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.
