Selective mutism

Selective mutism or the 'silent period'?

A few children don’t manage the transition from silence to speech in spite of staff using the strategies suggested for children in the silent period. This small percentage of children is sometimes referred to as “selectively mute”; there is no physical reason for their lack of speech but in particular environments, for instance when at school, they do not speak. By contrast in other environments, for instance when at home with family members or friends, they are quite happy to talk.

Much of the recent research into selective mutism defines it as a form of social anxiety or phobia while people who have been able to reflect on their own experiences of selective mutism sometimes talk about their throats feeling “tight” or paralysed. The disorder is quite debilitating and emotionally painful to the selectively mute child. For children who come from bilingual families and have been exposed to another language during formative language development (2 – 4 years of age), the additional stress of ‘speaking another language’ and being insecure in their skills can cause an increase in their anxiety levels which can lead to mutism. Such children are usually innately shy and temperamentally inhibited and there is evidence to suggest that they may have a genetic predisposition to anxiety.

Common personality traits of selectively mute children:

• mutism (in specific environments)

• blank facial expression (when anxious)

• lack of smiling (when anxious)

• staring into space (when anxious)

• difficulty with eye contact (when anxious)

• frozen appearance (when anxious)

• awkward/stiff body language (when anxious)

• heightened sensitivity to surroundings, noise, crowds, touch

• excessive tendency to worry and have fears

• behavioural manifestations in the home environment such as moodiness, assertiveness, inflexibility, procrastination, bossiness, domination, extreme talkativeness, easily upset and prone to crying

• overly sensitive

Diagnostic criteria for selective mutism

A child meets the criteria for selective mutism if the following statements apply to him or her:

• Child does not speak in particular places such as school or other social events.

• Child speaks normally in settings where (s)he feels comfortable e.g. at home.

• Child’s inability to speak interferes with their ability to function in educational and/or social settings.

• Mutism has persisted for at least one month.

• Mutism is not caused by a communication disorder (e.g. stuttering) and does not occur as part of another mental disorder (e.g. autism).

Staff should monitor children’s progress over at least a term, implementing Priscilla Clarke’s strategies for use during the silent period to support children as they settle in but they should seek advice and support if the problem persists. Ignoring a child’s persistent silence can allow patterns of behaviour to become entrenched which makes it even more difficult for them to find a route to verbal self-expression later. If left untreated, there can be serious academic, social and emotional repercussions such as:

• development of worsening anxiety

• development of depression and/or other anxiety disorders

• social isolation and withdrawal

• poor self-esteem and low self-confidence

• school refusal, poor academic performance

• underachievement at school and in the workplace

• self-medication with drugs and/or alcohol

• crime

• suicidal thoughts and possible suicide

For these reasons, it is crucial that children are diagnosed and treated as early as possible.

Treatment approaches

Selectively mute children cause much concern for their parents and teachers whose increasingly desperate attempts to get a child to speak can compound the problem. Threats, cajoling, begging, bribery and punishment are counter-productive. Attention of this type will not help the selectively mute child to relax or feel any less self-conscious than they already do.

The main goals with treatment are to lower anxiety, increase self-esteem and increase confidence in social settings. The focus should never be on getting the child to talk: all expectations for verbalisation should be removed. If anxiety levels can be reduced and confidence developed, verbalisation will eventually follow.

Treatment can consist of a combination of:

• behaviour therapy (positive reinforcement and desensitisation)

• play therapy

• psychotherapy

• cognitive behavioural therapy

• medication (usually in the form of serotonin uptake inhibitors or drugs that act on one or more neurotransmitters). Although parents are often reluctant to start medication, it seems that many selectively mute children have a true biochemical imbalance and in many cases positive effects have been noted in as little as a week.

• self-esteem boosters

• frequent socialisation

• school involvement

• family involvement and parental acceptance

If children are diagnosed accurately and suitable treatment plans are put in place, the likelihood of them overcoming their selective mutism is strong.

Ways forward

Teachers should monitor a child causing concern carefully and consistently and seek help if the problem persists for more than a term. The child’s hearing should be checked and previous medical history obtained from the parents if possible.

Parents need to be informed if there are concerns about a child’s mutism: their help and support will be needed if the child does have the disorder. They may also be able to offer additional information about the child which can help with an early diagnosis.

Hampshire EMTAS may be able to assess the child’s first language skills. This can help to rule out other communication problems such as stuttering.

Selective Mutism Information and Research Association (SMIRA) is a UK-based charity that offers useful advice and support for teachers and parents. Their email address is: smiraleicester@hotmail.com

Referral to the family’s General Practitioner (GP).

Referral to a speech and language specialist and/or Educational Psychologist.

(Achievement Projects Strand © 2003)