Selective Mutism - Understanding Different Types of Anxiety
Learn more about Selective Mutism, it's symptoms, reasons why it happens, how to get a diagnosis, and possible treatments for kids with this type of anxiety.
<1% of kids develop selective mutism.
According to the NHS, about one in every 140 young children is affected by selective mutism.
Children who suffer from severe anxiety, known as selective mutism, cannot talk in specific social situations, such as when they are around their classmates at school or with relatives they do not see very often.
In most cases, the condition manifests itself throughout childhood and, if untreated, can continue into adulthood.
A kid or teenager who suffers from selective mutism does not make a conscious decision to remain silent during particular situations; rather, they are physically incapable of not doing so.
It is impossible to speak because the anticipation of having to converse with specific individuals sets off a freeze response, accompanied by feelings of terror similar to those experienced by someone suffering from severe stage fright.
Over time, they will gain the ability to recognise the circumstances that lead to this distressing reaction and do everything in their power to steer clear of them.
On the other hand, children with selective mutism can communicate freely with particular people, such as members of their immediate family and close friends, when no one is there to cause the freeze response.
Symptoms of the Selective Mutism Disorder
In most cases, the onset of selective mutism occurs in early childhood, between the ages of 2 and 4.
It is common for it to be seen for the first time when the child begins to engage with individuals who are not members of their immediate family, such as when they join nursery school or school.
The primary warning sign is the mfost significant difference in the child's capacity to interact with various individuals. This difference is characterized by an abrupt immobility and a frozen facial expression when the child is asked to speak to someone outside their comfort zone.
They might also avoid making eye contact and come across as:
Timid, shy, withdrawn, rigid, tense, or badly coordinated, stubborn or belligerent, temper tantrums when returning home from school, or upset when parents are questioned.
Some children with selective mutism, especially those who are more confident, may be able to use gestures to express themselves, such as nodding their head to indicate "yes" or shaking it to mean "no."
Most of these kids really want to communicate - but can’t because their anxiety stops them.
However, children affected more seriously tend to avoid speaking, writing, or gestural communication.
Why Do Some Children Choose Not to Speak?
According to the medical community's consensus, selective mutism is a phobia of communicating with particular individuals.
The child will typically tend toward anxiousness and will have difficulties remaining calm in the face of the typical stresses of daily life.
When they are taken away from their parents, many kids become so upset that they can't even talk, passing that worry on to the professionals trying to calm them down.
Speaking can be a very unpleasant experience for children who struggle with speech and language disorders, hearing problems, or both.
A disorder known as sensory integration dysfunction causes certain toddlers to have difficulty integrating sensory input, such as intense noise and the jostling that occurs in crowds.
When faced with an overwhelming situation, this may cause them to "shut down" and be unable to communicate verbally.
Mutism, as a sign of post-traumatic stress disorder, has its specific course. The child will suddenly cease talking in settings where they had no problems communicating verbally in the past.
However, if the causes of the child's reluctance to speak are not addressed, the child goes on to acquire a more generalised fear of communicating with others.
As a result, the child may eventually develop selective mutism.
Another common fallacy is the idea that a child with selective mutism is authoritarian or manipulative or that they have autism. There is no correlation between autism and selective mutism; a kid can have both conditions simultaneously.
The Importance of a Selective Mutism Diagnosis
In the absence of treatment, selective mutism can develop into a larger social anxiety disorder, low self-esteem, and social isolation.
This issue, if left untreated, can follow a person into adulthood.
How to get a Selective Mutism Diagnosis in Children
If the condition is correctly identified and treated in a child at a young age, selective mutism can be effectively overcome.
Families and schools should aim to get an early diagnosis of selective mutism in children to collaborate on alleviating the stress that the condition causes.
It is possible for the staff working in early childhood institutions and schools to undergo training to improve their ability to give appropriate support.
