For most young children, entering school is an exciting time. Some children, however, experience significant anxiety and fear about being in a strange place and having to talk to people they do not know well. In the home, these children may speak freely and many are often described as “chatterboxes: by family and close friends. In situations with strangers, and even with some family members the child does not see on a regular basis, these children become silent and they are described by observers as “frozen” and “ vacant.” Such a child, as well as the child’s family, needs help and support. This child is suffering from a childhood disorder known as selective mutism.
Selective mutism, once believed rare, is perplexing for many mental health professionals because they have never heard of the disorder. Of greatest concern is that selective mutism (SM) is frequently misdiagnosed as autism or Asperger’s disorder, so a more comprehensive and widespread understanding of the disorder and its treatment are needed. Selective mutism (SM) is a childhood anxiety disorder. Children with this disorder feel a tremendous amount of fear about speaking in certain situations. The most common situation where this disorder arises is in the school setting, as most SM kids feel overwhelming anxiety about speaking in the classroom.
What is frustrating for many who know a selectively mute child is that the child speaks normally in situations where comfortable. If you are one of the people the child does not speak to, you can easily feel frustrated and perhaps even take the problem personally. SM does not occur because the child doesn’t like you, though. The anxiety is due to the child’s fear of being evaluated or being made fun of. Please visit the other links on this page for more information about diagnosing and treating this disorder.
Diagnosing Selective Mutism
The essential feature of Selective Mutism is the persistent failure to speak in specific social situations (e.g., school, with playmates) where speaking is expected, despite speaking in other situations (Criterion A). The disturbance interferes with educational or occupational achievement or with social communication (Criterion B). The disturbance must last for at least one month and is not limited to the first month of school (during which many children may be reluctant to speak) (Criterion C). Selective mutism should not be diagnosed if the individual’s failure to speak is due solely to a lack of knowledge of, or comfort with, the spoken language required in the social situation (Criterion D). It is also not diagnosed if the disturbance is better accounted for by embarrassment related to having a Communication Disorder (e.g., Stuttering) or if it occurs exclusively during a Pervasive Development Disorder, Schizophrenia, or other Psychotic Disorder (Criterion E). Instead of communicating by standard verbalization, children with this disorder may communicate by gestures, nodding or shaking the head, or pulling or pushing, or by short utterances, or in an altered voice.
Associated features of Selective Mutism may include excessive shyness, fear of social embarrassment, social isolation and withdrawal, clinging, compulsive traits, negativism, temper tantrums, or controlling or oppositional behavior, particularly at home. There may be impairment in social and school functioning. Although children with this disorder generally have normal language skills, there may occasionally be an associated Communication Disorder (e.g., Phonological Disorder, Expressive Language Disorder, or Mixed Receptive-Expressive Language Disorder) or a general medical condition that causes abnormalities or articulation. Anxiety Disorders (especially Social Phobia), Mental Retardation, hospitalization, or extreme psychosocial stressors may be associated with the disorder.
Do’s and Don’ts for Parents and Teachers
1. Listen and encourage
2. Parents should form a united team and work together to help the child
3. Parents should privately discuss the SM behaviors and create a plan they can both agree to.
4. Educate others; this is not “stubbornness” or willful behavior on the part of the child, as is commonly believed.
5. Reward communicative behavior (nodding, note writing, waving, etc.) not speech.
6. Build upon the child’s existing strengths (singing, reading, etc.)
7. Know how and where the child communicates so you can build plans to expand the child’s communication skills
8. Help the child build friendships one at a time
9. When ready, introduce the use of audio and video taping
1. Ask, “Did you talk today?”
2. Criticize the child for not talking
3. Pressure by demanding speech or trying to trick him or her into speech
4. Forget to give as much attention to the other children in the home
5. Foster dependence. Instead, find ways to help him or her communicate with others nonverbally
6. Discuss the child and his or her problems in front of the child or the other children in the family.
7. Praise in public; this attention makes the child feel more self-conscious
8. Try to bribe the child to speak