What is selective mutism?

Talking about Selective Mutism

Imagine being faced with a paralyzing fear every day of your life. Well-intentioned people may encourage you to face that fear, but to you, it is the scariest thing in the world. Around 0.71 to 1.9 percent of young school children are likely to have Selective Mutism.

(Kumpulainen et al, 1998; Bergman et al, 2002; Kumpulainen, 2002; Kopp & Gilbert)

For these children, talking is that fear. It can manifest itself in different ways. Perhaps the fear is only apparent when at school, talking to adults or talking to other children. The situational nature of the fear can cause others confusion.

Why are some children with selective mutism talkative in one situation but not another?

Selective Mutism is a childhood anxiety disorder. Children may display different skills in different settings dependent on how relaxed they feel or who they are with at the time.

For some children, it means that they are unable to make any sounds at all, rendering them completely silent. For others, it may be that they can make some environmental noises e.g. the ‘choo choo’ sound when playing with a train. Others may be comfortable enough to speak in a whisper but when the demands increase to raise their volume, they recoil. Many children with selective mutism have speech or language difficulties, thus adding to the anxiety of speaking. The manifestation is as unique as the child themselves.

Usually selective mutism will occur before the age of 5 years but it may not be picked up until the child reaches school. In rarer cases, the onset could be from preschool age until teens.

Why might a child develop Selective Mutism?

Selective mutism is a complex disorder and experts cannot pinpoint one single root cause. There are thought to be some contributing factors however.  An extremely sensitive or anxious predisposition (Johnson & Wintgens 2001) could put a child at a higher risk.  It is thought that in fearful situations there may be a ‘decreased threshold of excitability’ in the part of the brain that receives a warning about potential dangers. This means that protective reactions are set in motion more easily e.g. decreased eye contact, not speaking. Because the threshold needed to trigger a danger warning is low, these reactions are set off by every day events such as school or family parties (Dr Elisa Shipon-Blum)

It can be alarming and very confusing for those who care for the child. As the communication disorder is anxiety based, being armed with information is of paramount importance. Understanding selective mutism will help to allay some concerns and provide the tools needed in order for parents and carers to provide optimum support.

Understanding Selective Mutism

Looking at the myths

  • Children with Selective Mutism don’t want to talk

When talking comes so naturally and easily to most us, we may think staying silent is a choice. Public misconception is not helped by headlines in newspapers such as ‘The children who chose to stay silent’ ran by The Daily Mail in 2012. Staying silent is not a choice, in fact, it is a very hard thing to do and maintain!

  • Children with Selective Mutism have suffered a trauma.

When a behavior is extreme, it is understandable to try and pinpoint causes. there is no evidence that children with selective mutism have suffered any trauma. In fact, the rates of trauma amongst this population are the same as in the general population.

  • Children with Selective Mutism are shy and will grow out of it

Shyness is a very common personality trait in young children and is quite different from selective mutism. When a child is shy, they may hide behind a parent or blush but usually, slowly they will overcome that shyness as familiarity builds.  If a child has selective mutism, they will find creative ways to function during the communication exchange e.g. point or nod to avoid speaking (Maggie Johnson 2002)

  • Children with SM are stubborn

It may appear as though a child is willful when they won’t answer your questions or join in discussions, however what is perceived as willfulness is really the buildup of anxiety.  This in turn leads to more avoidance. In such situations, it’s important to take steps to reduce the anxiety and the pressure on the child by recognizing the inner battle that is taking place.

Keeping the conversation going.

As selective mutism has its foundations in mental health, children can be referred to mental health services as well as to a speech and language therapist. If a child is suspected of having selective mutism, it is important to obtain advice and support early on. Early intervention leads to more successful outcomes and improvements in a majority of cases (Keen et al 2008; Johnson & Wintgens 2001). With the right kind of support in place at home and at school, barriers to communication can be broken down and addressed.  Being armed with the right information is key to supporting these children and giving them their voice. The language we use to speak to children about their challenges is instrumental in managing their anxieties. In the next blog we will talk more about these strategies and look at how we can keep the conversation going with children with selective mutism.

For more information and support for parents, look at http://www.smira.org.uk, a registered charity supporting the families of children with selective mutism.

Written by Carolyn Fox, Children's Speech and Language Therapist

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