Selective mutism. Symptoms, Causes, Features and More

Some children are shy and don’t like talking to people they don’t know, usually starting to talk when they feel most comfortable. However, some children will not speak at certain times, whatever happens this is called selective mutism, it is often frustrating for the child and others.

What is selective mutism?

It is a complex childhood anxiety disorder characterized by the inability of a child to speak and communicate effectively in selected social settings, such as school, they can speak and communicate in settings where they feel comfortable, safe and relaxed.

It is not a form of shyness, although it can be considered extreme shyness, nor is it an intentional refusal to speak, although it can be perceived that way. Symptoms and coexisting conditions can vary from person to person, as do treatment options.

It usually begins during childhood and, if left untreated, can persist into adulthood. A child or adult with selective mutism does not refuse or choose not to speak, they literally cannot speak.

The expectation of talking to certain people triggers a freezing response with feelings of panic, more like a bad case of stage fright, and talking is impossible. Over time, the person will learn to anticipate the situations that cause this distressing reaction and will do everything possible to avoid them.

However, they can speak freely to certain people, such as close family members and friends, when no one else is present to trigger the freeze response. It affects approximately 1 in 140 young children and is most common in girls and boys who are learning a second language, such as those who have recently emigrated from their country of birth.

Symptoms of selective mutism

It is characterized by a lack of speech in certain situations and can interfere with social and academic functioning:

• Consistent failure to speak in specific social situations, despite speaking in other situations.
• Interferes with educational or occupational achievement or with social communication.
• Lasts at least one month, not limited to the first month of classes.
• Not speaking is not due to a lack of knowledge or comfort with spoken language.

Other symptoms may include the following:

• Excessive shyness.
• Isolation, social anxiety .
• Difficulty maintaining eye contact.
• Fear of embarrassment in front of a group.
• Difficulty expressing feelings, even to family members.
• Tantrum.
• Sensitivity to noise and crowds.
• Opposition behavior.
• Compulsive traits
• Negativity

On the positive side, many people with this condition have:

• Intelligence, perception or curiosity above average.
• Creativity and love of art or music.
• Empathy and sensitivity to the thoughts and feelings of others.
• A strong sense of right and wrong.

Causes of selective mutism

Since this disorder is quite rare, the risk factors are not well known. There are some triggers that may be related to it:

• Temperamental factors:  Note behavioral inhibition, negative affect, and parental history of shyness, social withdrawal, and social anxiety . Children diagnosed with selective mutism may also have difficulties with receptive language .
• Environmental problems:  Parents who exhibit social inhibition shape children’s behavior. Overly controlling or overprotective behavior on their part can also be a risk.
• Genetics: Due to the overlap with social anxiety, there may be a shared genetic component between the two disorders .

What are the most common characteristics of children with selective mutism?

Temperamental inhibition: Shyness in new and unfamiliar situations, restrained, generally evident from childhood.

Symptoms of social anxiety:  Discomfort when being introduced to people, mocked or criticized, being the center of attention, drawing attention to oneself, perfectionist (fearful of making a mistake), shy bladder syndrome (Paruresis), problems with feeding (embarrassed to eat in front of others).

Appearance: Many children with Selective Mutism have a blank, frozen-looking face and stiff, awkward body language with lack of eye contact when anxious, this is especially true for younger children at the beginning of the school year or suddenly when they are approached by an unknown person.

Developmental delays:  A proportion of children with selective mutism have developmental delays, some have multiple delays, and are diagnosed with an autism spectrum disorder, such as Pervasive Developmental Disorder, Asperger’s, or Autism . Delays include motor, communication and / or social development.

Behavior:  Children with selective mutism are inflexible and stubborn, moody, bossy, assertive, and domineering at home, they may also exhibit dramatic mood swings, crying spells, withdrawal, avoidance, denial, and procrastination. These children need internal control, order, and structure, and they may resist change or struggle with transitions.

Comorbid anxiety:  separation anxiety , obsessive compulsive disorder , hoarding, trichotillomania (hair pulling, skin pulling), generalized anxiety disorder , specific phobias, panic disorder.

Communication difficulties:  Some children may have difficulty responding non-verbally to others, that is, they cannot point, nod in response to a question from the teachers, or indicate thanks for the pronunciation of the words, for many to say hello or goodbye is extremely difficult. However, this is situational.

Social Participation Difficulties:  When one really examines the characteristics of a child with Selective Mutism, it is obvious that many are unable to participate socially adequately. As the child ages, there is seldom freezing and blocking, but he remains non-communicative or will respond non-verbally after an indeterminate amount of time.

Treatment of selective mutism

It can involve a combination of psychotherapy and medication, although psychotherapy is usually the first recommendation. Some children have a concurrent speech and language disorder , although this is not always the case, it is a good idea to get a speech and language evaluation to rule out communication disorders.

Behavioral strategies and cognitive behavioral therapy are the most widely supported therapeutic treatments for selective mutism.Using a wide variety of strategies aimed at reducing low behavioral anxiety, these therapeutic interventions help children learn to gradually participate in more speaking behaviors.

Behavioral interventions must be tailored to the specific child, but examples may include the following:

• Contingency management:  Positive reinforcement for verbal behavior that works from whispering and verbalizing aloud.
• Stimulus  fading : Gradually increasing the number of people and places where speech is rewarded.
• Desensitization:  Children are gradually exposed to anxiety situations in which speech is expected, but they receive emotional support and guidance with relaxation exercises to help them overcome it.
• Cognitive reframing:  They are taught to identify patterns of anxiety even if they generate positive alternative thoughts.
• Social Skills:  They can practice social interaction skills to reduce anticipatory anxiety related to engaging in reciprocal interactions.

Tips for parents

You may find the tips below helpful if your child has been diagnosed with selective mutism.

• Don’t reward or bribe your child to encourage him to speak up.
• Let your child know that he is afraid to speak and that he has a hard time at times. Tell him that you can take small steps when he feels ready and assure him that talking will be easier.
• Do not publicly praise your child for speaking, because this can cause embarrassment, wait until you are alone with them and consider a special gift for their achievement.
• Reassure her that non-verbal communication, such as smiling and saying hello, is okay until she feels better talking.
• Don’t avoid parties or family visits, but consider what environmental changes are necessary to make the situation more comfortable for your child.
• Ask your friends and family to give your child time to warm up at their own pace and focus on fun activities instead of getting them to talk.
• In addition to verbal comfort, give them love, support, and patience.