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What is Selective Mutism in Children

This is a real issue. Some children act awkwardly around people they don’t know well. Have you ever been with a child that gets quiet around certain people? For example, your child would not talk in daycare or with other kids but does with you. Or the child freezes and looks to the ground if someone, even other kids, tries to interact with him.


The child will be energetic, silly, and talkative with people they’re comfortable with. That means there is no language or speech development disorder. That child may have selective mutism.


This article explains everything you need to know about selective mutism and what it can mean for your child. We will also discuss how you can help a child with this condition.



What is Selective Mutism?


Selective mutism (SM) is an anxiety disorder that affects children's ability to speak in certain settings or to certain individuals. School is the most common setting where children with selective mutism struggle.


Despite being able to speak comfortably and easily at home, children with SM feel so much anxiety in certain situations that they become unable to speak. Adults may find this disorder confusing, and children may find it painful. Children with SM may not exhibit physical signs of anxiety and may appear frozen or stare back when asked a question or prompted to engage.


Parents may not realize that their child has trouble speaking around others because their child does not have difficulty speaking at home. Parents may also mistake their child's anxiety for shyness and underestimate the severity of their child's disorder.


Children with selective mutism may whisper when speaking to teachers or peers or be completely unable to speak, going an entire school year without speaking once. They may have difficulty answering questions in class, asking for help, or initiating conversations. Many children with SM may struggle to ask to use the bathroom, leading to them going hours without using it or having accidents.


Signs a Child Might Have Selective Mutism


How can you identify SM in a child? It is important to understand what selective mutism is. Early detection and intervention in selective mutism are crucial for a child's emotional and social development. The longer the child goes without appropriate support, the more challenging it can be to overcome.


Here are common signs of selective mutism:


  • Refusing to speak in specific social situations, such as school, extracurricular activities, or social events, despite being able to speak at home or in other comfortable environments.


  • Limited social interactions or lack of verbal communication with peers or adults in certain settings.


  • Extreme shyness or social anxiety, particularly in unfamiliar situations or with unfamiliar people. Appearing paralyzed with fear or shutting down when unable to speak.


  • Difficulty making eye contact or exhibiting other physical signs of anxiety, such as sweating, trembling, or avoiding social situations altogether.


  • Refusal to participate in classroom activities, answer questions, or speak to teachers, even when they know the correct answers.


  • Speaking freely and being sociable at home, but being entirely or mostly nonverbal at school or around strangers.


  • Limited or nonexistent communication with classmates, teachers, or other adults, even through nonverbal means, such as nodding or gesturing.


  • Fear or avoidance of situations where they may be required to speak, such as public speaking or presentations.


  • Difficulty expressing emotions or needs, leading to frustration, tantrums, or emotional outbursts.


It is important to note that some children may exhibit only a few of these signs, and the severity of their symptoms can vary widely. A diagnosis of selective mutism should only be made by a trained mental health professional.


This is an anxiety disorder that may have different signs in each child. Some children with SM may be able to talk to peers but unable to talk to their teacher, while others will stay silent around peers.


Many children with selective mutism enjoy school and have friends but interact nonverbally during playtime. Some may be able to speak to their classmates in their own homes, but many cannot. Some children with SM may be able to smile and point to things they want, while others will struggle with even these gestures.


Children with selective mutism are typically diagnosed between the ages of 3 and 8. In hindsight, professionals often observed that these children displayed signs of severe anxiety and inhibited temperament in social settings as infants and toddlers, but the adults thought they were just being very shy.


These children typically have a history of separation anxiety and may be slow to warm up to new people or situations. The signs of selective mutism may not become apparent until the child enters school, when there is a greater expectation to perform, interact, and speak.


In such cases, teachers may inform parents that their child is not speaking or engaging with other children. Alternatively, parents may notice early on that their child is only speaking to a select few individuals outside the home.


While it may take time for children to adjust to a new classroom environment, being nonverbal for over a month can cause concern. It is essential to note that these signs can vary widely in their severity and presentation. A diagnosis of selective mutism should only be made by a trained mental health professional.


Importance of Early Intervention


Here are some reasons why early detection and intervention in SM are essential:


  • Improved social and emotional functioning: SM can cause significant distress and impair a child's ability to form relationships, communicate their needs, and participate in social situations. Early intervention can help children develop communication skills and socialization strategies, leading to improved emotional and social functioning.


  • Better academic performance: Children with SM may struggle in academic settings due to their difficulty communicating with teachers and peers. Early intervention can help children overcome their anxiety and communicate more effectively in the classroom, leading to improved academic performance.


  • Preventing comorbid disorders: Untreated SM can increase the risk of developing other anxiety disorders, such as social anxiety disorder or separation anxiety disorder. Early intervention can prevent the development of comorbid disorders.


  • Greater treatment success: The earlier SM is identified and treated, the more likely it is that the child will respond well to treatment. Early intervention can help prevent the disorder from becoming chronic, which can be more challenging.


