Misti Nicholson, PsyD
Imagine walking into school, the grocery store, the mall, or church. As soon as you walk in, you are suddenly paralyzed with anxiety, unable to speak to anyone. You are unable to ask questions or get help with your basic needs. You struggle to make eye contact. For many children with selective mutism this crippling anxiety is part of everyday life.
Selective mutism is a childhood anxiety disorder that is diagnosed when a child consistently does not speak in some situations (i.e. at school, in public places), but speaks comfortably in others (i.e. at home with family). These children may even be considered a chatterbox when they feel they are in a safe place, but will immediately clam up in certain social situations.
Parents and teachers may think the child is refusing to speak or speak loud enough, but the child instead experiences it as an inability. Selective mutism can cause severe distress for the child, who cannot communicate when she is in pain, ill, or needs to use the restroom. It can also prevent children from socializing with other children and engaging in fun childhood experiences.
Your child may have selective mutism if he/she:
- speaks in certain settings, but stops talking either completely or almost completely, when around other people.
- looks frozen or even angry when interacting with strangers or when she feels uncomfortable.
- reverts to gestures or facial expressions to communicate needs.
These symptoms need to have occurred for more than a month, excluding the first month of school or while combating a language barrier. Parents often notice signs of selective mutism as early as age 3 or 4 years; however, most children with selective mutism are not diagnosed until they begin school and efforts to elicit speech have failed. Girls are twice as likely to develop selective mutism than boys, and approximately one percent of the population has selective mutism.
If you are concerned that your child may have selective mutism, please consult with your child’s pediatrician who will help assess hearing and screen for developmental delays. The next step is to meet with a child psychologist who will help confirm a diagnosis of selective mutism. Since young, anxious children with selective mutism have difficulty answering questions of strangers, the diagnosis relies heavily on reports from parents and other adults in the child’s life.
The most recommended treatment for selective mutism is cognitive behavioral therapy using controlled exposure. The therapist works with the child and with parents to gradually expose the child to increasingly difficult speaking tasks. In time, children gain confidence and learn that the anxiety they experience in social situations subsides without having to avoid the situation to find relief. The child should never be pressured to speak or tricked into speaking, which is ineffective and will often increase anxiety. Treatment goals should include development of coping strategies to manage and reduce anxiety. Treatment strategies should be multimodal and may include cognitive behavioral therapy, family therapy, school based and community based behavioral interventions.
When used in combination with multimodal treatment interventions, medication (typically selective serotonin reuptake inhibitors or SSRIs) can be helpful for some children with selective mutism, particularly if they have experienced symptoms for a long time, or are not responding to behavioral therapy. Typically, medication will be prescribed for a short time and is used to decrease anxiety enough to allow the child to participate in cognitive behavioral therapy. Medication is also used to treat depression, which can be common in older children and adolescents. A psychiatrist can help you decide if medication may be beneficial for your child.
October is Selective Mutism Awareness month, so whether you have a child who suffers from selective mutism, has recovered from the disorder, or you suspect they may be experiencing it, take this time to explain it to others. Selective mutism is more than shyness and it is not something that children “just grow out of.” In fact, symptoms tend to persist and worsen when untreated; however, with appropriate treatment, the prognosis for children with selective mutism appears to be excellent. Spread the word and help rid the silence!
For more information about selective mutism or to schedule an appointment with one of our selective mutism treatment specialists please call (512) 246-7225 or email us at [email protected]. We are currently accepting new patients at our Round Rock and Westlake therapy offices.