Parents and carers can also seek a referral to a speech and language therapy clinic by speaking with a health professional or primary doctor. Alternatively, you can call your medical clinic directly.
If you’re concerned about your child not speaking, get a second opinions and don’t listen to people who tell you that your child's problem will go away as they get older or that they are "just shy."
It is possible that older children need to consult with a mental health professional or an educational psychologist at their school.
The health professional may first want to speak with you separately to your child so that you are free to discuss any concerns regarding your child's behaviour or development without being interrupted by your child.
They will want to know whether there is a family history of anxiety disorders and if anything is giving the child distress, such as a disruption in their routine or trouble learning a second language.
In addition, they will most likely conduct a thorough medical history and examine the individual's behavioural features.
A child suffering from selective mutism may be unable to talk during their evaluation but the clinician must be prepared for this possibility and be open to establishing alternative methods of communication.
Alternative Forms of Communication for Kids with Mutism
If a child is suffering from selective mutism, they may recommend alternative methods of communication with their parents, such as writing down or typing in their answers.
They could also suggest the child get acquainted with a computer.
Diagnosing Selective Mutism
The diagnosis of selective mutism is conducted according to certain protocols. These contain the following observations regarding the child in question:
This incapacity to talk has endured for at least one month (2 months in a new setting)
Their inability to talk makes it impossible for them to function in that context; no other behavioural, mental, or communicative impairment adequately explains their failure to communicate.
Situations when kids get Selective Mutism
Kids can sometimes develop selective mutism in large groups or particular social situations.
Kids can’t speak in front of new people, large groups or educators
Kids can’t speak in front of other people knowing they might be overhead by strangers
Kids might avoid anything that would put focus on them
Kids might find it hard to make friends or join in with other kids activities - event when invited
Kids struggle to voice their needs e.g. putting their hand up in class to go to the bathroom or speaking to a teacher when they need help
Problems Associated With Selective Mutism
A child who suffers from selective mutism will typically struggle with other phobias - especially social anxieties - and may also have additional difficulties with speech and language.
They frequently avoid doing anything that might bring attention to themselves because they believe that if they do, others will anticipate that they will have something to say in response.
For instance, a kid may not perform to the best of their potential in class if they observe other children being asked to read homework aloud, or they may be reluctant to alter their routine if doing so prompts remarks or inquiries from the teacher or other students.
Children of school age may choose not to eat or drink anything during the day, so they do not have to excuse themselves to go to the bathroom.
Because they cannot ask questions during class, children may have trouble completing some homework tasks or understanding particular subjects.
It's possible that adolescents won't establish their independence if they're too terrified to venture out of the house on their own.
In addition, they might not have the necessary qualifications since they cannot participate in college life or the interviews that follow.
Strategies of Managing Selective Mutism Through Treatment
The majority of children can overcome selective mutism if they are handled and treated appropriately. However, it will take longer for them to heal the older they are when the problem is discovered.
The following factors will determine the treatment's success:
How long has the individual been suffering from selective mutism
Whether or not they struggle with additional communication, learning challenges, or fears, the cooperation of everyone associated with their school and home life is essential for their success.
The actual act of speaking is not the primary focus of treatment; rather, the treatment is directed toward lessening the anxiety associated with speaking.
To do this, first, remove any pressure the person may feel to talk. Then, they should gradually progress from speaking in fragments in school, nursery, or social settings to speaking in entire sentences to one person and ultimately be able to converse freely in all contexts with everyone.
If the kid's family and the staff in early years settings collaborate to minimise the child's anxiety by cultivating a pleasant environment, then the need for the child to receive individual treatment may be eliminated.
How famillies can support kids with selective mutism:
Not communicating your anxiety to the child.
Instead, reassure them that they can speak when they feel ready.
Acknowledging the child's attempts to join and interact with others, like passing and receiving toys, nodding, and pointing.
Not being surprised by the child's speech.
In addition to these environmental modifications, older children may need direct assistance to overcome their anxiety.
