What is Selective Mutism

A young girl staring at the camera with her chin resting on her hands

selective mutism is a complex childhood anxiety disorder characterized by a child’s inability to speak in select social settings, such as school.

What is Selective Mutism?

It is a beautiful little 4 year old girl who loves to talk to her dolls… but she cannot speak a word outside the home…

“It is an adorable 6 year old boy who runs around boisterously in his back yard… but stands expressionless, staring into space, when he enters his classroom…

selective mutism is a… child suffering in silence…

These children are able to talk normally in settings where they are comfortable, secure and relaxed. Although the etiology of Selective Mutism is varied, the majority of cases are due to severe anxiety, specifically social phobia. These children are so anxious they literally freeze, are expressionless, unemotional and often, socially isolated.

Why does a child develop Selective Mutism?

The majority of children have a genetic predisposition to anxiety. They have inherited anxiety from various family members. Very often these children show signs of severe anxiety, such as separation anxiety, frequent tantrums and crying, moodiness, inflexibility, sleep problems and extreme shyness from infancy on. They have developed Mutism as a means of controlling their inner anxiety. Approximately 20-30% of SM children have a subtle speech and language abnormalities. However, these children still have anxiety as their underlying cause for their mutism.

Diagnostic Criteria for Selective Mutism

A child meets the criteria for selective mutism if the following are true:

  1. Does not speak in certain places, such as school or other social events.
  2. But, they can speak normally in settings where the child is comfortable, such as at home.
  3. The child’s inability to speak interferes with their ability to function in educational and/or social settings.
  4. Mutism has persisted for at least one month.
  5. Mutism is not caused by a communication disorder(such as stuttering), and does not occur as part of other mental disorders (such as autism).

Treatment:

  1. The main goal is to lower the anxiety while increasing self-esteem.
  2. Behavior approach: positive reinforcement such as stickers given for verbalization . Desensitizing the child to school – Parents take the child into school, when few people are around, to get the child to “Practice’ speaking. After the child is speaking quite normally, the teacher and other students are gradually introduced into the classroom.
  3. Self-esteem boosters: Parents should emphasize their child’s positive attributes.
  4. Frequent socialization: Encourage as much socialization without pushing your child, frequent play dates so the child becomes comfortable with other children in their class and will communicate with them and hopefully carry that over into school.
  5. School involvement: Parents need to educate teachers and school personnel to Selective Mutism. The school needs to recognize that children with SM are not being defiant or stubborn by not speaking, they truly CANNOT speak. Non-verbal communication is acceptable in the beginning. As the child progresses with treatment, the teacher should be involved in the treatment plan as well. Verbalization being encouraged in subtle, non threatening ways.
  6. Family involvement and Parental acceptance: Family members must be involved in the entire treatment. Remember never force your child to speak.
  7. Cognitive Behavioral Therapy: Trained therapists help the child modify their behavior by helping them redirect their anxious fears and worries to positive thoughts.
  8. Medication: When all else fails and a child is not responding to other therapeutic measures, often medication in the form of Serotonin reuptake inhibitors (SSRI’S) such as Prozac, work well in children that have a true biochemical imbalance. That seems to be the case in the majority of SM children. It is recommended it only be used for 9-12 months.

It is important to realize that with proper diagnosis and treatment, the prognosis for overcoming Selective Mutism is excellent.!

Resources

Information for this article was obtained from
Dr. Elisa Shipon-Blum
Executive Director/Medical Director
The Selective Mutism Group, Inc.
The Childhood Anxiety Network
215-887-5748

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