Selective Mutism: Is my child just shy?

Selective Mutism

Selective mutism is a childhood anxiety disorder that starts before the age of 5 years. It is characterised by inability of children to communicate in certain social situations. With selective mutism children have a hard time initiating conversations or responding when spoken to in social situations.

Children with selective mutism are able to talk in settings they feel safe and comfortable in such as with family and friends. Therefore, it might come to clinical attention once a child starts school and interacts with people outside of the family. 

What causes selective mutism

Since it’s a relatively rare condition, causes or risk factors of selective mutism are not known. There are few factors or triggers that make it more likely to develop.

  • Genetics:  Family history of any anxiety disorder including selective mutism, phobias and speech-language problems.
  • Speech-language problems: Speech-language difficulties or minor learning disabilities and shyness might add to the child’s anxiety in situations where they are expected to speak.
  • Environmental factors: Poor familial relationships and overly controlling or overprotective parents 

There is a common misconception that selective mutism in children is often a result of trauma or abuse. However, children who become mute after abuse or trauma are mute in all situations and not specific social settings as is the case with selective mutism.

Lastly people believe that children with selective mutism are shy or will grow out of it. In fact, these children are willing to speak but are unable to talk or communicate what they want to say due to extreme anxiety.

Signs of Selective Mutism

According to DSM-V the diagnostic criteria for Selective Mutism is as follows:

  1. Consistent failure to speak in specific social situations in which there is an expectation for speaking, e.g., at school despite speaking in other situations.
  2. The disturbance interferes with educational or occupational achievement or with social communication.
  3. The duration of the disturbance is at least 1 month (not limited to the first month of school).
  4. The failure to speak is not attributable to a lack of knowledge of, or comfort with, the spoken language required in the social situation.
  5. The disturbance is not better accounted for by a Communication Disorder (e.g. Childhood-onset fluency disorder) and does not occur exclusively during the course of autism spectrum disorder, schizophrenia, or another psychotic disorder.
Treatment 

Selective mutism is most receptive to treatment when it is started early. The success of treatment will depend on the age of the child, presence of co-existing speech-language or learning difficulties and the cooperation of the parents and teachers. The treatment for selective mutism may include psychotherapy or medication and aims at reducing the anxiety associated with speaking. 

  • Mental-Health Counselling: It is a common treatment for selective mutism. In order to reduce the anxiety in social settings behavioural interventions such as Cognitive Behavioural Therapy (CBT) is most widely used by therapists.
  • Speech-Language Therapy: Speech and language therapy plays an important role in the assessment, identification and management of selective mutism. An SLP works with the child to reduce anxiety associated with speaking in certain situations.
  • Medication: It is only used in chronic cases or when therapy fails to achieve desired results. Anxiety medication is prescribed by doctors after consultation with the parents.
What can you do at home?
  • Don’t let your child know when you are anxious
  • Create a positive environment for them to encourage speech
  • Reassure them that they'll overcome the conditions when they're ready
  • Praise their effort when they interact with others verbally or nonverbally (nodding or pointing)
  • Don’t act surprised when your child makes progress but respond normally as you would to any other child

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