It can prevent kids from asking for help if they need it, like telling the teacher they need to use the bathroom. And it can prevent kids from engaging in many fun activities that require verbal communication, including play dates. The good news is that with the right help, kids with SM can get better. Selective mutism is relatively rare, so people, even pediatricians or other specialists, might not immediately recognize it, or might mistake it for autism or a communication disorder.
In other words, a child with SM is unable to speak, not refusing to speak. In fact, kids who become mute after a traumatic experience are typically mute in all situations, not specific social environments, as is the case with SM. The good news is that selective mutism is very treatable with the right care. Kids with SM respond best to behavioral therapy that is focused on helping them learn to speak in new settings, during new activities and with new people.
If you are concerned that your child might have SM, you should get a comprehensive evaluation that establishes a diagnosis. The evaluation should specifically examine the circumstances in which your child is verbal and non-verbal, and if she might have any co-occurring conditions like other anxiety disorders. An evaluation will also rule out other diagnoses, such as a communication or language disorder, which could also be causing restricted speech.
Children with SM should never be pushed to speak. Instead, treatment should follow specialized behavior therapy techniques that prompt speech and then reinforce successful speaking experiences with lots of labeled praise and small incentives.
This careful progression helps children gain confidence and prepares them for experiences that get progressively more challenging. Instead of meeting with clinicians for just one hour a week, children in intensive group treatment can participate in daylong or weeklong sessions. This concentrated focus helps jumpstart treatment by giving kids bigger and more immediate gains. This means that clinicians should model treatment around real life settings and situations.
This helps children bring the speaking skills they are developing with them when they return to their real classroom. While her anxiety may not diminish completely, her ability to tolerate her distress will increase. Kids with SM get too much practice not talking. Selective mutism. Signs of selective mutism Selective mutism usually starts in early childhood, between age 2 and 4.
They may avoid eye contact and appear: nervous, uneasy or socially awkward rude, disinterested or sulky clingy shy and withdrawn stiff, tense or poorly co-ordinated stubborn or aggressive, having temper tantrums when they get home from school, or getting angry when questioned by parents More confident children with selective mutism can use gestures to communicate — for example, they may nod for "yes" or shake their head for "no".
What causes selective mutism Experts regard selective mutism as a fear phobia of talking to certain people. Diagnosing selective mutism Left untreated, selective mutism can lead to isolation, low self-esteem and social anxiety disorder. Diagnosis in children A child can successfully overcome selective mutism if it's diagnosed at an early age and appropriately managed. Diagnosis in adults It's possible for adults to overcome selective mutism, although they may continue to experience the psychological and practical effects of spending years without social interaction or not being able to reach their academic or occupational potential.
Diagnosis guidelines Selective mutism is diagnosed according to specific guidelines. These include observations about the person concerned as outlined: they do not speak in specific situations, such as during school lessons or when they can be overheard in public they can speak normally in situations where they feel comfortable, such as when they're alone with parents at home, or in their empty classroom or bedroom their inability to speak to certain people has lasted for at least 1 month 2 months in a new setting their inability to speak interferes with their ability to function in that setting their inability to speak is not better explained by another behavioural, mental or communication disorder Associated difficulties A child with selective mutism will often have other fears and social anxieties , and they may also have additional speech and language difficulties.
Treating selective mutism With appropriate handling and treatment, most children are able to overcome selective mutism. The effectiveness of treatment will depend on: how long the person has had selective mutism whether or not they have additional communication or learning difficulties or anxieties the co-operation of everyone involved with their education and family life Treatment does not focus on the speaking itself, but reducing the anxiety associated with speaking.
This means: not letting the child know you're anxious reassuring them that they'll be able to speak when they're ready concentrating on having fun praising all efforts the child makes to join in and interact with others, such as passing and taking toys, nodding and pointing not showing surprise when the child speaks, but responding warmly as you would to any other child As well as these environmental changes, older children may need individual support to overcome their anxiety.
Cognitive behavioural therapy Cognitive behavioural therapy CBT helps a person focus on how they think about themselves, the world and other people, and how their perception of these things affects their thoughts and feelings. Behavioural therapy Behavioural therapy is designed to work towards and reinforce desired behaviours while replacing bad habits with good ones. Techniques There are several techniques based on CBT and behavioural therapy that are useful in treating selective mutism.
Graded exposure In graded exposure, situations causing the least anxiety are tackled first. Stimulus fading In stimulus fading, the person with selective mutism communicates at ease with someone, such as their parent, when nobody else is present.
Shaping Shaping involves using any technique that enables the person to gradually produce a response that's closer to the desired behaviour. Positive and negative reinforcement Positive and negative reinforcement involves responding favourably to all forms of communication and not inadvertently encouraging avoidance and silence.
