that will teach him he can tolerate those circumstances and manage any anxiety that may emerge. “A professional working with a selectively mute child will guide the child through gradual steps of exposure on a ‘ladder’ of least- to most-feared situations,” Dr. McHolm reveals. “By having the child successfully conquer his apprehension about speaking in a relatively low-tension scenario, the professional enables the child to gradually transfer that mastery behavior to slightly modified situations. Over time and with repeated exposure in the properly controlled settings, the child will become empowered to face increasingly anxiety-producing circumstances with success, and slowly but surely shed his Selective Mutism.”
In my work with children in our community who have been definitively diagnosed with Selective Mutism, I have found that a combination of the above approaches – with particular emphasis on the process of exposure and transfer – will produce positive results. Working in conjunction with the child’s parents and educators, I create a carefully mapped out “conversational ladder” wherein the child is introduced on a gradually incremental basis to locations, activities and people at school that challenge the child to “break through” and engage in conversation where they have been previously reluctant to do so. I have also found that the child’s family members can play an important role at home, by gently encouraging the child to communicate whenever he will be at school or in other potentially anxiety-provoking public situations. Last but certainly not least, I have learned that early intervention is crucial; the sooner parents have their selectively mute child diagnosed and treated, the greater the likelihood that the child will grow up with normal social skills and healthy communication abilities.
Of course, before getting started, we must listen to our child and understand where he or she is coming from. With the right person listening, your child can excel and ultimately succeed.