Cognitive Behavioural Therapy
A child getting cognitive-behavioural therapy (CBT) is assisted in focusing on how they think about themselves, the world, and other people and how their perceptions of these factors influence their thoughts and emotions.
In addition to this, CBT uses a technique called graded exposure to challenge their fears and preconceptions.
Older children who have grown up with selective mutism are the best candidates for cognitive behavioural therapy (CBT), administered by trained professionals in the mental health field and best suited for treating social anxiety disorder in adolescents.
Approaches based on cognitive behavioural therapy (CBT) designed to support the general well-being of younger children can also be beneficial.
For instance, this may involve discussing anxiety, understanding how it affects their body and behavior, and learning various techniques or strategies for managing stress or coping with its symptoms.
Treatment Techniques
Several effective treatments for selective mutism are derived from cognitive behavioural therapy (CBT) and behavioural therapy.
Children, their families, and staff members at schools or colleges can utilise these simultaneously, albeit maybe with the assistance of a speech-language pathologist or psychologist.
Exposition that increases gradually
In graded exposure, individuals begin by confronting the situations that produce the least amount of anxiety.
The anxiety that comes with these circumstances can be brought down to a more bearable level with the help of realistic goals and regular exposure.
Stimulus fading
In stimulus fading, a child with selective mutism can converse normally with a specific individual—for example, their parent—when there is no one around.
A third party is brought into the scenario, and the parent removes themselves from the setting after they are involved in the conversation. The newcomer can introduce additional people to the group in the same manner.
Shaping
The process of shaping involves the application of any strategy that enables the child to produce a response closer to the desired behavior gradually.
For instance, beginning with reading out loud, then moving on to taking turns reading, then moving on to interactive reading games, structured talking exercises, and lastly, having a dialogue back and forth between the two of you.
Desensitisation
Desensitisation is a technique that involves lowering a person's sensitivity to the sound of their voice being heard by others by having them listen to or watch recordings of themselves speaking.
For instance, a conversation that begins via email or instant messaging may eventually evolve into an exchange of voice recordings or voicemail messages, followed by more direct modes of contact such as telephone or Skype talks.
Reinforcement of both the positive and the bad
In both positive and negative reinforcement, it is important to respond favorably to all kinds of communication and to avoid fostering avoidance and silence unwittingly.
If the child is under pressure to talk, they will feel a huge sense of relief after the moment has passed, confirming their idea that talking is a terrible experience. However, if the child is not under pressure to say, they will not experience this sense of release.
Parents can encourage using non-verbal communication, signs or written language to engage them in conversation.
Medicine
Only older children and adolescents might consider medication for their condition, especially those whose anxiety has progressed to depression and other issues.
Patients must never get prescriptions for medication as a replacement for making lifestyle and environmental adjustments. In older children suffering from selective mutism, however, a mix of medication and behavioural therapy is recommended by several medical authorities.
Antidepressants, on the other hand, can be used in conjunction with a treatment program to reduce anxiety levels. This is particularly effective when prior efforts to get the child to participate in treatment have been unsuccessful.
Advice for Parents of Kids with Selective Mutism
If you want your child to talk more, try not to force them or bribe them in any way.
Give your child the reassurance that you understand that they struggle to communicate due to their fear of doing so and that you do understand.
Reassure them that communicating will become less difficult over time and tell them they can take baby steps whenever they feel ready.
It is best to avoid praising your child for speaking in public because this can make them feel embarrassed.
Assure your child that it is acceptable for them to communicate with non-verbal gestures such as smiling and waving until they feel more comfortable talking.
You should not avoid having your child attend family gatherings or parties. Still, it would be best to consider how the environment can be modified to make the situation more comfortable for your child.
Make requests of your child's friends and relatives to give your child time to warm up at their own pace and that they instead focus on getting your child to talk about fun activities.
In addition to providing verbal reassurance, show them love and support while also being patient.