Selective mutism is a condition that thousands of parents around the world have to deal with. Children who are afflicted by selective mutism might be perfectly fine and chatty at home when they are communicating with their loved ones, but when they leave the safety of their house, they are unable to speak.
This article will help you understand the causes of selective mutism and give you advice on how to help your child (or one of your students) overcome this condition.
What is selective mutism?
Selective mutism is an anxiety-induced disorder that prevents children (and even some adults) from speaking in certain situations.
Children who have this condition most commonly have difficulty communicating in class. They typically use body language and facial expressions to indicate what they want and how they are feeling. They might not even be able to talk to their parents if a stranger is present.
If a child has this condition, it will most likely become noticeable at a very early age (when they start going to kindergarten). However, the silence at the kindergarten might be mistaken for shyness and the disorder might go undiagnosed until the child starts attending primary school.
In some severe cases, children sit in class for months without once making their voices heard.
It is noteworthy that this disorder is typically not accompanied by behavioral problems. On the contrary, children with selective mutism tend to be mild-mannered and quite polite towards adults and their peers.
This is probably why most cases of selective mutism are dismissed as shyness and the treatment is delayed (since these types of children do not cause any problems to others).
Read also a reference site from NUH on selective mutism
Moreover, even the pediatricians have difficulty diagnosing selective mutism which further misleads the parents and delays treatment.
If you suspect that your child is afflicted with this condition, seek help from a qualified mental health professional (preferably one that specializes in children’s mental disorders), such as kidstherapy.sg or think-psych.com
If you ignore the problem, it will fester and become worse. Not only will it prevent the child from having normal social interaction with their peers, but it will also cause them to underperform academically. If children do not understand the topic their teacher is talking about, they will not ask for help, they will be unable to do presentations, etc.
The good news is that this condition is curable. So, let's see what you can do to help your little one.
Correct diagnosis is the first step.
Selective mutism is a relatively rare condition so even someone as experienced as a pediatrician might mistake it for shyness or even autism. Some people might even tell you that the child won’t speak on purpose because they are trying to spite you (which, of course, is not true).
Children with selective mutism simply cannot force themselves to utter a word because of extreme levels of anxiety.
Another myth is that trauma is always responsible for a child’s inability to speak. But trauma-induced mutism differs from selective mutism in that the children who have been traumatized cannot speak in any situation (even to their family members), whereas children with SM go quiet only in specific social situations.
And, last but not least, adults often think that the child will overcome this condition on their own and will simply “grow out of it”.
In rare cases that might happen, but most children who suffer from anxiety-induced mutism carry that anxiety into their teenage years or even into adulthood. And the longer the disorder is allowed to fester the harder it will be to get rid of it.
Treatment of selective mutism.
The vast majority of children with SM respond well to behavioral therapy. The first step is for the child to undergo a comprehensive evaluation process at the hands of an experienced professional in order to determine the severity of the condition and plan the appropriate course of action.
Other than determining what situations cause your child to go mute the mental health professional will determine whether the child has any other co-occurring anxiety disorders.
The main thing to remember is that you should never forcibly push the child out of their comfort zone and coerce them to speak.
Instead of that, the treatment should proceed in a gradual manner and the tasks should be divided into manageable chunks. Only in this way will be child be able to rebuild their confidence and come out of their shell.
The aim of treatment is to teach a child how to express themselves in real-life situations around other people and not just in their doctor’s office. So ideally the treatment will include practicing speaking in real-life situations and settings. For instance, if a child has a particular difficulty in speaking during the lesson then the treatment program should be conducted in the simulated classroom.
The activities should mimic a typical school day (for example show and tell, having a snack with your peers, or the morning greeting). In this manner, children will be able to take the skills they have learned during therapy sessions into their real classroom.
If your child has difficulty talking when he is outdoors and then it is advisable to make short "field trips" outside (for example to the ice cream store, your child’s favorite park, etc.) and conduct the therapy sessions there.
Learning how to manage anxiety.
Anxiety is a serious problem that doesn’t tend to go away on its own; for this reason, it is imperative that every child who suffers from selective mutism is involved in behavioral therapy.
Parents always want to help their children in difficult situations however the "rescuing" approach might not be the best course of action when it comes to children with SM.
For instance, if a parent knows that a child suffers from anxiety when they are at a restaurant and they can’t talk to a waiter, then when the waiter asks the child what he would like to eat the child’s parent tends to intervene and answer the question instead of the child.
