This article aims to give a better insight into what selective mutism is, how it is developed, and understand what can be done to treat selective mutism effectively.
Introduction
As children start to talk and interact with a wider range of people, their personalities begin to shine through. Some children may be an introvert, showing more shyness, whilst others are extroverts and jovial. Selective mutism is an anxiety communication disorder that is predominately diagnosed during the early years. This condition can disrupt children’s lives. Unfortunately, due to the rarity of the disorder, there is limited research available in understanding selective mutism.
Many things can be done to support children and help them communicate. In terms of treatment, there’s no specific medication or cure. Early intervention and making children feel comfortable is the key to supporting children in facing their fears and eventually overcoming selective mutism.
What is Selective Mutism?
Selective mutism refers to a condition where children desire to speak and are comfortable talking in some situations, but not all. Sometimes, they are held back by embarrassment, nervousness, fear, or anxiety. The inability to speak can have a detrimental impact on children’s education and career in the future, and they struggle to communicate in certain situations. Children may also lack confidence and have lower self-esteem because they are worried about how others perceive them.
In the Sydney Morning Herald, Dr Elizabeth Woodcock, a clinical psychologist, explains that many people misinterpret the child as stubborn due to a lack of awareness. It’s important to understand that the behaviours displayed by a child in different situations are not an act of defiance. Instead, it’s the underlying anxiety that causes the child to freeze.
What does selective mutism look like?
Selective mutism looks different because all children react differently. The average age of onset is typically when children enter preschool or formal schooling. A child with selective mutism might be confident speaking at home with family members or with certain friends, but when you ask them to talk to a whole group at school, they may not be able to speak due to anxious feelings. Others might be able to speak to children but not adults outside of the home.
Other signs of selective mutism are:
- Stiff body posture
- Frozen or unresponsive manner
- Clinginess to the primary caregiver
- Slow response in social situations
Some children may display additional signs and symptoms such as anxiety, shyness, panic disorder, obsessive-compulsive disorder and developmental delay. Sometimes, physical symptoms can also be present such as tummy ache, headaches, nausea or shortness of breath.
What Causes it?
Because this is such a rare disorder, the lack of research suggests that there is no one particular cause. In most cases, it is linked to social anxiety. Other potential causes that affect the development of selective mutism are the child’s surrounding environment and temperament. Selective mutism often overlaps with other disorders such as anxiety, developmental delays, OCD or speech or language problems.
“The name is difficult, because people still think of the word ‘selective’ in connection with choice, but it has nothing to do with choice. Situational mutism would be a better name.”
Alison Wintgens, the London Royal College of Speech and Language Therapists’ adviser on selective mutism – SMH
Is Selective Mutism part of autism?
There is no direct correlation between autism and selective mutism. Although there is a possibility that the child can have both, it is a common misunderstanding to assume that children with selective mutism also have autism.
Does Selective Mutism go away?
Yes, It’s possible to overcome selective mutism. However, it doesn’t naturally go away by itself. Individuals will need a lot of support and reinforcement. Building positive relationships with family and friends can be a great way to start. Early intervention is crucial in identifying the problem and giving children the appropriate care they require. There is no set age limit, and it is never too late to seek help from a professional.
How does selective mutism affect the brain?
Selective mutism affects a part of the brain known as the amygdala. Typically, people diagnosed with this disorder will have a lower capacity for excitability which is why they display more irritable behaviour or feel more nervous. That specific part of the brain feels pressure and danger and processes signals from the sympathetic nervous system. Big gatherings and whole-class activities may be perceived as risky or dangerous by the child, which is why they are triggered to feel apprehensive or frightened.
How rare is it?
Fewer than 1% of children have selective mutism. Research suggests that selective mutism affects 1 in every 140 children in the first three years of school. Unfortunately, there is no accurate data available in adults for the number of cases in Australia. It is also likely that many parents may not seek professional help, or misdiagnosis may occur, leading to more severe problems in adulthood.
In my 20 years of working in early learning services, I have had experience with only 3 or 4 cases of selective mutism. These were children between the ages of 3 and 5, and the parents described a loud, talkative, boisterous child at home, where in the early learning setting, there were no words spoken at all for some, with very minimal from others. When it came time for that child to begin primary school, it was important that us, as early childhood professionals, as well the parents, informed the school of the child’s condition so they could better support that child and continue early intervention programs.
“Selective Mutism is slightly more common in females than males. The average age of onset is five years, even though most parents report that their children’s symptoms began years earlier.”
(Leonard & Dow, 1995) – Selective mutism.org
What triggers selective mutism?
An article by News Medical outlines some triggers that could play a vital role in developing this disorder. This includes:
– Genetic Factors
Family history of selective mutism, anxiety and shyness can make children more prone to developing selective mutism
– Sensory Disorders
In some cases, children may have a pre-existing condition of sensory processing difficulties, which affects their ability to process sensory information in the brain. For example, a child might be sensitive to light, certain textures to touch or the sound of busy environments. This will make the child withdrawn or hesitant to respond because it is a sensory overload for them to comprehend.