  • Decreased emotional distress: Children with SM may experience significant emotional distress due to difficulty communicating in certain situations. Early intervention can help reduce this distress and improve the overall quality of life.


In conclusion, early detection and intervention of selective mutism are crucial for a child's emotional, social, and academic development. Parents and teachers need to recognize the signs of SM and seek professional help as early as possible.


What Looks Like SM But Isn’t


Oppositional Behavior


Selective mutism is often confused with oppositional behavior because a child with SM may appear to be refusing to answer questions. However, this is not the case, as children with SM are very anxious and may find it impossible to speak even when they want to. It is important to note that children with SM are not choosing not to speak; they are simply unable to do so.



Autism


Autism and SM can be challenging to differentiate since both conditions affect socialization. However, children with SM can still understand nonverbal cues and emotional subtleties, while autistic children may struggle with social nuances and the limits of conversation even in familiar surroundings.


Trauma


While trauma can cause a child to become mute, they will more likely avoid talking about aspects of the trauma rather than becoming completely silent. PTSD has additional symptoms such as difficulty sleeping, nightmares, and the need to recreate the traumatic event during play, differentiating it from SM.


Second Language


When a child speaks a different language at home, it is essential to consider whether difficulty with the second language could cause their reluctance to speak before diagnosing them with SM. However, bilingual children can still develop SM, which is more common among those who speak multiple languages.


Social Anxiety Disorder


This can occur alongside SM, as children with a social anxiety disorder may also be anxious about speaking or performing in front of others. A thorough evaluation should be done to determine if a child has a social anxiety disorder.


Causes of Selective Mutism


Since selective mutism is relatively uncommon, the risk factors associated with this disorder are not well established. However, a few triggers have been identified:


  • Temperamental factors: Children with a history of behavioral inhibition and parents with a tendency towards shyness, social isolation, and social anxiety may be at risk for developing selective mutism. Additionally, some children with selective mutism may also have receptive language difficulties.


  • Environmental factors: Parents who exhibit social inhibition may model this behavior for their children. Furthermore, overly controlling or overprotective behavior from parents can also increase the risk of selective mutism.


  • Genetics: Since selective mutism and social anxiety share similarities, the two disorders may have a shared genetic component.


How Selective Mutism Is Treated


If a professional has assessed your child and confirmed that the child has selective mutism, you must immediately commence treatment with a psychologist with experience. You can also find RiteCare Clinics to help you. The recommended treatment is specialized behavior therapy involving techniques that encourage speech and reinforce successful speaking experiences with labeled praise and small incentives.


The treatment also involves helping children confront the situations that trigger anxiety instead of avoiding them, which helps to reduce anxiety gradually over time. However, children should not be coerced or pressured to speak, and the pace of treatment should be gradual.


The objective is to build the child's confidence by accumulating successful speaking experiences. Demanding more than the child can handle may harm the child's progress and self-esteem.


Since children with selective mutism are typically young, treatment should involve direct work with parents, caregivers, and other supportive adults to learn how to help the child communicate and engage in conversation. Treatment providers should teach caregivers to avoid answering for the child or relying too heavily on nonverbal communication, as this can reinforce the child's SM.


Knowing when and how to encourage participation from a child with selective mutism can be challenging. Therefore, you must understand the child's treatment goals and receive guidance on how to best support and reinforce progress.


Collaboration between the child's therapist and teachers is essential for successful treatment, as progress made in the clinician's office must translate into progress at home.



Strategies to Help A Child With Selective Mutism


To help a child who has struggled with selective mutism, you need to make them feel comfortable. Here are some suggestions:


  • Act like a sportscaster: Give a play-by-play commentary of what the child is doing, such as "You're drawing a flower" or "I see you're pointing to the picture in the book." This demonstrates your interest in the child's activities and can be a useful technique when the child is nonverbal.


  • Allow for a five-second wait time: Giving the child enough time to respond is important when asking questions. Waiting five seconds without repeating the question or prompting someone else to answer can be a good guideline. This helps the child learn to tolerate anxiety and build confidence in their ability to communicate.


  • Use labeled praise: Instead of generic praise like "Great job!" try being specific and saying something like, "Great job telling me you want water!" This lets the child know exactly what they did well and motivates them to continue to use their communication skills.


  • Rephrase questions: Instead of asking yes-or-no questions or questions that the child can answer can answer nonverbally, try giving the child choices or asking open-ended questions that are more likely to prompt a verbal response. For example, "Would you like a puppy sticker or a star sticker?" or "What do you think we should play next?"


  • Practice echoing: Repeat or paraphrase what the child says to show that you understand and have heard them. This can be reinforcing and help the child feel more comfortable participating in larger group settings, especially if they speak quietly.


While the behavior of children with selective mutism may appear deliberate, it is rooted in anxiety. Prompt intervention can aid these children in increasing their communication and enhancing their academic and social success.


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