Selective Mutism

Has your child been affected by selective mutism? Brisbane Psychologist Meggy Delaunay explains how selective mutism can impact a child’s life, and how it can be treated…

Previously also known as “Elective Mutism”, The Diagnostic and Statistical Manual of Mental Disorders (DSM –IV-TR), explains that selective mutism is a “persistent failure to speak in specific social situations”.

For example, most of my clients affected by selective mutism do not have any speech pathology or issues; they can talk with their close family eg mum, dad and siblings, but become silent when they go to kindy, school, the supermarket, or when family friends visit, etc.

This difficulty in interacting and communicating verbally with people must have been present for at least one month to make a diagnosis. It is also important to note that the failure to speak must not be limited to the first month of school.

Selective mutism is considered as a childhood anxiety disorder. This inability to speak in different environments may significantly interfere with academic, educational and occupational activities. As reported by Shipon-Blum, “90 percent of children with Selective Mutism also have social phobia or social anxiety’’. But not all children manifest their anxiety the same way. For instance, some of my young clients are completely mute, while others manage to talk to their peers at school or kindy but cannot talk to teachers or adults in the school environment.

The onset of selective mutism typically occurs before children reach their 5th birthday.

The DSM-IV-TR criteria for selective mutism specify that the persistent failure to speak in specific contexts should not be explained by the following:

1. An organic inability rooted in language ability (comprehension and comfort speaking the language);
2. Another communication disorder, such as stuttering;
3. Concurrent diagnosis of pervasive development disorder, schizophrenia, or other psychotic disorder.

What can cause Selective Mutism?

It is not clear what causes children to develop selective mutism although it is known to be associated with anxiety. Most experts believe that there are also environmental, biological and interpersonal factors that cause selective mutism.

Research shows that most children who develop selective mutism were anxious in social situations from an early age. Genetic predispositions to anxiety are often reported, with one or both biological parents showing signs of anxiety.

It has also been reported that children born in bilingual families/environments can also develop selective mutism, becoming fearful of speaking the less familiar language.

Will it just “go away”?

Selective mutism should be diagnosed and treated as early as possible, otherwise your child may be at risk of developing:

• Low self-esteem;
• Depression;
• Worsening anxiety;
• Poor self-confidence;
• School refusal;
• Social isolation;
• Academic difficulties etc.

Common signs/behaviours associated with selective mutism include:

• Minimal eye contact;
• Crying;
• Lack of smile, looking “frozen”, expressionless;
• Blushing;
• Tantrums;
• Clinging to parents;
• Withdrawal;
• Shyness in infancy;
• Separation anxiety.

There are many things that parents can do to help their child affected by selective mutism, such as:

• Model appropriate language;
• Avoid making negative comments about their child being mute;
• Avoid putting excessive pressure on their child;
• Avoid blaming their child;
• Not avoid social situation, birthday parties, family gathering, shopping centres etc;
• Encourage their child to participate in activities promoting conversations;
• Praise their child for trying;
• Celebrate their child’s successes;
• Let their child know that they understand their fear and that they are scared to talk;
• Help their child use non-verbal communication first and then gradually ask their child to whisper or say a few small words;
• Keep their calm. Getting angry or upset is only going to make the situation worse;
• Listen to their child;
• Encourage;
• Help your child to build friendships.

It is important that parents do not:

• Criticise;
• Blame;
• Force;
• Punish;
• Praise in public.

Treatment for Selective Mutism

The main goal of therapy for selective mutism, is to lower the child’s anxiety level by using different kinds of therapy techniques.

1. Behavioural strategies

During the early stages of treatment, non-verbal communication such as pointing, nodding, and use of pictures to express needs, can be encouraged and rewarded. Though some fear that allowing non-verbal communication will enable the mutism to continue, many therapists believe it is a necessary step to help the child overcome their communication anxiety in a step-by-step manner (6):

• Step by step exposure technique with reward for speaking under anxiety provoking situations. Exposure can also be used for the child to confront more and more social activities.
• Shaping, where the therapist helps the child work on mouth movements that approximate speech (mouthing without vocalising, whispering).
• Stimulus fading. Gradually a new person is included in the conversation that the child is having with their parents.
• It means exposing a child to something that is feared in a gradual way, in order to help the child overcome the fear. It can be done using voice or video recordings in order to help reduce the child’s sensitivity to the sound of their own voice.

2. Cognitive Behavioural Therapy (CBT)

• Negative and worrying thoughts can be explored with the child. For example, I may work with your child on how they perceive their voice: Do they like the sound of their voice? Do they find it embarrassing? Have other children already laughed at the sound of their voice?
• Working on the child’s perceived strengths and weaknesses can also be appropriate in therapy, as well as exploring feelings, working on self-esteem and looking at ways to boost it.

3. Play Therapy

In addition, your doctor may recommend your child take medication in order to help reduce anxiety.

Some children with selective mutism may present with a communication disorder and may require the assessment and support of a speech and language specialist. It is also important to note that the child’s hearing should also be assessed to make sure that the mutism is not due to hearing problems.

Other children may have sensory processing issues and may be sensitive to sound, light, smell etc.

If your child has been diagnosed with Selective Mutism you may wish to make an appointment with me in order to discuss your concerns and a therapeutic plan tailored to your child’s specific difficulties.

Author: Meggy Delaunay, PG Dip Psych Practice, PG Dip Dev Psych, M Genetic Psych, B Psych, MAPS.

Meggy Delaunay is a psychologist who primarily works with children, adolescents and young adults. She is a registered Psychologist in Australia, New Zealand and France, and can provide therapy sessions in English and French.

To make an appointment try Online Booking. Alternatively, you can call Vision Psychology Brisbane on (07) 3088 5422.