Selective Mutism: Why Some Children Can’t Find Their Voice
Selective Mutism is the Result of Anxiety
Selective Mutism is an anxiety disorder, wherein children who are able to speak and speak freely at home, do not speak in other situations, such as birthday parties or at school. Sometimes these children speak to peers but not adults outside the home and, sometimes, they speak exclusively within the walls of their own homes, and only to immediate family members. Selective mutism was called “elective” mutism before 1994 when it was believed that these children refused to speak because they were oppositional and controlling. Since that time, selective mutism has been understood as a form of anxiety, closely associated with social anxiety. It is relatively rare, occurring at rates of about 1% in clinic and classroom samples, although some studies put the rate as high as 7% in children between 4 and 8 years of age. Children usually develop selective mutism before the age of 5 years but it may not become a problem until school entry.
Personality Traits Associated with Selective Mutism and Comorbid Conditions
The traits most associated with selective mutism are hypersensitivity, extreme shyness, perfectionism, inflexibility, negativism, temper tantrums, and mild oppositional behaviour, usually in situations requiring speech. Most common comorbid conditions are separation anxiety, specific phobia, and speech impediments. Most common misdiagnoses are Autistic Spectrum Disorder, Developmental Delay, and Oppositional Defiant Disorder.
What Triggers Selective Mutism?
Any number of events can trigger selective mutism including a move to a new community, learning a new language as a result of a move, teasing or bullying regarding the child’s speech, or entering kindergarten. Sensitive children who are not readily understood, and who have to repeat themselves frequently, may prefer not to speak at all.
Selective Mutism is Baffling
Parents, teachers, and peers often experience children with selective mutism as confusing, disturbing, and frustrating. Parents are embarrassed when their chatty child suddenly becomes silent in front of grandparents and friends, unable to say hello or make eye contact; a teacher can be offended and perplexed when she overhears a child whispering to a classmate animatedly in the schoolyard, and then sees that same child, frozen and silent, in response to her overtures in the classroom. Peers often perceive a child’s silence as odd or unfriendly, and they may avoid or tease the child in response. The longer the mutism continues, the longer the child remains stigmatized, and thwarted in his/her social development. In the worst instances, the children, parents, and teachers become embroiled in a battle of wills and recrimination, resulting in everyone’s distress.
The Child’s Perspective
Children with selective mutism are a diverse group in that some use nonverbal communication very effectively, some whisper to one or two friends who do their speaking for them, and some participate in a range of activities, while others are extremely withdrawn and isolated. All appear to suffer anxiety, self consciousness, frustration, and a sense of self as “abnormal,” or “incompetent.” Some children with selective mutism continue to be labeled ‘stubborn’ and/or ‘uncooperative’ which adds to their experience of being misunderstood, as well as undermining their self-esteem. The frustration and hurt feelings which accumulate during the day are usually expressed when they get home. Anger outbursts, tears, and temper tantrums are common when the child returns after a tiring day at school.
What Helps?
The goal is to facilitate the child’s speech in all situations and settings. Communication between teachers and parents is particularly vital as selectively mute children make huge distinctions between school and home, and function very differently in the two settings.
Tips for Teachers:
Explore with parents the best way to encourage the child and make him feel more comfortable at school; find some method to communicate with parents about significant day to day, or weekly events; encourage the parents to visit.
Build a positive, communicative, nonverbal relationship with the child who doesn’t speak. Many teachers worry that this approach will encourage the child to continue to be nonverbal but, in fact, it calms him and motivates him to participate, engage, and ultimately speak.
Invite the parents or an older sibling into the class for a private tour by the child during lunch or after school, and ask to be allowed to sit in as a silent observer. If denied, sit outside the class and hope to be invited to sit in on a subsequent visit. Don’t get too excited if you hear the child speak. Keep it low key.
For assessment purposes, ask the parents or an older sibling to come to the classroom to record the child telling a story about their favorite picture, identifying letters, or words, or reading if they are able.
Talk to the child without expecting her to respond verbally; make observations, suggestions, and direct her but refrain from asking questions which require a spoken response. The more these children are coaxed to speak, the more anxious and reticent they become.
If he is uncomfortable making eye contact, stand beside him or obliquely, and engage him by pointing at something or lightly touching his shoulder.
Encourage him to participate in small groups or with a child or children who are a suitable match, but don’t single him out, as this greatly increases anxiety.
Compliment her for any behaviour which is independent, competent, or involves taking a risk; create opportunities for her to help or lead, if she is able.
Although the child’s behaviour may be frustrating and defeating, remember that he is anxious not obstinate, or deliberately provocative.
Tips for Parents
The number one suggestion for parents is to invite classmates home to play. When a classmate or classmates have heard the child speak, they will encourage him to speak at school.
Don’t allow your child to give up, or accept that this is just the way he/she is. Your child needs to learn to speak at school and needs your support and encouragement.
Consult the teacher about a compatible child or children to invite; one child at a time is best as your child can’t avoid participating.
If your child is anxious about playdates, plan an activity and agree on a signal if assistance is required.
Discuss any potential difficulties and engage your child in problem solving about the potential difficulties.
Record your child’s voice as she describes a photograph or relates a story and play these for your child so that she can hear how she sounds, get comfortable with her voice and enjoy how well she speaks. Play the recording for grandparents, teachers or peers while your child listens; their delight will likely have a positive and rewarding effect.
Visit your child at school, talk to the teacher, say hello to the other children.
What Happens to Children Who Continue to be Mute at School?
As with most psychosocial difficulties, the sooner selective mutism is resolved, the better. Most children are able to overcome their anxiety about speaking in the classroom with patience and encouragement, although many will continue to be anxious and self-conscious about presentations, debates, and other forms of public speaking. Children who continue to be unable to speak at school for several years are usually stigmatized, marginalized, and perform poorly in academic, as well as social realms. As teens, they face increasing social isolation.
When to Seek a Mental Health Referral from Your Family Doctor
When your child is refusing to go to school or developing psychosomatic symptoms such as stomach aches and headaches.
When your child is having regular crying bouts, temper tantrums, or withdrawing at home.
When the teacher or principal is expressing concerns about your child’s isolation or withdrawal, and their inability to help.
If the mutism is getting worse or becoming more pervasive during the course of the first school year.
In cases where your child is experiencing extreme anxiety, an antianxiety medication may be helpful.
Last Word
With help, children who are selectively mute are usually just fine. However, they don’t ‘grow out’ of it, or spontaneously begin to speak at school or other settings. They need a concerted, practical, immediate plan to overcome their anxiety about speaking and expressing themselves outside their homes.
Resources:
Elaheh Bos, Leo’s Words Disappeared, Plant, Love, Grow, 2014.
Maggie Johnson and Alison Wintgens, Can I Tell You About Selective Mutism: A Guide for Friends, Family, and Professionals, Jessica Kingsley Publishers, 2012.
Sharon Longo, My Friend Daniel Doesn’t Talk, Routledge, 2017.
Ruth Perednik, The Selective Mutism Treatment Guide, Manuals for Parents, Teachers, and Therapists, Second Edition, Oaklands, 2011.
About The Author
Janet Morrison, M.A., C. Psych Assoc. is a psychological associate in private practice and a senior lecturer at the Factor-Inwentash Faculty of Social Work, University of Toronto. Over the past 30 years she has assessed, treated and supervised treatment of children in long-term care, as well as, consulted for Children's Aid Society and group homes across Ontario.