– Environmental Factors
Overprotective parents or adults with very high expectations may place too much pressure on the child, causing them to be more apprehensive.
– Other Languages
According to research conducted by The Selective Mutism Anxiety Research and Treatment Center, children who displayed signs of selective mutism were from bilingual or multilingual families. Sometimes, the extra pressure to be fluent in multiple languages can lead to insecurities and stress-causing mutism.
– Post Traumatic Stress Disorder
Occasionally, a traumatic event might trigger children to feel more apprehensive in a specific situation causing an inability to speak.
Can you develop selective mutism as a teenager?
Selective mutism is more likely to occur in children rather than adults. However, if left undiagnosed or mistreated, selective mutism can continue to adulthood. In rare cases, a traumatic event may cause a teenager or adult to develop selective mutism.
The characteristics of both are very similar, so it can sometimes be hard to distinguish between the two! It is highly recommended to seek professional help to get the correct diagnosis and support for children to develop more comfort. Although research is limited, as summarised in a study, selective mutism can be classed as a variant of social anxiety disorder as it is associated with higher levels of social stress.
How can I help my child with selective mutism?
Alongside professional help, some other strategies and techniques can be incorporated into your daily life to help children manage their anxiety and reduce the severity of the symptoms. Below are some simple tips to help you and your child out:
- Try not to force and pressure the child. Children will tend to get more anxious when they need to meet certain expectations! Acceptance is the key.
- Work on building children’s self-esteem and confidence. Provide positive reinforcement and help them feel comfortable, so they are more at ease.
- Have a positive night time routine of reading stories before bed, to improve overall language and literacy skills. You can read my article here on the many benefits of bed storytime.
- Set small goals and milestones and be realistic. It’s important to work gradually towards helping children improve their social skills rather than expecting everything at once.
- Work in collaboration with the child’s school or early learning service and form a parent-teacher partnership in which the same skills and methods are used between home and school, so there is consistency for the child.
- Continue providing fun, engaging, and hands-on activities that nurture the child’s interest and allow them to be themselves! When children feel comfortable in their surrounding environment, they are more likely to loosen up and be at ease.
- If children are scared to talk, use nonverbal communication, and encourage children to do the same. Teach children to nod, point, smile, wave etc., so children can feel confident doing the same, and if the child speaks, don’t display shock or surprise, but rather respond calmly and positively, as you would with other children.
The Selective Mutism Resource Manual by Maggie Johnson and Alison Wintgens is a fantastic resource for those wanting more information on the condition and to help assess, diagnose and treat it. You can find it on Amazon here.
Treating selective mutism
Children are mostly diagnosed between the ages of 3-8. Typically, treatments are carried out by either a mental health professional or a speech therapist, in conjunction with speech therapy. In some cases, both might be used simultaneously to tackle both things. The treatment is not merely focused on teaching children to speak but also on reducing the anxiety they feel when talking.
Treatment doesn’t happen overnight and can sometimes take years. It needs to happen step-by-step, and remaining consistent will benefit the child’s overall development. Every child will need treatment tailored to their specific needs. Below are some of the most common and effective behavioural interventions used to treat selective mutism.
– Cognitive Behavioural Therapy
This short-term mental health therapy technique aims to help manage problems by changing how you perceive things. Children would learn how to manage their stress and anxiety for selective mutism when they feel overwhelmed and anxious.
– Stimulus Fading
A great technique to gradually build confidence in children. In this method, a child with selective mutism will talk to someone they are comfortable with, e.g. family members. A third person is then introduced to the conversation, and the parent will slowly fade out, helping children build relationships with others.
– Shaping
For selective mutism, the desired aim is to help the child face their fears and speak. You can start by doing basic activities such as reading aloud, playing informal speaking games, and asking the children open-ended questions to nurture a two-way conversation.
– Desensitisation
In this therapy method, the purpose is to make the child less sensitive and conscious of other people listening to their voice. This is done starting with basic things such as voice recordings and then moving forward to more complex tasks such as a video call. Through this method, children can build their confidence without feeling too overwhelmed and judged.
– Medication
Medication is only prescribed in more severe cases and is not recommended for younger children. The above behavioural techniques and one-on-one interactions are trialled first, whilst medicine is usually considered the last resource for treatment.
There is a FACT SHEET you can find here by The Selective Mutism Association.
Conclusion
Due to a lack of awareness, children with selective mutism are often wrongly judged as being defiant or stubborn when in fact, everything they feel is beyond their control. It’s essential we support, understand, and motivate children to build positive self-esteem to help them overcome their fears and feel a sense of comfort.
Early diagnosis and intervention are essential for improving social and academic outcomes for children. When selective mutism is detected and treated early, children may be able to grow out of it. There is no specific cure for selective mutism, although many different therapies and treatments are available to help overcome the disorder, decrease anxiety levels, improve communication skills and reduce the symptoms.
I would love to hear from you if you have experience with selective mutism. Let me know in the comments!
