What is
selective mutism?
Selective mutism is disorder where your
child does not speak in public even though he can speak and
understand spoken language. It used to be called elective
mutism.
The disorder occurs in about 1 in every
1,000 children. It is more common in girls than boys.
What are the
symptoms?
You may notice your child is very shy when
she enters school and seems unable to talk to other
children.
Many parents are confused by this behavior
because their child is often very outgoing at home. Some
children will talk easily on the phone to people, but cannot
talk to them face-to-face.
Your child may have selective mutism if:
- Your child does not speak in social
situations where talking is expected (such as school,
play groups), but can talk at home to family members.
- The problem starts to cause problems
at school and with social development.
- The problem lasts longer than a month.
- Your child has no other problems with
language, such as understanding language or stuttering.
- Your child often seems shy, afraid, or
anxious.
What is the cause?
The cause of selective mutism is not known.
It tends to run in families. A child is more likely to have
this disorder if other family members have had problems with
selective mutism, social anxiety, or other anxiety
disorders. It is not caused by abuse or trauma.
Children with this disorder do not choose to
be silent. They are afraid. Most children with selective
mutism also have social phobia or social anxiety. Social
phobia is an anxiety disorder in which people fear
situations where they might say or do something
embarrassing. People with this disorder often fear speaking
in public or to strangers.
How is it
diagnosed?
Your health care provider or therapist will
ask about your child's symptoms and any drug or alcohol use.
Your child may have some lab tests to rule out medical
problems.
You may want to contact a mental health
therapist who specializes in working with children and
teens. The therapist will ask questions, observe the child,
and may give some special tests. Parents and teachers will
also be asked about the child's behavior. It is important to
get a very thorough medical, social, and psychological
history from the child and family. The mental health
specialist will assess:
- how severe the child's symptoms are
- how much they interfere with the
child's daily activities
- if the anxiety seems appropriate for
the child's age.
How is it treated?
Children do not just grow out of this
disorder. Treatment at an early age is important. It helps
if the child and parents learn about the disorder.
The main goal with treatment is to lower
anxiety and to increase self-esteem and confidence in social
settings. Cognitive behavior therapy (CBT) helps children
learn what causes them to feel anxious and how to control
it. CBT might also include social skills training,
role-playing, and learning relaxation skills. A speech
language pathologist (SLP) may be helpful. Medicine may be
used along with behavioral therapy to help with anxiety.
Medicine should be prescribed by a child psychiatrist
familiar with this disorder.
How can I
help my child?
- Let your child watch you talking in a
relaxed way in a lot of different situations such as in
the neighborhood with friends, at school events, and
while ordering at restaurants.
- Always reinforce any attempt your
child makes to speak in a public place by gently patting
his or her shoulder or providing verbal praise in a soft
voice.
- Don't force your child to talk or
ridicule your child for not speaking. This does not work
and often makes the child more anxious.
- Don't talk about your child's problem
to relatives or friends when the child is present. This
also may make the child more anxious.
- Help your child to speak where she is
comfortable. Usually that means in small groups of
people that your child knows. If your child is more
comfortable at home, it may be helpful to invite friends
over often to give your child more chances to talk with
others.
- Many children who are shy begin to
speak in new places after they have become familiar with
the teacher, new children, or the place. If this does
not happen and the shyness begins to affect a child's
ability to progress in school and socially, it is time
to seek help.
Resources
Selective Mutism Foundation
http://www.selectivemutismfoundation.org
