Medical Advice >> Pediatric Advisor

What is selective mutism?

The most common feature of selective mutism is when your child does not speak in social situations, including school, even though he can speak and understand spoken language. It used to be called elective mutism.

What are the characteristics of selective mutism?

You may notice your child is overly shy when she enters preschool or kindergarten and seems unable to talk to others in the new class. You may have noticed that your child had a limited group of people she spoke to before starting school. Then, after your child is in school for several months, you find out that your child is not talking there.

Some characteristics of selective mutism are:

1. Continues to not speak in social situations where talking is expected (such as school, Sunday school, play groups, around parents' friends), even though the child can speak in other situations (such as to family members).

2. The situations of "nontalking" begin to interfere with the child's school work and social development.

3. The difficulty lasts longer than a month.

4. The child has no other problems with language, such as lack of knowledge of the language or a problem such as stuttering.

5. The disorder occurs in about 1 child per 1,000; it is seen twice as often in girls.

6. These children often appear shy, afraid, or anxious. In the past, their silence was thought to be stubborn behavior. It is now thought that the anxious feeling makes them unable to speak.

Many parents are confused by their children's inability to speak because their children are often very outgoing and animated at home. Some children will talk easily on the phone to people they are unable to talk to face-to-face.

What is the cause?

The cause of selective mutism is not clear. Over the years, experts have suggested that an unpredictable environment might be a cause. Being a witness to a family conflict, experiencing a trauma before age 3, or being overly attached to one's mother may cause the mutism. More recently, researchers are suggesting that selective mutism is a sign of an anxiety disorder. Social phobia is an anxiety disorder in which people fear situations where they might say or do something embarrassing. People with this disorder often fear speaking in public or to strangers. People with social phobia often report being fearful of speaking when they were very young.

What is the treatment?

As children become older, there are fewer reports of selective mutism. This means that some children are able to begin speaking in public places without special help. Experts suggest that if the problem has lasted at least 6 months, parents should get professional help for their child.

Selective mutism is relatively rare. Your child's doctor should refer you to a therapist who knows about the disorder and has treated it before. It is important that the therapist get a very thorough medical, social, and psychological history from the child and family. Any treatment plan must involve the parents and include ways of dealing with this behavior at home.

It is also important to include teachers in the treatment plan. Many times teachers are unable to find out how much the child is learning. Often the treatment plan includes an educational in-service program for the teacher as well as specific recommendations for increasing the number of people your child will talk to.

Therapy

A number of treatments have been used by speech therapists, social workers, psychologists, and psychiatrists. The best results have come from behavioral therapy. Behavioral therapy is a treatment that helps families identify the problem and then plan a way to change it.

Many treatment plans begin by having the therapist watch your child through a one-way mirror while he plays with you. This is a good way to check if there are any problems with language development that are causing the mutism. If there are no language problems and your child acts normal, then the therapist "fades-in" slowly to become included in the family group. When your child is talking freely with the therapist, then the therapist can begin to help your child slowly expand the variety of people with whom she is able to talk. Often a reward system of some type is used as well.

Medication

In some recent cases in which anxiety was a problem, medication has been used along with behavioral therapy to help the child. This treatment should only be considered if the child has not responded to other therapy and is supervised by a pediatric psychiatrist familiar with the disorder.

How can I help my child?

1. Provide many opportunities for your child to watch you talking in a relaxed manner in a number of different situations such as in the neighborhood with friends, at school gatherings, and while ordering at fast food restaurants.

2. Always reinforce any attempt your child makes to speak in a public place by gently patting his or her shoulder or providing verbal praise in a soft voice.

3. Don't force talking or ridicule your child for not speaking. This is usually unsuccessful and often makes the child more anxious.

4. Don't talk about your child's problem to relatives or friends when the child is present. This also may make the child more anxious.

5. Provide many chances for your child to speak where she is comfortable. Usually that means in small groups of people that your child knows. If your child is more comfortable at home, it may be helpful to invite friends over frequently to encourage talking.

6. Many children who are shy begin to speak in new places after they have become familiar with the teacher, new children, or the place. If this does not happen and the shyness begins to affect a child's ability to progress in school and socially, it is time to seek help.

References

Selective Mutism Foundation
Caroline Miller, codirector
P.O. Box 13133
Sissonville, West Virginia 25360-0133

Selective Mutism Foundation
Sue Leszczyk, codirector
P.O. Box 4506
Sunrise, Florida 33345-0632

This content is reviewed periodically and is subject to change as new health information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.