Selective Mutism

September 16, 2020 The Ed Psych Practice No Comments Referrals Behavioural Therapy, Childhood, Communication and Language Disorder, Depression, Selective Mutism, Shy, Situational Anxiety, Social Anxiety, Speech & Language Therapist

Takeaway: ‘Selective mutism’ is a complex, uncontrollable reaction to anxiety, where children can’t speak in certain situations. It’s not that they don’t want to, or choose not to, they simply CAN’T. The trick is to get a diagnosis quickly (before things get worse) and use the training techniques your speech and language therapist provides.

How do you react to anxiety? Do you freeze? Do you look for help? Do you try to avoid whatever makes you anxious?

Each of us processes anxiety slightly differently. For some, it’s quite apparent that we’re not okay. It shows on the outside. Perhaps we freeze, or clam up, or withdraw? But for others, you might not notice that anything is wrong. They seem casual and relaxed on the outside but inside, their mind is racing and they’re gearing up to ‘fight or fly.’

‘Selective mutism’ is a complex, uncontrollable reaction to anxiety. Here, children can talk perfectly well when they feel relaxed and secure, but go mute when stressed.

You might notice your child is very sociable, curious, talkative, and perhaps even high-energy at home. But she becomes quiet and withdrawn at school. Or maybe she’s her usual chirpy self at the supermarket but freezes and shrinks as soon as someone talks to her. Note that it’s not that she can’t speak — it’s that she can’t speak in certain situations. So, it’s very different to a child who, say, is traumatised by the death of a parent and stops speaking. There, the child is mute all the time, while with selective mutism it’s only some of the time.

With selective mutism, your child isn’t refusing to speak. She’s genuinely unable to.

In the early days, specialists called the phenomenon ‘elective’ mutism — implying that the children could speak but chosenot to. And this complicated things because it painted them as being rebellious or troublesome. Now we know that it’s not a choice. Your child is genuinely unable to speak in those anxiety-provoking situations — even if she wants to.

So, how badly can your child be affected? Well, it depends. This type of context-specific mutism can range from mild to severe.

On one end of the spectrum, your child might be able to socialise with her close friends at school but can’t speak to her teachers and other classmates. Or perhaps she can speak to them but only in a whisper. And at the opposite end of the spectrum, those same social situations might make her freeze and unable to say even a single word. Instead, she’ll use gestures and facial expressions to communicate.

It can be a highly unpleasant experience for most children. Imagine, for example, not even being able to ask to go to the bathroom!

It’s everyday things like this that begin to add up. Your child might be too afraid to ask permission to go to the bathroom. And so she might stop eating and drinking in school to avoid an ‘accident.’ She might struggle with her homework because she’s unable to ask questions and clear doubts. And this will terrify her because it means she’ll be noticed by the teacher and expected to talk. Many children with selective mutism also have other fears and social anxieties, which make things even worse. For example, they might be terrified of leaving home, might have severe mood swings, insomnia, and a host of other physical expressions of anxiety (nausea, vomiting, joint pains, headaches, etc.).

This is why we need to make a diagnosis quickly and take action. Because selective mutism can slowly take over more of your child’s life.

It’s rooted in anxiety issues and if left unaddressed, will probably get worse — for example, leading to depression (remember, anxiety and depression are two sides of the same coin). Equally challenging, your child might start systematically avoiding stressful situations, which will make it harder for her to attend school, socialise, and learn how to live more independently. Finally, the mutism can become an ingrained, unshakeable habit. So, she’ll slowly stop speaking everywhere and use nonverbal gestures instead. These problems can be reversed, but the longer they’re allowed to fester, the harder they are to solve.

So, how do you get your child diagnosed? You’ll need to contact a speech and language therapist,

The therapist will do the following:

She’ll hear your concerns — first in private and then along with your child.
She’ll try to learn more about your child’s life. For example, is there anything stressful happening? A new daily routine, perhaps?
She’ll take a full medical history of your child and your family (e.g., do any relatives have anxiety disorders?).
She’ll look for patterns in your child’s mutism. When does she speak and when is she mute? Are there common factors tying together the various situations?
She’ll rule out other diagnoses like a developmental language disorder, which could also affect her speech. She’ll check to see if there are physical obstacles to speaking (e.g., problems with your child’s lips, jaw, or tongue) and listen to how she uses words, answers questions, and explores ideas. She’ll also test her hearing to see if that’s okay, too.

If your child is diagnosed with selective mutism, we can now move on to helping her cope.

You might be tempted to shield her from stress and anxiety — for example, talking for her when a stranger addresses her. This comes from a place of love, but it allows your child to withdraw, and this isn’t ideal. Also, many children might grow out of their anxiety but remain selectively mute. So, instead of just trying to reduce her anxiety levels (as critical as that is), we want to address the mutism and change her behaviour. For this, your speech and language therapist will use techniques like:

Stimulus fading: Using something your child is comfortable with to help her adapt to something that usually bothers her. For example, you start up a conversation with her and then a new person slowly joins in. But since you’re there, your child doesn’t freeze or clam up. As she gets used to the new person, you can slowly leave the conversation, and the potential stressor (a stranger) doesn’t bother her as much anymore.
Shaping: Gradually ‘shaping’ your child’s behaviour by moving from easy tasks to tougher ones. Say you want to get her comfortable talking to someone. You could start by having her read aloud. Then she and the person can take turns reading aloud. Then they could play an interactive reading game. Then they could use a ‘structured’ talking activity and finally transition into a free-flowing two-way conversation.
Self-modelling: Your child watches videos of herself speaking in stressful situations, and they help her get more comfortable in those situations. Here’s how it works: A teacher asks your child some questions – which your child probably won’t answer. You then ask her the same questions, and this time she will answer them. You’ve recorded both these instances and you edit them together so it looks like she did answer the teacher’s questions. You then show her the recording over the next few weeks, giving her a treat each time to reinforce the positive behaviour. And soon, she gets used to the idea of talking to her teacher.

Remember the good news: your child can learn to cope, and you are a great ally.

Just keep reminding her that you understand she gets too scared to speak, that it’s okay for her to be afraid, and that she can take tiny steps to get past that fear. Most exciting of all — in time, talking will get much much easier for her!

Does your child have problems speaking in specific situations? Consider consulting a specialist.

The Ed Psych Practice offers consultation, advice, and problem solving for parents, nurseries, schools, and colleges, in London. We have psychologists and therapists who can help assess your child and offer guidance and support.

Phone: +44 (0) 78 3344 7356
E-mail: Office@TheEdPsych.com