This week, World Mental Health Day 2016 opened up discussions about mental health conditions. Today, we’re putting one of them under the spotlight – Selective Mutism.
Have you ever wondered ‘what is Selective Mutism?’ ‘what causes Selective Mutism?’ ‘are there any treatments for Selective Mutism?’. We’ve asked SMIRA – Selective Mutism Information and Research Association to help answer your questions.
What is Selective Mutism?
Selective Mutism is a severe anxiety disorder. It prevents people, usually children, speaking in certain social and/or public situations, such as within school. This happens even if they are able to speak easily and freely with family or friends in environments where they feel comfortable. Researchers and clinicians call it an extreme form of ‘social phobia’.
Selective Mutism is much more than simple shyness or an unwillingness to speak. It is a disorder that affects a person’s day-to-day function and communications. A child or adult with selective mutism doesn’t refuse or choose not to speak -they can’t speak. The expectation to talk to certain people triggers a freeze response in them. They have feelings of panic, like a bad case of stage fright. This makes talking impossible.
Is Selective Mutism common?
Selective Mutism is more common that you would think. It affects about one in every 140 children. Evidence suggests that it is more common in girls and children of an ethnic minority background, or those that have recently migrated, where the language and/or culture are very different.
When does Selective Mutism start?
Symptoms of Selective Mutism are usually noticed in early childhood. This is when a child begins to socialise beyond the family circle, such as at nursery or primary school.
What are the symptoms of Selective Mutism?
Children with Selective Mutism tend to have other fears and social anxieties. They may also have additional speech and language issues.
Besides a lack of speaking in social circumstances, symptoms of Selective Mutism may include:
- Inability to retain or give eye contact.
- Social awkwardness.
- Being excessively shy and withdrawn, dreading they may be expected to speak.
- Stubborn or aggressive temperament – throwing tantrums in the home.
- Frozen and expressionless during the periods they cannot talk.
- Using gestures or one-word answers to communicate.
- A fear of using public toilets.
Can Selective Mutism be diagnosed?
There are specific guidelines that help practitioners diagnose Selective Mutism. According to the NHS Choices website, they say that a child with Selective Mutism:
- Is unable to speak in specific situations. This could be at school or where they can be overheard in public. However, they can speak freely in situations where they are comfortable, such as with their parents at home.
- Their inability to speak interferes with their ability to function properly in that moment.
- Has experienced Selective Mutism for at least two months.
- Their Selective Mutism cannot be explained by another behavioural, mental or communication disorder.
To help with a diagnosis, the practitioner may ask about
- The child’s development when they were smaller (did they have any delays in hearing, speech, motor and cognitive development).
- Family history (is there a history of anxiety).
- Medical history.
- Stress factors within the family (divorce, death of a relative or moving home).
The child’s school, doctor and other practitioners in the child’s life will be asked for more information about the child’s behaviour. The professional will then directly assess the child.
Older children may need to see a mental health practitioner or school educational psychologist.
It is important that the child receives an assessment to rule-out other issues, such as speech or language disorders, or hearing impairments which may cause their lack of speech.
What causes Selective Mutism?
It is not always clear why some children develop Selective Mutism. It is known to be connected to anxiety, and this may have been inherited from a family member.
Stressful environments may also cause or affect Selective Mutism. Some children become overwhelmed by loud noises and big crowds. They may struggle to process the sensory information associated with these. This can cause them to ’shut down’ and become unable to speak.
Is there a treatment for Selective Mutism?
According to the NHS Choices website, the success of treatment tends to depend on:
- How old the child is.
- The length of time the child has had the condition.
- Whether the child has additional communicational or learning difficulties.
- The support and co-operation of those involved with the child on a regular or personal basis.
Treatment doesn’t focus as much on speaking itself. However, a child should be encouraged to say single words and sentences to one person in a relaxed environment, before being able to speak freely to all people in all settings.
