Selective Mutism

Have you ever found a kid whom spoke only at certain place/setting and became mute in other places/settings? Or a kid in a kindergarten whom tent to mute while you knew exactly that he wasn’t deaf nor dumb? It could be selective mutism. Have you ever heard about it? To help you understanding selective mutism, here I share information I got about it. Let’s check this out!

What is Selective Mutism?

Selective mutism is a condition in which a child who can speak well stops speaking, usually in school or social settings.




How Common is Selective Mutism?

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), selective mutism is an apparently rare disorder that affects fewer than 1% of individuals seen in mental health settings.

How Many Types of Selective Mutism?

Previous research have identified different types of selective mutism and grouped them into four categories:

1. Transient Mutism (the most common). It is normally manifested at a younger age, before five years. It is short-lived but can often be misunderstood –selectively mute children are able to communicate non-verbally when they find it extremely difficult to speak in certain social surroundings. That said, they are perfectly confident in speaking at home or with close family and friends.
2. Migrant Children. Mutism in these children arises as a result of lack of confidence in speaking a new language. This phobia evades over time but as noted by Australian child psychologist, Dr Louise Porter, migrant children’s mutism could sometimes be the effect of post-traumatic stress, particularly refugees.
3. Secondary. This is believed to be only secondary to other medical problems, affecting around 30 per cent of selectively mute children. Conditions that are likely to lead to selective mutism include Asperger's Syndrome, delays in childhood developments and speech difficulties.
4. Persistent. It has all the characteristics of transient mutism but lasts for a longer period of time, typically three or more years, and is rare. Sufferers of this type of selective mutism are thought to be overall anxious in other aspects of their lives.

What Causes Selective Mutism?

The cause of selective mutism is unknown. Most experts believe that children with the condition inherit a tendency to be anxious and inhibited. Most children with this condition have some form of extreme social phobia. Parents often think that the child is refusing to speak, but usually the child is truly unable to speak in certain settings. Many times a child with selective mutism has or is experiencing inner self/self-esteem issues, a speech, language, or hearing problem, and trauma. Some affected children have a family history of selective mutism, extreme shyness, or anxiety disorders, which may increase their risk for similar problems. This condition is most common in children under age 5.

This syndrome is not the same as mutism. In selective mutism, the child has the ability to both understand and speak, but fails to speak in certain settings or environments. Children with mutism never speak.

What are Some Signs or Symptoms of Selective Mutism?

• Consistent failure to speak in certain social situations specific social situations (in which there is an expectation for speaking, such as at school) despite speaking in other situations (especially at home with family).
• Not speaking interferes with school or work, or with social communication.
• Failure to speak is not due to a lack of knowledge of, or comfort, with the spoken language required in the social situation
• Not due to a communication disorder (e.g., stuttering). It does not occur exclusively during the course of a pervasive developmental disorder (PPD), schizophrenia, or other psychotic disorder.
• Anxiety disorder (e.g., social phobia)
• Excessive shyness
• Fear of social embarrassment
• Social isolation and withdrawal

This pattern of mutism must be observed for at least 1 month. (The first month of school does not count, because shyness is common during this period.)

How is Selective Mutism Diagnosed?

A child with selective mutism should be seen by a Speech-Language Pathologist (SLP), in addition to a pediatrician and a psychologist or psychiatrist. These professionals will work as a team with teachers, family, and the individual.

It is important that a complete background history is gathered, as well as an educational history review, hearing screening, oral-motor examination, parent/caregiver interview, and a speech and language evaluation.

The educational history review seeks information on:

• academic reports
• parent/teacher comments
• previous testing (e.g., psychological)
• standardized testing

The hearing screening seeks information on:

• hearing ability
• possibility of middle ear infection

The oral-motor examination seeks information on:

• coordination of muscles in lips, jaw,and tongue
• strength of muscles in the lips, jaw, and tongue

The parent/caregiver interview seeks information on:

• any suspected problems (e.g., schizophrenia, pervasive developmental disorder);
• environmental factors (e.g., amount of language stimulation)
• child's amount and location of verbal expression (e.g., how he acts on playground with other children and adults)
• child's symptom history (e.g., onset and behavior)
• family history (e.g., psychiatric, personality, and/or physical problems)
• speech and language development (e.g., how well does the child express himself and understand others)

The speech and language evaluation seeks information on:

• expressive language ability (e.g., parents may have to help lead a structured story telling or bring home videotape with child talking if he or she refuses to do so with the SLP)
• language comprehension (e.g., standardized tests and informal observations)
• verbal and non-verbal communication (e.g., look at pretend play, drawing)

To contact a speech-language pathologist, visit ASHA's Find a Professional.

What Treatments are Available For Individuals With Selective Mutism?

The type of intervention offered by an SLP will differ depending on the needs of the child and his or her family. The child's treatment may use a combination of strategies, again depending on individual needs. The SLP may create a behavioral treatment program, focus on specific speech and language problems, and/or work in the child's classroom with teachers.

A behavioral treatment program may include the following:

1. Stimulus fading: involve the child in a relaxed situation with someone they talk to freely, and then very gradually introduce a new person into the room
2. Shaping: use a structured approach to reinforce all efforts by the child to communicate, (e.g., gestures, mouthing or whispering) until audible speech is achieved
3. Self-modeling technique: have child watch videotapes of himself or herself performing the desired behavior (e.g., communicating effectively at home) to facilitate self-confidence and carry over this behavior into the classroom or setting where mutism occurs.

If specific speech and language problems exist, the SLP will:

1. target problems that are making the mute behavior worse;
2. use role-play activities to help the child to gain confidence speaking to different listeners in a variety of settings; and
3. help those children who do not speak because they feel their voice "sounds funny".

Work with the child's teachers includes:

• encouraging communication and lessening anxiety about speaking;
• forming small, cooperative groups that are less intimidating to the child;
• helping the child communicate with peers in a group by first using non-verbal methods (e.g., signals or cards) and gradually adding goals that lead to speech; and
• working with the child, family, and teachers to generalize learned communication behaviors into other speaking situations.

How Long It would be Last?

Children with this syndrome can have different outcomes. Some may need to continue therapy for shyness and social anxiety into the teenage years, and possibly into adulthood.

What’s the Possible Complications It Can Cause?

Selective mutism can affect the child's ability to function in school or social settings. Without treatment, symptoms may get worse.

When to Contact a Medical Professional?

Call your health care provider if your child has symptoms of selective mutism, and it is affecting school and social activities.

What Other Organizations Have Information On Selective Mutism?

ASHA's Find a Professional

K12 Academics

NYU Child Study Center

Selective Mutism Foundation

Selective Mutism and Childhood Anxiety Disorders Group

Selective mutism support groups.

References:

American Speech-Language-Hearing Association. (2010). Selective mutism. Accessed on January 20, 2011. Available at http://www.asha.org/public/speech/disorders/SelectiveMutismCauses.htm.

Cunningham, CE. Selective Mutism Group. Understanding Selective Mutism: Tips for Parents and Educators (accessed February 18, 2010).

Simms MD, Schum RL. (2007). Language development and communication disorders. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson textbook of pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier.

Stafford B, Boris NW, Dalton R. (2007). Anxiety disorders. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson textbook of pediatrics. 18th Ed. Philadelphia, Pa: Saunders Elsevier.

Victor AM, Bernstein GA. (2009). Anxiety disorders and posttraumatic stress disorder update. Psychiatr Clin North Am 32:57-69.

Vorvick, LJ. (28 February 2010). Selective mutism. Accessed on January 20, 2011. Available at http://www.nlm.nih.gov/medlineplus/speechandcommunicationdisorders.html.