Selective Mutism

Is a rare condition occurring in childhood. Selective Mutism is characterized by a consistent failure to speak in specific social situations in which there is an expectation for speaking. Children with this disorder have the ability to both speak and understand language, but fail to use this ability. Most children who experience selective mutism function normally in other areas of their lives. Selective mutism is not a communications disorder and is not part of a developmental disorder. Therefore by definition, the disorder does not include children with conduct disorders, oppositional defiant behavior, and/or attention-deficit hyperactivity disorder. The main characteristics are:

Does not speak in certain places; such as school or other social events.

Can speak normally in other settings such as in their home or in places where they are comfortable and relaxed.

The 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.

Associated Features:

Psychological trauma or stressors may be apparent particularly during the time of speech development.

A particular mother profile and mother-child relationship (maternal anxiety, depression, dependence and a domineering and overprotective approach to the child).

Minimal brain dysfunction.

History of developmental delays and speech and language disabilities.

Neuropsychological social cue processing disorder.

Anxious temperament: shyness, worry, social avoidance,fearful, social withdrawal clinging, Negativism

Differential Diagnosis :

Some disorders have similar symptoms. The clinician, therefore, in his diagnostic attempt, has to differentiate against the following disorders which need to be ruled out to establish a precise diagnosis.

The problem appears to be anxiety. This anxiety, which causes avoidance, seems closest to the definition of social anxiety disorder (social phobia).

Transient Adaptional Shyness in an adjustment disorder.
Mental Retardation.
Pervasive Developmental Disorders
Expressive Language Disorders
Mood Disorders
Hearing Impairment.

Cause:

At the present time, it cannot be said with any certainty however, the apparent cause of selective mutism is due to a psychologically determined refusal to speak. Some children have histories of speech problems or delay of onset of speech. Problems within the family or at school appear to acerbate this disorder. Young children have a higher incidence of this disorder.

Research has indicated that most children with this disorder are very shy and anxious when interacting with unfamiliar persons, or in any situation where they feel that they are the center of attention or are being observed or evaluated. In fact, it seems likely that in many cases, selective mutism is no more than an extreme shyness or an early childhood form of “public speaking anxiety.” Many of the children we have studied have parents or siblings who have suffered from selective mutism or from extreme shyness. This observation, suggests that a vulnerability or tendency to develop the disorder is passed on genetically.

Treatment:

Individual, behavioral, and family counseling are the best approaches to this type of disorder.

Many children seem to improve over time without any specific treatment. The process of deciding when and how to treat a child with selective mutism is a complex one. Multiple factors must be considered, including: the severity, how much is it interfering with the child’s academic and social development.

For children who have been in school for less than 3 to 4 months, treatment may not be recommended, unless there are other significant problems in addition to the selective mutism and shyness. In these cases, watching and waiting is usually the wisest course. For children who have been in school more than 3 to 4 months, CBT with an experienced therapist is recommended.

Counseling and Psychotherapy [ See Therapy Section ]:

It appears that cognitive-behavioral therapy, with the emphasis being on the behavioral component, depending on the age of the child, is the therapy of choice.

Gentle and consistent encouragement, support, and reassurance are most likely to be helpful. Struggles between the child and adults, particularly regarding speaking, should be avoided as much as possible. Attempts to pressure, demand, or force the child to speak, to trick the child into speaking, or to punish or shame the child for not speaking are most often counter-productive.

Pharmacotherapy [ See Psychopharmacology Section ] :

For more severe or persistent cases, trial of treatment with a medication called fluoxetine (Prozac) may be recommended.