Of course, parents have the best intentions when they are doing this. They want to rescue their child from feeling anxious. However, if a parent does this every time they go out to a restaurant then the child will never feel the necessity to speak to waiters and will never have an incentive to overcome their anxiety.
Instead of inserting themselves into the communication parents should help their children by developing strategies to cope with anxiety and giving their children advice on how to behave in such situations. In this way, children will build up a tolerance and eventually learn how to calm themselves down.
Remember that you will not always be there to hold their hand throughout their lives; so instead of doing the difficult thing for them give them the necessary tools to deal with it themselves.
Practice makes perfect.
This expression does not just apply to academic achievements and passing your exams successfully. Learning how to defeat anxiety also takes a lot of practice.
By creating simulated environments you and your therapist will help your child practice communication in the places where they feel most uncomfortable.
Keep in mind that the child with selective mutism will probably only spend several hours at the therapist’s office, compared to a much larger amount of time they spend at home. So if you want the treatment to succeed you need to reinforce these strategies at home.
Parents are the most essential part of the treatment process. Other than working with your child your therapist should also spend a lot of time teaching you how to help your child. Ask your therapist to teach you specific ways of encouraging speech, discuss the most effective speaking exercises with them, etc.
Get the school involved.
Since most children have difficulty speaking at school it is essential that the school is involved in the child’s treatment program.
The first thing you should do is explain to the school's administrators and teachers what SM is and how it affects your child so that they do not mistake your child resistance to speak for lack of cognitive ability or stubbornness. The last thing we want is for the teacher to be annoyed at your child and thinking that they are refusing to speak on purpose.
Your child’s therapist can give advice to the educators on how to interact with the child to encourage them to express themselves.
Child Mind Institute has clinicians who are constantly collaborating with the teachers and providing them with the necessary training to deal with such problems.
Is medication necessary?
The best way to treat selective mutism is by employing behavioral therapy. However, in some severe cases, if you see that your child hasn't experienced any progress from behavioral therapy alone they might need to take medication.
If behavioral therapy alone proves to be sufficient then you will see the results rather quickly. If you have not seen any improvement after one month then you should consult a qualified psychiatrist who specializes in adolescent behavior; they will prescribe appropriate medication.
Most commonly anti-depressants are prescribed for such conditions. Although anti-anxiety medications work relatively foster the advantage of antidepressants is that they work better over the long-term at making children less inhibited.
How long a child will have to take these medications will depend on the severity of their symptoms. On average they will have to take them for 9 to 12 months.
It is vital for the behavioral therapist to be in close communication with the psychiatrist who is prescribing the pills. Only if the treatment is coordinated will we get positive results.
Tips for helping children with selective mutism talk
Here are a few useful tips on how to encourage your child to speak.
1. Give them a few seconds to collect their thoughts.
Often when adults ask a question or talk to a child they expect the answer immediately. Simply waiting five or six seconds without interrupting or repeating the same question again might do the trick.
2. Praise them for the specific thing they said.
If your child speaks in the situation where they normally wouldn’t, instead of praising them with a generic “great job” be more specific. For instance, in a restaurant, you can tell them “great job for telling the waiter what you wanted”.
3. Avoid asking yes or no questions.
If you keep asking simple questions to which an answer can be either yes or no then your child might choose to just shake or nod their head as a response. Try to phrase your question in a way that will make your child utter a full sentence.
If your child gives a full and coherent answer repeat what they have said. This type of echoing exercise makes your child feel heard and understood. This is also a very useful practice for encouraging children who tend to speak very quietly.
4. Comment on what your child is doing.
If your child feels that you are interested in the activity they are engaged in then they are more likely to communicate. When a child is drawing a picture it is an excellent opportunity to practice this technique. Start by asking them to describe what they are drawing, then compliment their drawing once they’re done explaining it.
Bilingual children with selective mutism.
This condition is more prevalent among those who are bilingual. Being bilingual does not cause selective mutism but it might make the child more anxious if they are expected to speak in a language that they are not fluent in.
We should be careful not to diagnose children with selective mutism if they just have difficulty understanding the second language, and vice versa, we should not assume that the child simply doesn’t know how to speak the second language well if they suffer from selective mutism. It will take an experienced and qualified therapist to tell the difference between these two cases.
To conclude, selective mutism is a rather rare condition that, nevertheless, affects thousands of children and their parents around the world.
Although it is not easy to diagnose, it is easily curable if the treatment process starts as early as possible. If you suspect that your child or one of your pupils is suffering from selective mutism do not hesitate to take action now. Alternatively, speak to us on how to engage a special needs educator to help you.