Selective Mutism

Do you know a child who speaks freely at home but does not utter a word in school or social situations? The child is not refusing to speak; he or she is most likely not able to speak, as is if frozen by fear or anxiety. Selective mutism is a social anxiety disorder, and most children with this condition tend to be more anxious, inhibited, and shy than other children and may even have some form of social phobia.

While the causes are unknown, a family history of anxiety disorders or shyness can increase a child’s risk of developing this condition. Experiencing a traumatic event early in a child’s life can also be a risk factor. Selective mutism often starts before a child is five years old but is usually first noticed only when the child starts school.

If a child exhibits the following symptoms for over one month (shyness is common at the start of any school year), a diagnosis of selective mutism may be given:

• Ability to speak at home with family
• Inability to speak in certain social situations
• Fear or anxiety around people the child does not know well
• Shyness

Selective mutism is mostly observed in a school setting. As such, several treatment techniques can be utilized by the teacher and school psychologist/counselor.

Shaping: The teacher reinforces all efforts by the child to communicate. A reward, often as simple as verbal praise, can be given when the child uses gestures, mouthing, or whispering a word until audible speech is achieved.

Small group instruction: Small groups are less intimidating to a child. Being with familiar peers and being given less attention may lower the child’s anxiety level and lead the way to increased opportunities for verbal expression. This may begin as nonverbal signals and may gradually lead to sounds, then words.

Play Therapy: In this type of therapy, a child is seen in a playroom filled with age-appropriate toys. The pressure to talk or interact directly with the therapist is removed. The child uses the toys to express his or her feelings and thoughts. The therapist makes comments and observations in order to help clarify the child’s feelings. Due to the familiarity of the therapist and the one-on-one environment, the child may begin to vocalize by whispering or making sounds. For example, the child may have the toy dog bark. Once he or she feels comfortable and safe making sounds, the child may begin to use words and then sentences.

Group Therapy: In addition to individual play therapy, the therapist may also provide group therapy in the classroom. Entering the classroom during free play time, the therapist can facilitate a small group, two or three children, to help the child generalize to the classroom the feeling of safety when speaking in the one-on-one therapy room.

While this disorder is quite rare, occurring in less than 1% of individuals seen in mental health settings, according to the DSM-IV-TR, children with this disorder, with support and a treatment plan in place, can overcome the fear of talking in social situations. While they may always be shy or have social anxieties, the diagnosis of selective mutism is usually short-lived. By providing a safe and encouraging environment, the teacher or counselor can create a safe place for the child to voice their ideas and feelings.