Selective Mutism
Overview
Selective mutism is a complex childhood anxiety disorder characterised by a child's inability to speak and communicate effectively in select social settings, such as school. These children are able to speak and communicate in settings where they are comfortable, secure, and relaxed. It is not to be confused with children who refuse to speak in certain situations when they have the ability to do so.
Defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) under the umbrella of anxiety disorders, selective mutism often co-exists with social phobia and other anxiety disorders. It is more than just shyness, and it is not associated with speech and language problems.
Key Features
Consistent Failure to Speak: Children with selective mutism consistently fail to speak in specific social situations, such as school or public places, despite speaking comfortably in other settings, such as at home.
Duration: The failure to speak persists for at least one month and is not due to a lack of knowledge or comfort with the spoken language.
Social Anxiety: Selective mutism is often accompanied by symptoms of social anxiety, such as fear of embarrassment, fear of negative evaluation, or excessive shyness.
Context-Specific: The inability to speak is context-specific, meaning it occurs only in certain situations or around specific people.
Normal Speech Development: Children with selective mutism typically have normal speech and language development in settings where they feel comfortable speaking.
Interference with Functioning: Selective mutism can interfere with a child's academic, social, and emotional development if left untreated.
Coexistence with Other Disorders: Selective mutism often coexists with other anxiety disorders, such as social anxiety disorder, generalised anxiety disorder, or specific phobias.
Types of Selective Mutism:
Primary Selective Mutism: This is the most common type, where the child has never spoken in certain social settings, such as school or public places, despite being capable of speaking in other environments.
Secondary Selective Mutism: In this type, the child has spoken in certain social situations in the past but has stopped speaking due to a traumatic event, significant stress, or prolonged exposure to an anxiety-provoking situation.
Situational Selective Mutism: Selective mutism may be limited to specific situations or settings. For example, a child may speak at home but remain silent at school or in public places.
Generalised Selective Mutism: In rare cases, selective mutism can be generalised, where the child is unable to speak in most or all social situations, regardless of the setting or the people present.
How We Can Help
Behavioral Therapy: Behavioral interventions, such as gradual exposure and shaping techniques, can help individuals with SM gradually become more comfortable speaking in anxiety-provoking situations. Psychologists use systematic desensitisation to slowly expose the individual to feared situations while teaching coping strategies to manage anxiety.
Cognitive-Behavioral Therapy (CBT): CBT helps individuals challenge and reframe negative thoughts and beliefs associated with speaking in certain situations. By identifying and changing maladaptive thought patterns, individuals can develop more adaptive coping strategies and reduce anxiety.
Social Skills Training: Psychologists may provide social skills training to help individuals with SM develop the necessary communication and social skills to interact with others more confidently. This may include role-playing, modeling appropriate behavior, and teaching assertiveness skills.
Parent Training and Support: Since selective mutism often involves significant involvement from parents and caregivers, psychologists provide education, training, and support to parents on how to best support their child. This may involve teaching effective communication strategies, promoting positive reinforcement, and addressing any parental anxiety or concerns.
Family Therapy: Family therapy can help improve communication and family dynamics, reducing stressors that may contribute to or exacerbate selective mutism. By addressing family interactions and relationships, therapists can create a supportive environment conducive to the child's progress.
School-Based Interventions: Psychologists collaborate with educators and school personnel to implement accommodations and support strategies within the school setting. This may include creating a comfortable transition plan, providing opportunities for the child to communicate in non-verbal ways initially, and educating teachers and peers about selective mutism.
Multidisciplinary Collaboration: Psychologists often work as part of a multidisciplinary team, collaborating with speech-language therapists, pediatricians, and other healthcare professionals to provide comprehensive assessment and treatment for individuals with selective mutism. This collaborative approach ensures that all aspects of the individual's well-being are addressed.
Parent-Child Interaction Therapy (PCIT): PCIT focuses on improving the parent-child relationship and communication through structured interactions and positive reinforcement. By strengthening the parent-child bond, children with selective mutism may feel more supported and encouraged to communicate.
If your child is struggling with selective mutism, don't hesitate to reach out. Our team of compassionate, experienced psychologists is here to help your child find their voice. Contact us today and take the first step towards a brighter future.