In the popular American sitcom “The Big Bang Theory”, one character simply can not bring himself to speak to women. He is so shy and nervous that instead he has to whisper into his male friends’ ears to communicate anytime a woman is present. His affliction makes for some funny situations on television, but in real life, selective mutism is not the stuff of comedy.
Selective mutism is childhood anxiety disorder whereby children can not speak in certain social settings, such as at school, family gatherings, or birthday parties. Where they feel secure and at ease, these children may be animated chatterboxes, full of opinions and expression, but totally shut down in situations they find uncomfortable.
A range of behaviour
Not all children with the disorder behave in the same manner. Some appear to freeze completely, unable to communicate verbally and nonverbally, not even nodding or forming a facial expression. Others may whisper to only a select few people, but otherwise stay silent. Others still appear at ease, but rarely speak, and are simply regarded as extremely shy or reserved.
In situations where they feel uncomfortable, children with select mutism may:
- speak rarely or not at all
- have a blank facial expression
- never seem to smile or be happy
- seem to be physically frozen
- have stiff or awkward body language
- turn their head from others or avoid eye contact
- chew or twirl their hair, or fidget with their hands to avoid interaction
- physically withdraw, play alone
- whisper only to select friends and seem disinterested in others
- older children may appear totally absorbed in their studies
Regardless of their symptoms, what all these children have in common is anxiety, which underlies their fear of speaking in these scenarios.
Underneath it all, anxiety
Children with selective mutism often show other symptoms of anxiety, including problems with emotional regulation, frequent tantrums and outbursts, moodiness, inflexibility, sleep problems, picky eating, and extreme shyness from an early age. Separation anxiety as an infant is a common precursor. Selective mutism often occurs along with other anxiety disorders, such as Obsessive Compulsive Disorder, Panic Disorder, phobias and Trichotillomania.
Selective mutism may also be a by-product of certain sensory processing disorders, whereby children may feel overwhelmed by sensory input, and can not form a response. Some may struggle with speech and language abnormalities, or subtle learning disorders that affect communication. Research shows that children from bilingual or multilingual environments, particularly in third culture situations, may also undergo periods of selective mutism. In all cases, anxiety about speaking remain at the root of their silence.
Many children with selective mutism share a specific disposition that is present from a very early age. They display an inhibited temperament, and are timid, cautious and restrained in new situations. People with inhibited temperaments are more prone to anxiety-related problems than those with less “shy” temperaments.
Sometimes children can present as selectively mute with no precursor and no other signs or symptoms. It can come as quite a surprise to parents who very suddenly have a child who can not speak in certain settings.
Speaking and belonging
Most children are diagnosed with selective mutism between the age of 3 and 8 years old, when they go to school and find themselves in an environment where they must interact and speak on demand, both socially and academically. To be diagnosed, children must be selectively mute for at least one month, excluding the first month of school — a stressful time for many kids.
Fortunately, the prognosis for overcoming selective mutism is excellent. Treatments that focus on building coping skills to manage anxious and fearful feelings are very helpful in overcoming the disorder. Play therapy, behavioural therapy, CBT and other forms of therapy, along with a healthy dose of family and school involvement to build confidence and competence have lasting positive effects for selectively mute children. Programs that boost social skills and emotional regulation are also good, and provide a structured environment to learn to interact with others.
One of the poignant characteristics of selectively mute children is that they are often very social beings, and crave the company and friendship of others, but are afraid to make any move at all for fear of making a mistake. If you suspect your child is selectively mute, contact the BFDC. We can help them enter the world they wish to be part of.