Selective mutism (se-LEK-tiv MU-ti-zum) is a condition in which children feel so inhibited and anxious that they do not speak in particular situations, most commonly in school. Children with selective mutism are capable of speaking and communicating normally, and do so in other situations, for example, at home.
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When Brandon first started kindergarten, his teacher just thought he was a very quiet boy, that he would come out of his shell in a week or two. As the weeks passed into months, though, Brandon still never spoke a word at school, even when the teacher called on him. Sometimes if he needed something, he would point or gesture, but he would never speak. His teacher was concerned, and when she called his parents, they told her that Brandon spoke easily at home, and that he had always been a little shy around others. It was clear that Brandon's problem was more than normal shyness. Since it was interfering with his ability to participate in class and on the playground, Brandon's parents took him to a mental health professional, who diagnosed his problem as selective mutism.
What Is Selective Mutism?
Selective mutism is a condition in which children feel anxious and inhibited and do not speak in certain situations. Children with selective mutism are capable of speaking normally, and do so in other situations where they feel more comfortable. These children often talk normally at home, but they may completely stop talking around teachers, other children, or other adults. Their behavior gets in the way of making friends and doing well in school. Selective mutism, once thought to be quite rare, is beginning to be more widely recognized. It used to be called elective mutism, because it was thought that children were purposely choosing not to talk. It was sometimes thought that a child's refusal to speak was a way to rebel against adults, or a sign of anger. It affects at least 1 in 100 school-age children. It usually begins before age 5, but it may not cause problems until children start school. The condition may last for just a few months, but in some cases, if left untreated, selective mutism can last for years. Some experts believe that untreated selective mutism in children leads to social anxiety disorder in their adult years. Experts now believe that selective mutism is an extreme form of social anxiety in a child. Social anxiety is an intense, lasting fear or extreme discomfort in social situations, and usually leads to avoidance of many social situations. With selective mutism, children seem to feel so self-consious or anxious in certain situations that they avoid talking altogether.
What Causes Selective Mutism?
There is no single cause of selective mutism. As with other forms of anxiety, some children may be more likely to have this problem if anxiety or extreme shyness runs in the family, or if they are born with a shy nature. Beyond genetics, in some families where adults are anxious, children may learn to feel socially anxious by watching the way adults react and behave. Upsetting or stressful events such as divorce, the death of a loved one, or frequent moves may trigger selective mutism in a child who is prone to anxiety.
What Are the Symptoms of Selective Mutism?
Many children are shy for a while when they first start kindergarten, but most eventually become comfortable in school, make friends, and talk to the teacher. For those with selective mutism, silence continues and lasts for a month or longer. Some children with selective mutism make gestures, nod, or write notes to communicate. Others use one-syllable words or whispers. Many children with selective mutism are very shy and fearful and may have nervous habits, such as biting their nails. They may cling to their parents and sulk around strangers but might throw temper tantrums and be stubborn and demanding at home. When pushed to speak, they may become stubborn in their refusal. It is sometimes hard for adults to understand that fear, not stubbornness, is at the root of selective mutism, and that children with this condition experience speaking as risky, scary, or dangerous. Understood in this way, it is possible to see a child's stubborn refusal to speak when forced as a strong, but misguided, attempt at self-protection.
* communication disorders affect a person's ability to use or understand speech and language.
How Is Selective Mutism Diagnosed?
Some children with selective mutism will speak to a mental health professional, but others will not. Even if children are silent, though, a skilled professional therapist still can learn a lot by watching how they behave. The therapist also can talk to parents and teachers to find out more about the problem and possible factors that contribute to it. In addition, a number of tests may be needed to exclude other possible causes for failing to speak. These include special medical tests to rule out brain damage, intelligence and academic tests to rule out learning problems, speech and language tests to rule out communication disorders * , and hearing tests to rule out hearing loss.
How Is Selective Mutism Treated?
Most children who have selective mutism want to feel comfortable talking. Though they resist efforts to help them talk at first, therapy can be very helpful in treating this problem. The most common treatment for selective mutism is behavioral (bee-HAY-vyor-al) therapy, which helps people gradually change specific, unwanted types of behavior. For example, after the therapist helps the child to feel comfortable, the child might be rewarded for speaking softly and clearly into a tape recorder. Once they have succeeded at this several times, they can move on to being rewarded for speaking to one child at school. Children who are selectively mute may speak to specific children. They then might be invited to participate in a group with the children the selectively mute child speaks to.
Often family therapy is added, which helps identify and change behavior patterns within the family that may play a role in maintaining mutism. When a child has selective mutism, it is common for the family members to speak for the child. While they begin to do this out of love and concern and the desire to be helpful, these patterns must be discontinued to help motivate a reluctant child to begin to speak for herself. Play therapy and drawing are often used to help these children to express their feelings and worries. In addition, some children with selective mutism are prescribed medications used for treating anxiety. These medications help lessen the anxiety that plays an important role in the selectively mute child's behavior, allowing the child to take the risks involved in talking out loud.
Selective Mutism Group, 30 South J Street, 3A, Lake Worth, FL 33460.
This organization provides online support for the parents of children
with selective mutism.