Child Developement

What is Selective Mutism

Selective mutism is an anxiety disorder that affects children. Left untreated, it can continue into adulthood. It is characterised by an inability to speak in certain situations such as school or in public, even when the child is verbal otherwise. This is different from a situation where a child refuses to speak or doesn’t want to talk, but rather where the individual is simply unable to, due to anxiety. Given its nature, selective mutism can be very frustrating and distressing both for the child and the people around them. 

What happens in Selective Mutism? 

Being an anxiety disorder, selective mutism happens when a child experiences unusual anxiety around talking. The expectation to talk in certain situations or to certain people triggers a freeze response and coupled with panic, the child finds it just impossible to speak. It is important to remember at all times, that the child isn’t choosing not to speak but is simply unable to overcome their anxiety and speak. You can compare to it having stage fright but with much more severity. 

Symptoms of Selective Mutism

Many children can be shy in front of strangers or during the first few days at school. This, however, doesn’t count as selective mutism. With this disorder, the signs and symptoms differ and vary in duration and intensity.

If a child is experiencing selective mutism, you will notice:

• It starts between the ages of 2 and 4. This is usually noticeable when the child starts school, as it coincides with children beginning to speak to people outside the family and familiar surroundings. 
• Even though the child is able to speak perfectly well otherwise, they appear frozen and still when they are in not in their comfort zone. This is accompanied by poor eye contact, nervousness and anxiety.
• They might cling to their parents and appear disinterested and withdrawn.
• As it is a frustrating experience for the child, they might react with aggression and tantrums when questioned by their parents. 
• Some children might be able to communicate or respond with gestures (nodding, pointing) but those severely affected are unable to communicate in any form, verbal or non-verbal. 
• An expression of the desire to speak but being held back by severe anxiety, fear of embarrassment.

 How Selective Mutism affects children

Children with this disorder often develop social anxiety and try avoiding situations they fear will trigger their anxiety. They may also develop other speech and communication difficulties.

They tend to avoid participation in social settings or situations where they will be expected to speak. Academically, children can be affected by not being able to ask for help with understanding concepts or assignments. Younger children might have toilet accidents or develop infections from not asking for help to use the toilet or by holding for hours at a time. 

Diagnosis and Treatment

A diagnosis is made through thorough observation which includes that

• They are able to speak in situations where they are comfortable, such as with parents, family, in their house or classroom when they are alone
• The child doesn’t speak in certain situations, such as in school or in public when they can be overheard by other people
• Their inability to speak to certain people has lasted for at least a month, (2 months in new settings)
• It is not better explained by any other communicative, mental or behavioural disorder
• Their inability to speak interferes with their functioning in that setting

Selective mutism can be identified and treated in childhood before it continues into adulthood. Left untreated it can lead to social withdrawal, anxiety and isolation. Children with selective mutism can overcome this disorder with timely help. 

Teachers at school or other caregivers can identify symptoms early on and get help. If the child also has any additional speech and language challenges, it is best to get an evaluation done by a Speech and Language Pathologist. Also, a supportive environment at home and school is very important to help the child feel more comfortable. Parents, teachers and caregivers can be trained on how to respond appropriately to the child’s selective mutism, so as to encourage speech and not punish the child when they are unable to speak. 

How parents can help

Often a child with selective mutism is misunderstood as being defiant or that they are deliberately refusing to speak, while it is actually caused by severe anxiety.  The earlier the intervention, the better the progress. So it is best to get children the help they need as soon as you suspect any difficulty. Older children can also overcome their disorder but the progress happens at a slower rate.

Apart from intensive therapy, a child with selective mutism immensely benefits from the environment around them and the response to their condition. Therefore it is important that parents

• Do not pressurize or bribe the child to speak. 
• Work with the staff at school to create a positive atmosphere for the child that makes them feel relaxed and reduces their anxiety.
• Reassure the child that they will be able to speak when they are ready.
• Provide support by telling the child, that you understand their difficulty and they will be able to overcome it.
• Not allow their own anxiety and frustration to show in front of the child
• Encourage and appreciate any interaction the child initiates with new people or in new situations. However, find a suitable time and place to do this. Praising the child publicly might make them feel embarrassed. 
• Respond warmly when the child speaks in new situations instead of showing surprise or any exaggerated response.
• Ask friends and family to cooperate and give the child time to warm up instead of reacting harshly or insisting they speak.

With timely intervention, children can overcome anxiety and selective mutism. A warm, accepting and supportive environment will go a long way in making intervention effective for your child.  If you need help, we are here for you. Reach out to our therapists at KinderPass for support. 

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