Selective Mutism In Children & How To Resolve It

Is your child comfortable at talking at home but faces difficulty in talking at school? Does your child refuse to talk at certain places while feels relaxed talking at other times and other places? 

Some children will not talk at certain times, no matter what. This is selective mutism. 

Selective Mutism is a complex childhood anxiety disorder characterized by a child's inability to speak and communicate effectively in certain social settings such as, at school, family gatherings, birthday parties etc. or with specific people such as his/her teachers or classmates or peers.  However, these children are able to speak and communicate in settings where they are comfortable and feel secure and relaxed.

This behaviour lasts for at least a month and does not include the first month of school as some children might be shy and may take time to open up. Also to be classified as someone with selective mutism child should know the language being used at that time and should not have a speech or language problem that might cause her to prevent from talking.

When does selective mutism begin?

Selective mutism usually begins during childhood. It is most common in children under age 5  but may not come to clinical attention until the child enters school. 

Why more cases of selective mutism are reported in children above age 5?

Once the child enters school, the social interactions increase and children are expected to interact with people outside their family and also participate in performance tasks. A child with selective mutism is usually unable to interact or perform in a social setting and hence gets reported.

What happens if the child with selective mutism does not get clinical attention?

If selective mutism is left untreated, it can have many undesirable negative consequences throughout the child's life and can persist into adulthood. It can pave the way for an array of issues such as academic, social and emotional repercussions which can, in turn, lead to low self-esteem, isolation and social anxiety disorder.

How does a child with selective mutism communicate?

Children with selective mutism are unable to communicate verbally, so they may use gestures, nodding their head to get their message across. Some of these behaviours might not be present at the onset of selective mutism.

What are the causes of selective mutism?

There could be a family history of selective mutism which could mean it is inherited, as is believed by most of the experts. Children who have selective mutism might also have a family history of anxiety disorders. 

What are the warning signs of a child with selective mutism?

The child with selective mutism might:

• Avoid eye contact

• May freeze and be expressionless

• Show sudden stillness

• Behave rudely or have temper tantrums

• Sulk

• Get clingy

• Seem nervous, or uneasy

• Get stiff, tense or poorly coordinated

• Display excessive shyness

• Negativity

• Have rebellious behaviour 

• Worried about embarrassing themselves in public

What all problems a child with selective mutism might have to face?

Children with selective mutism might fall behind academically because of inability to understand instructions in classroom or speak up about their struggles. These children might have low self-esteem and face difficulties in engaging in reciprocal social interactions thereby making it difficult for them to make and maintain friends.

Can a child overcome selective mutism?

Yes, a child can successfully overcome selective mutism if it is diagnosed at an early age and is appropriately managed. The families, professionals and the school needs to work closely to provide support to the child. In certain cases, the child might also have receptive, and/or expressive language abnormalities and language delays in which case SLP (Speech-Language Pathologist) can contribute to the treatment benefits of children with selective mutism.

What does the treatment for selective mutism involve?

The treatment for selective mutism may include a combination of psychotherapy and medication which addresses the anxiety that underlies the child's inability to speak in certain situations. Speech-language therapy, occupational therapy, sensory integration therapy, and other interventions might also benefit children with selective mutism if need be.

What should parents do once selective mutism is diagnosed in their child?

Parents need to educate themselves and others who interact with the child with selective mutism.  They should meet experts such as a psychologist or a psychiatrist if their child has been diagnosed with selective mutism who will help plan appropriate treatment for the child. These professionals should provide a comfortable setting where there is no expectation or pressure on the child to speak. The purpose is to get the message across to the child that he/she and their problem of difficulty in speaking is understood. This marks the beginning of helping the child in overcoming his/her symptoms.

Is it important to get the child diagnosed at an early age?

Yes, the earlier the intervention, the quicker and greater is the success rate. The older the child is, the more accustomed he/she becomes to non-verbal behaviour and the slimmer is the success rate as it gets more difficult for them to change. So, the response rate to treatment is inversely proportional to age for selective mutism.

Some children with selective mutism feel as though they are on stage every minute of the day! This can be quite disheartening and heart wrenching for both the child as well as the parent involved. The parents and the teachers need to understand that they need to help the child learn the coping skills to combat anxious feelings that lead to physical and behavioural symptoms in children with selective mutism.

The goal is to make the child comfortable talking in any situation. So, the earlier the intervention, the better the likelihood of child outgrowing selective mutism.