SELECTIVE MUTISM: When quiet time is all the time.

Selective Mutism (SM) is an anxiety disorder that is characterized by an inability to speak fluently in certain settings. Your child will most likely speak at home and with people they are very familiar with, but take them out to a restaurant, park, shopping, or school and it’s a different story.

The development of SM starts innocently enough. A child feels anxious in a new setting or with a new person and they withdraw. People (parents, siblings, etc.) around them start feeling anxious about the child’s lack of response and speak up for them, give up trying to get them to talk, or excuse the behavior as, “oh, she’s just shy.” 

After a month, the child has begun to develop a pattern of behavior of avoiding speaking. Instead they have learned to wait for a “rescuer” to speak up for them or they wait for the opportunity to speak to pass. 

SM is often confused for shyness, a quiet personality, or defiance. Parents often believe that their child is lacking confidence or they are not talking on purpose. It is assumed that they will “out-grow” this behavior and services are not sought until children are much older and their patterns of behavior are more ingrained. 

Although SM seems harmless, it is as dangerous as it is debilitating. Children have been known to have serious injury and illness but because of the crippling anxiety they feel around speaking, they suffer silently.

Even if professional help is sought for a child diagnosed with SM, many professionals, both speech therapists and psychologists, are not trained in how to work with this disorder. 

Defying the Myths.

Many people belief that SM is caused by trauma, but this is not the case. Trauma-induced mutism only occurs after a traumatic experience. Selective Mutism, however, usually begins between the ages of 2.7 to 4.1 years old. It impacts 1 in every 100 children, which surprisingly is the same rate as Autism Spectrum Disorder.

Selective Mutism is often co-occurring with other anxiety disorders, hearing and auditory processing deficits, as well as communication and speech deficits. Social Anxiety is a very similar disorder, except children with social anxiety will continue to communicate, though rarely and quietly.

Things like public speaking or large group gathering will raise the anxiety levels of a child with Social Anxiety and the result is extreme discomfort until they are out of the social situation. It may take them more time to speak, but they are capable of speak with new people and in new enviornments.

Children are often not diagnosed with SM until they enter school and their lack of speech becomes a problem in evaluating their academic progress.

How to Assess for Selective Mutism.

Due to the lack of communication (both verbal and non-verbal) assessment for this disorder can be very challenging. Emphasis is placed on a series of questionnaires and screeners to differenciate between SM and other co-morbid anxiety and speech related disorders as well as Autism Spectrum Disorder (ASD).

Assessment also takes into account observing the child in different settings with different people. Since SM is both an anxiety disorder and a pragmatic communication disorder, observations should be made by both a psychologist and a speech pathologist. 

Assessing SM is different because the child needs to have a certain level of comfort in the room with the psychologist prior to an assessment taking place. It is recommended that the child meet with the psychologist 2-3 times to play without the expectation of speech before the evaluation begins. 

Often parents are trained in test presentation as research has shown that test scores are higher when the child performs language skills with a parent than an evaluator. The use of video and audiotapes are also used in evaluating speech in comfortable settings.

How to Treat Selective Mutism.

A series of behavioral modification and exposure techniques are used to help the child feel comfortable speaking again. These techniques reduce anxiety by starting with non-verbal communication and taking small steps towards shaping speech behaviors.

Parents are heavily involved in treatment as a way to help bridge the gap of speech between the therapist and the child. Child-directed and Verbal-directed play techniques are often used to allow for natural opportunities for the child to practice typical speech patterns one-on-one with a therapist.

Like with all disorders early intervention is key in positive outcomes of SM.

Need help with getting your child to speak? Contact CDK for a psychological evaluation to determine if your child meets criteria for SM. 

Due to the lack of available SM treatment providers, if your child is diagnosed with SM, CDK will be able to provide brief therapy services. This is one of very few conditions we provide therapeutic services for.

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