Selective Mutism

Selective Mutism

What is it?

Selective Mutism is one of the various types of specific phobias, within the spectrum of anxiety disorders that children and adolescence can develop in regard to speaking out in particular social situations. The characteristics of Selective Mutism are very closely aligned with the symptoms of social phobia, as children appear to hold an intense fear of certain social interactions and communications for fear of being judged negatively or embarrassed. Selective Mutism may be more easily identified as an extreme case of childhood shyness or timidness, and while it may seem harmless in the short term, if it is not treated early, the disorder can inhibit development of essential communication skills in their future years in adolescence, and in their adult life – only creating a much larger problem to untangle down the track.

The symptoms of Selective Mutism vary across individual children, but the most common characteristics are identified in their behavioural symptoms such as:

  • Inability and/or ineffective communication to others, including verbal conversation and non-verbal body language
  • Reacting in particular social settings by “freezing” and becoming motionless, expressionless, or appearing emotionless
  • Making little to no eye contact with others
  • Being unable to talk at all, or speaking only very few words in a hushed whisper

Selective Mutism behaviour in children is best explained as an avoidance mechanism, triggered when they feel confronted with their feared social situation, in regard to how they feel they are expected to speak or act in given social settings, or around particular people. In many cases, Selective Mutism may be hard for parents to spot, as children with the disorder are usually able to interact in a completely normal manner with people they are close to and feel comfortable with. The symptoms of the disorder can usually be recognised by the age of three, although the disorder is often left undiagnosed until much later, usually during primary school years.

What causes it?

There are several theories suggesting an array of contributing factors for Selective Mutism to develop in children, although the predominant cause is attributed to stem from hereditary predisposition to anxiety and introverted personality types. Appropriately so, it has been estimated that up to 75% of children with Selective Mutism have at least one parent with an anxiety disorder. 

Other associations have been made between Selective Mutism and children with Sensory Processing Disorder (DSI). Children with DSI have difficulties processing sensory information (such as light, sound, taste, touch and smells), which often affects their emotional responses and interpretation to stimuli – and in turn, this can inhibit their ability to respond appropriately to social cues, competencies to interact with people, and their involvement in social environments. Similarly, children with slight speech or language impairments, minor learning disabilities, or processing disorders, may be more predisposed to Selective Mutism, as these children may feel increased anxiety around certain social situations where they feel there is an expectation to speak and interact that may highlight their insecurities.

Another interesting link has been made between Selective Mutism and overprotective parenting. Many children may feel anxious in new situations and around unfamiliar people, and parent’s first reaction may be to try and help their child by answering questions and talking for them to alleviate their anxiety. However, when parents do this it only makes matters worse by reinforcing their silent behaviour and thereby creating a habit.

While these factors have been suggested to influence the onset of Selective Mutism, it is noteworthy that Selective Mutism is an anxiety disorder in itself, and treatment for speech and language impairments, communication disorders, stuttering, or learning difficulties, should be treated separately. It is therefore critical to seek help from a specialising psychologist if in doubt, where they can make a formal assessment and diagnosis of the child so that the appropriate treatment can take place.

Diagnostic criteria for 313.23 Selective Mutism

  1. Consistent failure to speak in specific social situations (in which there is an expectation for speaking, e.g., at school) despite speaking in other situations.
  2. The disturbance interferes with educational or occupational achievement or with social communication.
  3. The duration of the disturbance is at least 1 month (not limited to the first month of school).
  4. The failure to speak is not due to a lack of knowledge of, or comfort with, the spoken language required in the social situation.
  5. The disturbance is not better accounted for by a Communication Disorder (e.g., Stuttering) and does not occur exclusively during the course of a Persuasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder.

Source: http://www.selectivemutismfoundation.org/info-on-selective-mutism/view-sm-in-the-dsm

What are the symptoms?

The main diagnostic criterion for Selective Mutism in children involves the child being able to speak in at least one social setting (or around certain people), and incapable of speaking in at least one other setting. The most common symptoms of Selective Mutism include:

  • Extremely shy behaviour and an inability to communicate properly around others apart from limited few (eg: family or other people the child feels comfortable around)
  • Fear of and inability to speak in particular social settings such as: school, day care, birthday parties, play dates, or extended family gatherings or celebrations
  • Social withdrawal
  • Lack of eye contact & poor body language when communicating with others
  • Clingy behaviour to parents including tantrums when having to separate from them or when confronted with their feared social situations (usually occurring at home)
  • School refusal
  • Blushing, looking down, freezing, or exhibiting other symptoms of extreme distress when confronted with speaking in social situations

What can parents & teachers do to help?

If parents or teachers begin to recognise the symptoms of Selective Mutism in their child or amongst their students, it is important they take action and seek help sooner rather than later. Selective Mutism is not just a shy “phase” kids will grow out of. In fact, if Selective Mutism is left untreated, the child’s symptoms may only worsen as their behavioural patterns become fixed; creating a stickier and harder problem to repair as they grow older.

How is it treated?

The main treatment for Selective Mutism involves Cognitive Behavioural Therapy (CBT), where the child and their parents are guided with the help and support from an experienced psychologist specialising in the field. The first step of CBT involves identifying the child’s negative cognitions and beliefs that are causing their Mutism behaviours. Following this, the child is then re-educated on alternate ways of thinking to replace their old negative thoughts with new, more realistic ones.

A big part of CBT involves GRADUAL exposure therapy – meaning the child’s fears are tested in real life, in order to prove to them that their engrained, negative thoughts are incorrect and do not result in the outcomes that have become engrained in their belief system over time.

Importantly, parents are not the only ones who need to be involved in the child’s therapy – it is essential that school teachers are kept in the loop and made aware of the situation so they can facilitate and support the child’s treatment plan. It is also critical for teachers not to punish the child for their Mutism behaviour as this can only exasperate the problem. Teachers should instead try to encourage communicational opportunities in the classroom, by prompting more conversational questions with the child, aiming to prevent short one worded answers.

Who we recommend

Clinical Psychologist

Source

Barbalich, A. (2015). What is Selective Mutism? Retrieved from http://www.parents.com/health/mental/children-and-selective-mutism/?page=1

Cunningham, C. Understanding Selective Mutism: Tips for Parents and Educators. Retrieved from http://www.selectivemutism.org/resources/library/SM%20General%20Information/Understanding%20SM.pdf

Selective Mutism Clinic Sydney. (n.d.) Retrieved from http://www.selectivemutism.com.au/

Shipon-Blum, E. (n.d). What is Selective Mutism? Smart Centre. Retrieved from http://www.selectivemutismcenter.org/aboutus/whatisselectivemutism

Winder, K. (2002-2005). Selective Mutism – What is Selective Mutism? BellyBelly. Retrieved from http://www.bellybelly.com.au/child/selective-mutism#.VK4aiCuUeSo

What is Selective Mutism (SM)? (2006). SMG. Retrieved from http://www.selectivemutism.org/faq/faqs/how-common-is-this-problem-to-be-worthy-of-our-attention