Treatment is most effective when the child has a supportive and positive environment. This means:
- Not letting the child know you are anxious/overly concerned about their Selective Mutism.
- Reassuring them that they will be able to speak when they feel ready.
- Concentrating on having fun.
- Praising all efforts to join in and interact with others.
- Not making a big fuss when the child does speak.
Other treatments may include behavioural therapy and cognitive behavioural therapy. These have been shown to be the most effective form of treatment. However, you will need to speak to a practitioner about the effectiveness of these in specific circumstances.
Medication is only advised for older children, teenagers and adults. Even then it is only when their anxiety has led to depression or other problems. It’s important to say that medication does not address the underlying triggers of Selective Mutism or help the person to manage the disorder in the same way as therapy.
Is what I’ve heard about Selective Mutism true?
- Selective Mutism does not mean that a child is trying to manipulate or control their parents or those around them;
- Selective Mutism does not only affect younger children. Older children and adolescents can experience Selective Mutism and are often not diagnosed at an early age. Whatever the age a person is diagnosed with Selective Mutism, they have the same chances of responding to treatment.
- There is no direct relationship between autism and selective mutism. However, the two can occur together in the same child;
- Selective Mutism symptoms may arise as a result of post-traumatic stress. If so, a different pattern of Selective Mutism occurs. It may be that a child will suddenly stop talking in situations or environments where they previously had no issues. However, this may lead to genuine Selective Mutism, if the underlying triggers are not properly addressed and the child develops a more heightened anxiety about communications;
- There is no evidence that children who suffer with selective mutism are more likely to have suffered abuse, neglect or trauma. However, if these have occurred, they may contribute to the Selective Mutism by making worse any anxiety the child may have.
What’s the advice for parents of a child with Selective Mutism?
It can be difficult for parents to know what to do or how to help their child. Early diagnosis of Selective Mutism is key. Families and schools should work together to reduce a child’s anxiety because as they grow older, Selective Mutism becomes increasingly difficult to treat.
There is a lot of information available on Selective Mutism. Try to read up on the subject as much as you can. Where possible share this information with anyone else who interacts with your child, from friends and relatives to their school and other practitioners.
Other useful tips include these from the NHS Choices website:
- Don’t pressure or bribe a child to encourage speaking.
- Let your child know you understand that they are scared to speak and have difficulty speaking at times.
- Don’t praise your child publicly for speaking, this may cause embarrassment. Wait until you are alone with them and consider a special treat for their achievement.
- Reassure your child that nonverbal communication (such as smiling and waving) is fine until they feel better about talking.
- Don’t avoid parties or family visits, but consider what environmental changes may be needed to make the situation more comfortable for your child.
- Ask friends and relatives to give your child time to warm up at his or her own pace and to focus on fun activities rather than getting them to talk.
- Give them love, support and patience as well as verbal encouragement.
Can Selective Mutism affect a child’s adulthood?
The long-term effects of Selective Mutism for adults have not been studied. However, research has indicated that untreated cases of social anxiety in childhood can develop into other mental health conditions in later life.
Who is SMIRA?
Selective Mutism Information and Research Association
SMIRA is a charity set up to support parents and carers of children with Selective Mutism and to provide information to professionals working with children who have Selective Mutism.
Teachers, Psychologists, Speech and Language Therapists, Psychiatrists and other professionals are encouraged to join SMIRA to help improve awareness, co-operation and co-ordination between all involved in the treatment of a child with Selective Mutism.
SMIRA gives parents and professionals an opportunity to feel less isolated and share ideas with others who have experienced similar issues in either home, school or treatment situations.
Visit www.smira.org.uk for more information.
Information and useful links for parents of children with SM www.nhs.uk
- Selective Mutism Network
- Selective Mutism Awareness
- Support Selective Mutism
- Selective Mutism Awareness
- Selective Mutism Support Group
- SMIRA – Selective Mutism Information and Research Association