Shyness is often seen as a normal part of childhood and growing up. But what if it persists – is it indicative of something more serious? Selective mutism (SM) is a widely misunderstood anxiety disorder which affects only about 1% of the population (“Selective Mutism”).

1. What is Selective Mutism?

SM is a childhood anxiety disorder whereby a child is unable to speak in select social settings (Shipon-Blum). However, they are able to speak in settings where they feel comfortable and safe, typically at home or with trusted adults. The exact cause of SM is still unknown. Most children are diagnosed between the ages of 3 and 8, which is when the children are exposed to social situations (ie. school); however, they may present symptoms of SM even as an infant.

Characteristics of SM may include (Shipon-Blum):

●  Inability to speak or soft-spoken in specific social environments, while still being verbal and social in comfortable settings (ie. home)

●      Difficulty initiating and responding to others

●      Social anxiety symptoms (over 90% of children with SM also have social anxiety)

●      Awkward body language (eg. avoiding eye contact, withdrawal from peers)

2. Common Myths

“It’s just shyness! Kids with SM will grow out of it.”

This is a common yet damaging misconception about SM. While SM and shyness may present similar symptoms, the two are wildly different. Shyness in children is common – they may experience separation anxiety from parents, or avoid talking to others. However, with time, these children will outgrow their shyness and warm up to unfamiliar situations. SM is an anxiety disorder that may cause a child to become paralyzed with anxiety when asked to speak in unfamiliar settings. Typically, this is persistent, as children with Selective Mutism cannot simply “outgrow” SM, despite desperately wanting to speak. While some children with SM eventually do get better without intervention, they may suffer for years and miss out on developing crucial interaction skills.

“Children with SM are abused.”

Often, it is believed that children with SM have experienced severely traumatic incidents that caused them to stop talking. However, SM diagnosed children are comfortable speaking in at least one setting in which they feel comfortable in, and is not in response to any major life changes. On the other hand, traumatic mutism develops as a response to a traumatic event (e.g. loss of a loved one, abuse, etc.) In this case, they become mute in all settings. It is important to distinguish between the two types of mutism, as the effects can be damaging. Parents may fear being accused of abusing their child and thus refrain from speaking out, preventing their child from receiving the treatment they desperately need to get better (Shipon-Blum).

“Children who don’t speak have a language or speech delay.”

It is easy to assume that children with difficulty speaking in social situations have a learning delay or speech articulation problems (Dummit). Hence, children with SM are often referred to speech therapists. However, when closely evaluated, most exhibit normal or above average speech and verbal skills, and are just unable to verbalize their thoughts.

3. Possible Treatments

Like most anxiety disorders, SM can be treated with both behavioural therapy and medication based therapies. 

Behavioural therapy is the recommended method of treating SM. Parents can begin by introducing the child to safe social environments to help them feel more comfortable (Shipon-Blum). Positive reinforcement is used, where children are complimented and rewarded for speaking up, which aims to reduce their anxiety around social interactions, and encouraging them to continue doing so. They are also exposed to increasingly challenging situations, such as having to order their own meals at a restaurant and interviewing strangers. During therapy, children are exposed to adults and children of the same age, which may encourage social interaction with their peers at school.

It is important to diagnose and intervene when the child is still young. Older children typically take longer to respond to psychological interventions and often require additional behavioural treatment to overcome their mutism. The first step to reducing the stigma and misconceptions surrounding this disorder is to understand it. By educating others on this disorder, it may prevent misdiagnoses and allow children with SM to receive help and treatment at a young age. Early diagnosis and consistent treatment can help children with SM to grow up and live amazing lives.

References

Dummit, E Steven. “Common Myths.” Selective Mutism Foundation, Inc.,

www.selectivemutismfoundation.org/knowledge-center/common-myths.

“Selective Mutism (SM) Clinic.” Central Health Child Department,

www.cdt.com.hk/selective-mutism-sm-clinic/.

“Selective Mutism.” Anxiety Canada, http://anxietycanada.com/disorders/selective-mutism/.

Shipon-Blum, Elisa. “What Is Selective Mutism.” Selective Mutism Anxiety Research & Treatment Center

| SMart Center, http://selectivemutismcenter.org/whatisselectivemutism/.