As another school year begins, it can be expected that some number of young children will approach the first day in the classroom with a fair amount of trepidation. For some, their shyness and anxiety will initially manifest itself in a failure to speak. But for a few – perhaps as many as 7 out of every 1,000 children – their silence will continue throughout the school year. These children may have a disorder known as selective mutism. “Children with selective mutism are fully capable of speaking and in fact generally communicate normally at home and in situations where they are relaxed and comfortable,” says Dr. Carly Orenstein, clinical psychologist with Morris Psychological Group. “These children are not willfully refusing to speak. They are actually unable to speak or communicate effectively in certain social settings, most notably school.” Morris Psychological Group is located at 50 Cherry Hill Road, Suite 305.
Almost all children with selective mutism also have social anxiety disorders. While an inability to speak might not show up until a child is exposed to social situations – most are diagnosed between the ages of 3 and 8 – in hindsight, many of these children showed signs of severe anxiety, timidity and fearfulness as infants and toddlers but were simply thought to be shy. They are often talkative and even boisterous at home but fearful and anxious in settings where there is the expectation of social interaction and communication. Some freeze in these situations and are expressionless, withdrawn and completely mute with both peers and adults while others seem relaxed and are able to communicate with a few select children, sometimes in a whisper.
It is thought that most children with selective mutism have inherited a predisposition to anxiety. Some affected children have one or more family members with a history of selective mutism, extreme shyness or anxiety disorders. It has been hypothesized that the timidity and fearfulness that characterize individuals with anxiety disorders is caused by a low threshold of excitability in the amygdala, a part of the brain involved in controlling emotional responses. When the child is in an uncomfortable or fearful scenario, the nervous system sends danger signals to the amygdala, which sets off a protective reaction, manifested in these children as withdrawal from the social situation. About 20-30% of children with selective mutism have speech or language abnormalities that place additional stress on the child and increase the anxiety in situations where there is an expectation to speak.
Tips for Parents
“Children with selective mutism should not be expected to simply grow out of it,” says Dr. Orenstein. “The earlier a child is diagnosed and treated, the better the prognosis. Left untreated, the mutism may become habitual and those around the child will stop expecting him or her to speak, reinforcing the social isolation and increasing the child’s anxiety.”
Dr. Orenstein advises parents who suspect selective mutism as follows:
- Do not pressure the child to speak. Convey understanding of the child’s fear and frustration and let him or her know that you can help. Offer positive reinforcement of the child’s efforts and successes.
- Excluding the first month or so of school, if the child’s failure to speak in specific situations continues for more than a month, talk to your pediatrician or consult a psychologist or psychiatrist. An experienced professional will be able to differentiate selective mutism from other disorders for which it is sometimes mistaken, including autism.
- The goal of treatment is to reduce the child’s anxiety and build up his or her confidence in social situations. There are several therapeutic approaches that have been successful, including behavioral therapy, in which the child is gradually introduced to social environments in a non-threatening way; and cognitive behavioral therapy, in which the child’s fear and anxiety are redirected to positive thoughts. The appropriate therapy for each child will depend on individual factors such as age, other conditions that may be present, and the duration and severity of mutism.
- Avoid any treatment plan that sees the child’s behavior as controlling or manipulative and recommends a disciplinary or punitive approach. This will only increase the child’s anxiety and reinforce the mutism.
“The most important thing for parents to realize is that selective mutism is caused by anxiety,” Dr. Orenstein concludes. “Pressure to speak from parents, teachers and peers simply intensifies the child’s fears and makes things worse. But with early intervention and a supportive environment, children can successfully overcome selective mutism.”
Dr. Carly Orenstein is a clinical psychologist with the Morris Psychological Group, Parsippany, who practices cognitive-behavior therapy with children, adolescents and adults through individual, family and group therapy.