Selective Mutism

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BY: ALLISON BROWN

This past week a reader asked me to write about selective mutism.  Each request for a topic allows me to share information in a way that is easy to understand.  I want to remind readers that it is important to build relationships with your primary care provider,  either a physician and or nurse practitioner. It is important to get symptoms checked out by a healthcare professional.

Selective mutism is a severe childhood anxiety disorder where a child is unable to speak in situations such as school. Affecting 1% of the population, selective mutism is rare. The term ‘selective’ means that it does not occur in all situations. Often extreme shyness, fear of social embarrassment, anxiety and social isolation can be present. In situations where the child feels relaxed (with friends and family) for example; speech is normal.

It is believed that children with selective mutism have a genetic predisposition to anxiety. They have inherited a tendency to be anxious from one or more family members.  Very often, these children show signs of severe anxiety, such as separation anxiety, frequent tantrums, and crying, moodiness, inflexibility, sleep problems, and extreme shyness from infancy on according to Dr. Shipon-Blum. 

Dr. Shipon-Blum also states that “…some children (20-30%) with selective mutism have subtle speech and/or language abnormalities such as receptive and/or expressive language abnormalities and language delays. Others may have subtle learning disabilities including auditory processing disorder. In most of these cases, the children have inhibited temperaments (prone to shyness and anxiety). The added stress of the speech/language disorder, learning disability, or processing disorder may cause the child to feel that much more anxious and insecure or uncomfortable in situations where there is an expectation to speak.”

It is said that some children feel as though they are on stage at all times and this is what adds to anxious feelings. Often negative behaviours are common before school and or social outings. It is very important for parents and teachers to understand that the physical and behavioural symptoms are due to anxiety and treatment needs to focus on helping the child learn the coping skills to combat anxious feelings. 

Once the diagnosis is made treatment can include behavior therapy;  self-re-enforcement, which involves receiving an award for speaking; self-modeling, in which the child views videos of himself speaking in a classroom and receiving an award; response initiation, in which the child spends time with the therapist until they speak, usually one to two hours but sometimes over four hours and up to a day; teaching the child’s teachers and parents to stop negative re-enforcement, such as assuming the child may not speak;  family therapy, which may help the child overcome anxiety, and medication to treat anxiety. 

It is important for parents to advocate for their children as the dialogue that comes from professionals and teachers will often tell a parent, the child is just shy, or they will outgrow their silence. Others interpret the mutism as a means of being oppositional and defiant, manipulative or controlling. Some professionals erroneously view selective mutism as a variant of autism or an indication of severe learning disabilities.

Like all conditions or diseases especially those in childhood it is vitally important to ensure a correct diagnosis, so that time and efforts are not lost on misdiagnosis.  Parents and caregivers, I cannot stress enough to meet your practitioners halfway and build those relationships. Don’t leave it all up to the practitioners, oftentimes as a parent or caregiver, your intuition or gut feeling is what makes the difference between a positive versus negative outcome.

This article is dedicated to all of the parents and caregivers out there who are coping with various situations day to day. Thank you for your perseverance, love, and sacrifices.

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