I Choose Not To Speak
Do you know a child who speaks freely at home, but never speaks in other settings, such as the classroom? Do you know a child that does not communicate at all in certain settings, appearing to be extremely shy and withdrawn? If the answer is yes, the chances are you know a child with selective mutism.
What is it?
Selective mutism is a disorder most commonly found in children. It is characterized by a persistent failure to speak in select settings (continuing for more than one month). Such a child understands spoken language, has the ability to speak normally and, in typical cases, speaks to parents and a few selected others; however, at other times, the child may not speak to certain individuals at home. Most children with selective mutism are unable to speak while at school and in other major social situations. Generally, most children function normally in other ways, although some may have additional disabilities. Such a child learns age-appropriate skills and academics. Recent research has confirmed that selective mutism appears to be related to severe anxiety and shyness.
A typical case
If your child suffers from selective mutism, she may respond or make her needs known by nodding her head, pointing or by remaining expressionless or motionless until someone correctly guesses what she wants. She will probably express a great desire to speak in all settings, but is unable because of anxiety, fear, shyness or embarrassment. She may participate in activities non-verbally. The withdrawn behaviour is not usually obvious until your child begins school. Sometimes, even then, your child may be viewed as shy, but it is most often assumed that the shyness is temporary and will be outgrown. By the time selective mutism is recognized—if it is recognized—your child will have usually experienced at least two years in which muteness has become a way of life. The behaviour becomes increasingly difficult to change as time lapses without intervention.
Symptoms
The first symptoms of selective mutism are usually noticed between the ages of one and three. They may include shyness, a reluctance to speak in some settings and a general fear of people. Although there may be a predisposition to selective mutism at birth, the symptoms become obvious when the child is requested to respond verbally or interact in social situations—preschool, for example.
Characteristics
Consistent failure to speak in specific social environments (where the child is expected to speak, such as at school) despite speaking in other environments (such as at home). The inability to function in educational and social settings.
The inability to speak is not due to a lack of knowledge of, or comfort with, the spoken language required in the
social situation. The inability to respond: for example, a child that does something wrong (breaks a rule) may become very anxious when a parent questions her and thus the child may not be able to respond to the parent.
Associated behaviours
If your child suffers from selective mutism, then she may also exhibit certain behaviours such as refusing to make eye contact, a lack of facial expression, immobility or nervous fidgeting when confronted with the general expectations of social situations. These symptoms do not indicate wilfulness, but rather an attempt to control rising anxiety. Your child may withdraw by pulling back when approached or touched and may exhibit different forms of body language. In many cases, the body language is misinterpreted as a sign of abuse, whereas the behaviour actually stems from anxiety.
Treatment
Two factors determine whether or not treatment is necessary: age and severity. If the mutism persists for more than two months, then treatment should be sought immediately. For a child who exhibits mild symptoms, such as responding in a soft voice, treatment may not be necessary unless the symptoms continue for many months or worsen. It is sometimes difficult to know if—or when—to intervene, as
there are varying degrees of the disorder. Many children improve over time without treatment while, for others, the disorder becomes difficult to manage. However, for those experiencing severe forms of selective mutism, immediate intervention is advisable, as the symptoms can worsen without treatment. Generally speaking, a younger child has a better chance of recovering if treated earlier. Behaviour management programmes for the treatment of phobias have proven to be successful. Techniques should be consistently used and should include desensitizing the child by providing short-term goals, positive reinforcement and rewards to motivate the child to speak. Pressure, including punishment, bribery or consequences, can be harmful. One-word responses should be elicited at first, with gradual requests for more. After extensive treatment, some have been able to speak spontaneously in most, if not all, social situations The intervention programme will differ depending on the needs of the child and her family. The child’s treatment may be a combination of strategies that, again, depend on individual needs. The specialized behavioural treatment programme will focus on specific speech and language problems and will be applied in a child’s classroom with her teachers.
Therapy may also include:
- Identifying problems that are triggering selective mutism.
- Using role-play activities to help the child to gain confidence speaking to different listeners in a variety of settings.
- Helping a child who does not speak because she feels her voice "sounds funny".
- Involving a child’s teachers in the therapy.
Keep in mind
Selective mutism is sometimes mistaken for autism. The striking difference between the two is that autistic individuals have limited language ability, while individuals experiencing selective mutism are capable of speaking and do so normally in comfortable situations. Selective mutism is not associated with learning or other impairments; therefore, special education programmes are considered cautiously and any programme is tailored to suit the individual child. Most programmes can be implemented within a regular educational environment.