Desensitisation Desensitisation is a technique that involves reducing the person's sensitivity to other people hearing their voice by sharing voice or video recordings. Medicine Medicine is only really appropriate for older children, teenagers and adults whose anxiety has led to depression and other problems. Advice for parents Do not pressurise or bribe your child to encourage them to speak.
Let your child know you understand they're scared to speak and have difficulty speaking at times. Tell them they can take small steps when they feel ready and reassure them that talking will get easier. Do not praise your child publicly for speaking because this can cause embarrassment.
Wait until you're alone with them and consider a special treat for their achievement. Reassure your child that non-verbal communication, such as smiling and waving, is fine until they feel better about talking. Do not avoid parties or family visits, but consider what environmental changes are necessary 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 focus on fun activities rather than getting them to talk.
As well as verbal reassurance, give them love, support and patience. We understand that selective mutism can be debilitating for either yourself or your child, which is why our nationwide network of hospitals and wellbeing centres are able to offer specialist therapeutic care across all age groups. Focused on lowering the associated anxiety symptoms of the disorder, a wide range of behavioural and play therapies can help to conquer fears of certain social settings and provide coping techniques to reduce the impact that this condition has on quality of life.
It is thought that the pressure and expectation to talk and engage with certain people makes individuals with selective mutism completely freeze, with feelings of panic and anxiety being overwhelming enough to prevent individuals from speaking. This distressing response can lead to pattern of anticipating and ultimately avoiding situations where symptoms of the disorder may occur. While you or your child will be able to speak freely to people that you know, such as immediate family and close friends, triggers at school, work or certain social events can make functioning in everyday life incredibly difficult.
As the disorder is more common in childhood, throughout the rest of this page, we refer to selective mutism in children. Get the support you need today by calling us on: or sending an enquiry form online.
If you believe that your child may have selective mutism, it is important that you seek help and support from mental health professionals as soon as possible. Early diagnosis and treatment for the disorder can increase the chances of your child overcoming or vastly improving related symptoms.
If you are an adult with selective mutism, treatment can still be effective, although the process may take longer due to behaviours of the condition having become deep-seated over time. If your child has a co-existing mental health condition alongside selective mutism, such as depression or an anxiety disorder , or a learning disability that affects their ability to communicate, then this may affect how long or complex the treatment programme will be.
Treatment options at Priory focus on reducing associated anxiety symptoms surrounding speaking in certain situations, as opposed to simply focusing on the speech itself. Whether triggering scenarios are found during nursery, school, work or social settings, the aim of talking and behavioural therapies will be a progressive, step-by-step process to gradually reduce the pressure to speak, which is at the core of symptoms of selective mutism.
In order to reach this stage, therapies used in the treatment of selective mutism in both children and adults include:. This action-based and problem-solving talking therapy is carried out by highly trained therapists, where you or your older child can benefit from further understanding of the disorder and anxiety in general. The therapist will provide a range of techniques for managing anxiety during triggering situations, focusing on how negative thoughts and feelings may be contributing to anxiety symptoms.
Younger children can still benefit from CBT, although the focus will be less on detailed understanding of anxiety and how your child feels they fit in with the world around them, and more about assessing their general wellbeing.
The child may talk at ease with someone, such as a parent. In stimulus fading, another person is introduced to the situation. Then, as they become included in talking, the parent withdraws and talking continues. Many people with social anxiety and selective mutism will feel more comfortable through non-vocal means of communication such as instant messaging or emailing, which can be used before increased exposure.
In addition to this primary symptom, children must also display the following:. Children who stop talking temporarily after immigrating to a foreign country or experiencing a traumatic event would not be diagnosed with selective mutism. Because the condition tends to be quite rare, risk factors for the condition are not fully understood.
It was once believed that selective mutism was the result of childhood abuse, trauma, or upheaval. Research now suggests that the disorder is related to extreme social anxiety and that genetic predisposition is likely. Kids who develop the condition:. Other potential causes include temperament and the environment. Children who are behaviorally inhibited or who have language difficulties may be more prone to developing the condition.
Parents who have social anxiety and model inhibited behaviors may also play a role. Selective mutism is most receptive to treatment when it is caught early. If your child has been silent at school for two months or longer, it is important that treatment begin promptly.
When selective mutism is not caught early, there is a risk that your child will become used to not speaking, and as a result, being silent will become a way of life and more difficult to change. Treatment for selective mutism may include psychotherapy, medication, or a combination of the two. A common treatment for selective mutism is the use of behavior management programs. Medication may also be appropriate, particularly in severe or chronic cases, or when other methods have not resulted in improvement.
The choice of whether to use medication should be made in consultation with a doctor who has experience prescribing anxiety medication for children. In addition to seeking appropriate professional treatment, there are things that you can do to help your child manage their condition.
In general, there is a good prognosis for selective mutism. Unless there is another problem contributing to the condition, children generally function well in other areas and do not need to be placed in special education classes. Although it is possible for this disorder to continue through to adulthood, it is rare and more likely that social anxiety disorder would develop.
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