Selective Mutism

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Selective Mutism

 

“Why doesn’t that child on the playground talk?” You have most likely, at some point in your life met a child who is so painfully shy that she is unable to speak, not even one word. Her mother will sheepishly whisper that her daughter is ‘just being shy’ ‘and she’ll grow out of it’, but what if it’s more than that?  What if she not only does not grow out of it…but she still won’t speak even once she reaches elementary school?  That shyness suddenly becomes a greater problem.  And it’s at that time when most parents, teachers and healthcare providers will begin the testing, and then concluding that the child suffers from a social anxiety disorder called ‘Selective Mutism’.

This anxiety disorder first diagnosed in 1934 was originally labeled ‘Elective Mutism’ and referred to a child as stubbornly refusing to speak, almost comparing it to a behavioral disorder.  However the term changed, and is now, in accordance with the new DSM-5 (The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) is a rare disorder and predominantly affects children, and generally recognized by the age of 5, once they begin school.  The child is commonly very happy and vivacious at home, but when in public, or at school they ‘freeze up’ and cannot respond, or communicate verbally or nonverbally, especially when there is an expectation of them to speak.  It is within these social situations that the symptoms of Selective Mutism will emerge.

Selective Mutism can carry on into adolescence and adulthood if not treated, which can interfere with public speaking and certain social functions.  In some cases, the disorder can be a precursor to other anxiety disorders such as agoraphobia or panic disorder.  Agoraphobia is an intense fear of wide open places, or events that involve a large number of people, and the individual suffering from agoraphobia will tend to stay in their homes for long periods of time, while panic disorder presents itself as severe physiological symptoms such as chest discomfort, numbness, flush, shaking and feelings of impending doom, which is uncontrollable, or unpreventable at the time.

Symptoms or behavior will vary from subtle to extreme including:

  • Excessive shyness
  • Incapability of speaking during certain social situations
  • Isolating behavior
  • Compulsive traits
  • Mild behavioral problems

The young child is often misunderstood, perhaps labeled as being stubborn or deliberately not wanting to engage in conversation, but in Selective Mutism this is far from the truth.  The child generally wishes to speak, but the anxiety within will not allow the words to come out.  Their vocal chords will not work and to try and escape the situation they may lower their head, or hide behind a parent. 

What causes Selective Mutism?

Selective Mutism tends to coexist with social phobia and social anxiety.  Therefore, a genetic component may be present meaning that this form of social anxiety could be inherited; otherwise the causes of this disorder are not yet known.  However, the disorder can be further aggravated by increasing expectations put onto them to speak.  It’s a negative cycle, the higher the expectation, the more difficulty they will have. 

The diagnosis of Selective Mutism is long and daunting, and early intervention is crucial as the longer a child lives with this disorder, the higher probability that the disorder will become increasingly difficult to treat, and the child will be more inclined to continue with this conditioned response.  One measure that has been successful in diagnosing children with various anxiety disorders is a test called (SCARED); ‘Screen for Child Anxiety Related Emotional Disorders’ in which the test consists of 41 questions and is a child and parent self-report test that has been proven to be reliable and valid. 

The Diagnosis Criteria for Selective Mutism;

  • Continual incapability to speak in certain situations, yet capable of speaking in a comfortable setting
  • Symptoms seriously interfere with school, employment, or social functions
  • Symptoms continue for at least one month
  • Symptoms are not related to language difficulties, or second language circumstances
  • Symptoms are not explicable in another anxiety disorder such as autism spectrum disorder

When Selective Mutism carries into adolescence and adulthood quality of life can be greatly hindered.  Depending on the severity of the disorder an individual may not even be able to order a meal at a restaurant, or hold a job.  However, the prognosis of recovery is very high, and most children that are treated immediately can outgrow the disorder and live a fulfilling life.

Treatments:

Successful treatments to date have been;

  • Behavioral and Cognitive Behavioral Therapy:  (CBT) the individual is taught a new way of interpreting their disorder, encouraging a new way of thinking
  • Behavioral Strategies:  a plan of action to slowly and gradually be given steps to increase communication efforts with positive reinforcement to help with the accomplishments
  • Systematic Desensitization:  relaxation techniques with gradual exposure to the fearful situation
  • Social Skills Training:  encouraging proper techniques of nonverbal communication such as eye contact and reading other peoples social cues
  • Medication:  SSRI’s (Selective Serotonin Reuptake Inhibitor) works best with (CBT)
  • Speech Language Therapy:  a slow progression from communicating through nonverbal gestures to communicating well and without hesitation

Living with someone that has Selective Mutism can be very challenging, however with understanding, patience and prompt treatment it is possible to overcome it and live a full and socially rewarding life.

Sources:

  1. http://www.dsm5.org/documents/changes%20from%20dsm-iv-tr%20to%20dsm-5.pdf
  2. http://www.selectivemutismcenter.org/aboutus/whatisselectivemutism
  3. http://www.theravive.com/therapedia/Selective-Mutism-DSM--5-312.23-(F94.0)
  4. https://www.psychologytoday.com/blog/shyness-is-nice/201110/scared-speechless-children-selective-mutism
  5. http://emedicine.medscape.com/article/917147-overview
  6. http://psychcentral.com/disorders/panic-disorder-symptoms/
  7. https://www.hindawi.com/journals/psychiatry/2014/517527/
  8. http://www.selectivemutismfoundation.org/info-on-selective-mutism/view-sm-in-the-dsm
  9. https://digest.bps.org.uk/2015/07/08/the-experiences-of-adults-with-selective-mutism-in-their-own-words/

 

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