What is Selective Mutism?
Selective Mutism is a complex childhood anxiety disorder in which a child, who has the ability to both understand and speak, fails to speak and communicate effectively in certain social settings or environments. This is different from a child with mutism who never speaks. Selective Mutism occurs most commonly in children under the age of 5 and usually occurs in school or social settings. Since the ability to speak and understand spoken language is not impaired, children with Selective Mutism are able to speak and communicate in settings where they are comfortable, secure and relaxed. Thus speaking may occur in more familiar environments, such as at home with family. The cause of Selective Mutism is unknown, but most experts believe that children with the condition inherit a tendency to be anxious and inhibited. Therefore, some affected children have a family history of selective mutism, extreme shyness, or anxiety disorders and most children with this condition have some form of extreme social phobia. Parents will often think that the child is refusing to speak, but usually the child is really unable to speak in certain settings. For a child to be diagnosed as having Selective Mutism, this pattern of mutism must be observed for at least 1 month. This does not include the first month of school, since shyness is common during this period. It is important that alternative causes for not speaking be considered. Therefore, teachers and counselors should consider cultural issues, such as recently moving to a new country and speaking another language. The reason for this is that children who are uncomfortable with a new language may not want to use it outside of a familiar setting. This is not necessarily selective mutism.
At What Age Does Selective Mutism Occur?
Selective Mutism occurs most commonly in children under the age of 5. However, while Selective Mutism is a disorder that first occurs in childhood, it can continue into adolescence and adulthood. Adults with this disorder, suffer functional impairment when public speaking or lecturing are required in their vocation or job.
What Causes Selective Mutism?
The cause of Selective Mutism is unknown, but most experts believe that children with the condition inherit a tendency to be anxious and inhibited. Therefore, some affected children have a family history of selective mutism, extreme shyness, or anxiety disorders and more than 90% of children with this condition have some form of extreme social phobia or social anxiety.
What Other Things Can Co-Occur With Selective Mutism?
Those with Selective Mutism may have inhibited temperaments, Separation Anxiety Disorder, and Social Phobia. About 20-30% of Children with Selective Mutism can also have speech and/or language problems such as receptive and/or expressive language abnormalities and delays. Some may have auditory processing problems. If left untreated, Selective Mutism can lead to depression and other anxiety disorders, social isolation and withdrawal, poor self-esteem and self-confidence, school refusal, poor academic performance, and the possibility of quitting school. Eventually it can lead to underachievement academically and in the work place, and self-medication with drugs and/or alcohol.
How is Selective Mutism Diagnosed?
The following professionals are involved in the diagnosis of child with Selective Mutism: a speech-language pathologist (SLP), a pediatrician and a psychologist or psychiatrist. These professionals will work together as a team with teachers, family, and the individual. The diagnostic process consists of several components that include not only a complete background history but other things as well. An Educational History Review will obtain information on: academic reports, parent/teacher comments, previous testing (e.g., psychological), and standardized testing. A Hearing Screening will check for hearing ability and the possibility of a middle ear infection. An Oral-Motor Examination will check for coordination of muscles in lips, jaw and tongue as well as the strength of muscles in the lips, jaw, and tongue. The Parent/Caregiver Interview seeks information on: any suspected problems (e.g., schizophrenia, pervasive developmental disorder); environmental factors (e.g., amount of language stimulation); child’s amount and location of verbal expression (e.g., how he/she acts on playground with other children and adults); child’s symptom history (e.g., onset and behavior); family history (e.g., psychiatric, personality, and/or physical problems); speech and language development (e.g., how well does the child express himself and understand others). The Speech and Language Evaluation seeks information on: expressive language ability (e.g., parents may have to help lead a structured story telling or bring home videotape with child talking if he or she refuses to do so with the SLP), language comprehension (e.g., standardized tests and informal observations), verbal and non-verbal communication (e.g., look at pretend play, drawing).
What Treatments are Available for Individuals with Selective Mutism?
The type of intervention offered by an SLP will differ depending on the needs of the child and his or her family. The child’s treatment may use a combination of strategies depending on individual needs. The SLP may create a Behavioral Treatment Program , Focus on Specific Speech and Language Problems, and/or Work in the Child’s Classroom with Teachers. A Behavioral Treatment Program may include: Stimulus fading – this takes place by placing the child in a relaxed situation with someone they talk to freely, and then very gradually a new person is introduce into the room. Shaping: uses a structured approach to reinforce all efforts by the child to communicate, (e.g., gestures, mouthing or whispering) until audible speech is achieved. Self-modeling technique involves having the child watch videotapes of himself or herself performing the desired behavior (e.g., communicating effectively at home) to facilitate self-confidence and carry over this behavior into the classroom or setting where mutism occurs. If Specific Speech and Language Problems exist, the SLP will: target problems that are making the mute behavior worse; use role-play activities to help the child to gain confidence speaking to different listeners in a variety of settings; and help those children who do not speak because they feel their voice “sounds funny”. Work in the Child’s Classroom with Teachers includes: encouraging communication and lessening anxiety about speaking; forming small, cooperative groups that are less intimidating to the child; helping the child communicate with peers in a group by first using non-verbal methods (e.g., signals or cards) and gradually adding goals that lead to speech; and working with the child, family, and teachers to generalize learned communication behaviors into other speaking situations.