Selective Mutism: When There’s More To It Than ‘Being Shy’

What Is Selective Mutism?

Selective mutism is a fear of speaking in certain situations or environments and is viewed as an anxiety disorder. The majority of children with selective mutism also have a diagnosis of social phobia.

Characteristics of Selectively Mute Children

Selectively mute children do not speak in certain situations, usually where they are in the care of others, like in kindergarten, occasional care or school, yet speak freely at home. In fact some parents say that at home, their children don’t stop talking – so much so that they wish they would speak a little less! Studies say that selectively mute children are most likely to speak at home, less likely to speak out of the home (e.g. supermarket) and least likely to speak at school.

Children with selective mutism usually do not speak to teachers, principals, teaching assistants and other students.

When selectively mute children are placed in a situation where they are expected to speak, they often look down or away, bite their lip, blush, freeze up, hide behind their hair or display other signs of anxiety.

They may make non-verbal gestures as a way to communicate, for example pointing or nodding, but they avoid making any noise (and usually eye contact) which may draw attention to themselves, like laughing, coughing or any other sounds. These children become so clever at communicating non-verbally that teachers and carers can often work out or know what the child wants by the expression used by the child.

When Do Children Commonly Display Signs Of Selective Mutism?

The symptoms of selective mutism typically present around three years of age, although some parents do say that they believe that their child has been that way from birth. However with the introduction to kindergartens and increased social exposure, selective mutism is more likely to be picked up at this age. Of course, many cases of selective mutism are not picked up and these children continue onto school.

Signs are usually present by the age of five, but many parents may not be able to recognise this until their child is in school, when it is harder to treat – as early as possible is the best way to treat it.

Who Treats A Child With Selective Mutism?

As a mother of a child with Selective Mutism, this is something I found very confusing, at a time when I was already overwhelmed with the likelihood that my daughter had this condition. On doing reasearch on the internet, there were speech therapists saying it is their domain, with psychologists saying the same. I didn’t even know where to start.

However to save you much confusion, start with a children’s clinical psychologist (as opposed to a regular child psychologist – clinical psychologists have Masters Degrees and have greater depth of training and experience in general for children with anxiety disorders) making sure that they have good experience with selective mutism. They can then establish if the selective mutism comes from a speech problem, requiring a speech therapist. But children like my daughter who are very confident with language and speak clearly to those close to them, do not need a speech therapist.

Another challenge is that very few professionals are experienced in the treatment of selective mutism. I had to contact many psychologists and ask about their experience with selective mutism before I found the right person. The majority of responses were, ‘I’ve heard of it, but not worked with it,’ or, ‘I’ve worked with one or two children who had it.’ So it’s very hard to track down professionals with this experience. But it’s so important to do your homework as it can make a huge difference in your child’s improvement.

The Progress of Selective Mutism

According to the book, Helping Your Child With Selective Mutism by McHolm et al, the following ten step ‘Conversational Ladder’ exists for children with Selective Mutism as they improve.

• Stage 1: Complete Mutism. Child speaks at home but is silent at school/kinder. Appears anxious at school and may resist going to school.

• Stage 2: Relaxed Nonverbal Participation. Child speaks at home but not at school. Begins relaxing and participating nonverbally in classroom activities. May begin to talk positively about school.

• Stage 3: Speaks to Parent At School. Child speaks at school when alone with a parent in a place where students and teachers cannot hear or see, often in a whispered voice.

• Stage 4: Speaking Observed By Peers. Child speaks at school, usually to a parent. Peers observe but do not hear the child speaking since he typically whispers so quietly as to be inaudible to observers.

• Stage 5: Speaking Overheard By Peers. Child speaks audibly at school, usually to a parent. Other children observe and hear the child speaking. Child does not speak directly to other teachers or peers.

• Stage 6: Speaking Through Parent To Peers. Child speaks to parent who conveys message to another classmate sitting closeby. The classmate may overhear the child and respond directly.

• Stage 7: Speaking to Peers. Child speaks at school to one peer, often on the playground. Child does not speak to teachers.

• Stage 8: Speaking to Several Peers. Child speaks to several children at school. Child does not speak to teachers.

• Stage 9: Speaking to Teacher. Child begins speaking to teacher and speaks to several peers.

• Stage 10: Normal speaking. Child speaks to most adults and peers in a normal conversational tone.

How Long Does Treatment Take?

It is an ongoing process to treat selective mutism and can take months or years. So be prepared to be in for the long haul and in conjunction with a psychologist, inform yourself through books which are available on the topic (see below).

How Common Is Selective Mutism?

Dr. Elizabeth Woodcock of the Selective Mutism Clinic in NSW says that approximately 1 in 100 children in the first three years of school are thought to have selective mutism. This rate is comparable to other disorders such as depression, and higher than that for autism.

Around one third of children with selective mutism also have language impairments, and there is an increased prevalence in bilingual families.

It is slightly more common in females than males.

A proportion of children are suggested to have a transient form of mutism that tends to remit without treatment, however, for other children the failure to speak can persist into adolescence or early adulthood. Parents and schools often delay seeking treatment due to the common expectation that the child will outgrow the behaviour. Thus, treatment is often sought after the child has failed to speak for four to five years, at which time the child may experience secondary social and emotional problems and treatment is much more difficult.

Research also suggests that of those children who do begin to speak without treatment, a proportion continue to experience clinically significant levels of anxiety as well as social and academic difficulties and communication deficits.

Tips For Parents With Selectively Mute Children

• Don’t force your child to speak or punish them for not speaking. They need your understanding and are not being difficult, they may be frozen with anxiety or fear.

• Inform yourself; read books, research on the internet, join forums – find out as much as you can about it, as the more you know, the easier life will be for all of you.

• Inform your child’s teacher/carer by giving them information. You can download some information for teachers and others at the selectivemutism.org website.

• Avoid speaking about your child’s selective mutism in front of them. I find the more I talk about it in front of others, its seems the more she feels she has to live up to that expectation. When I say less, she takes bigger steps.

• Seek help. I would not have coped without the constant support of our child psychologist, who was there to reassure me as a mother. Because things can be a little different, it’s easy to doubt yourself and if you are doing the right thing.

• Prepare your child for changes ahead of time, i.e. when they will be around people they are not familiar with or comfortable with. If you are due to have visitors, let your child know ahead of time. If you are going to visit someone else, again, let them know so they know. Sometimes I would set up something for my daughter to do so she could be kept busy without the expectation to interact, e.g. get out some colouring books and pencils, puzzles etc – away from the visitors.

• Don’t blame yourself. It’s nothing to do with your parenting skills or who you are. Some children are just more prone to anxiety (makes sense in my family – both my partner and I have suffered anxiety as children and I have post-natally), so just like any other condition or problem, they can have the genes for it. All you can do is to work with it and not let your child see that Selective Mutism is creating anxiety for YOU!

A good self-help book for parents is:

McHolm, A. E., Cunningham, C. E., & Vanier, M. K. (2005). Helping Your Child With Selective Mutism: Practical Steps to Overcome a Fear of Speaking. Oakland, CA: New Harbinger. BellyBelly stocks it in our online store here.

However, Dr. Woodcock recommends that parents use the book only in conjunction with receiving help from a professional that is experienced in the treatment of selective mutism.

Dr Elizabeth Woodcock of the Selective Mutism Clinic practices in Sydney – you can visit her website at www.selectivemutism.com.au. Another very helpful support and information site is www.selectivemutism.org.

Kelly Zantey is a birth attendant (aka doula) the creator of BellyBelly, mum to two beautiful children and has just opened the BellyBelly Pregnancy Centre in Canterbury, VIC.