What is selective mutism

De-Stressing the Season: Tips and Strategies for Navigating Bravery During the Holidays The holiday season often includes gatherings with family or friends and can be a time of togetherness and excitement.

Register Now. What is selective mutism SM? What are the symptoms of selective mutism? What causes selective mutism? How does SM differ from shyness? How is selective mutism treated?

Selective Mutism Facts. Featured Events Check out some of the upcoming featured events, webinars, conferences, and other educational opportunities offered around the country. Loading view. November Fri Tue Export Events.

With appropriate handling and treatment, most children are able to overcome selective mutism. But the older they are when the condition is diagnosed, the longer it will take.

Treatment does not focus on the speaking itself, but reducing the anxiety associated with speaking. This starts by removing pressure on the person to speak. They should then gradually progress from relaxing in their school, nursery or social setting, to saying single words and sentences to one person, before eventually being able to speak freely to all people in all settings. The need for individual treatment can be avoided if family and staff in early years settings work together to reduce the child's anxiety by creating a positive environment for them.

As well as these environmental changes, older children may need individual support to overcome their anxiety. The most effective types of treatment are cognitive behavioural therapy CBT and behavioural therapy.

Cognitive behavioural therapy CBT helps a person focus on how they think about themselves, the world and other people, and how their perception of these things affects their thoughts and feelings. CBT also challenges fears and preconceptions through graded exposure. CBT is led by mental health professionals and is more appropriate for older children, adolescents — particularly those experiencing social anxiety disorder — and adults who've grown up with selective mutism.

Younger children can also benefit from CBT-based approaches designed to support their general wellbeing. For example, this may include talking about anxiety and understanding how it affects their body and behaviour and learning a range of anxiety management techniques or coping strategies. Behavioural therapy is designed to work towards and reinforce desired behaviours while replacing bad habits with good ones.

Rather than examining a person's past or their thoughts, it concentrates on helping combat current difficulties using a gradual step-by-step approach to help conquer fears. There are several techniques based on CBT and behavioural therapy that are useful in treating selective mutism.

These can be used at the same time by individuals, family members and school or college staff, possibly under the guidance of a speech and language therapist or psychologist.

In graded exposure, situations causing the least anxiety are tackled first. With realistic targets and repeated exposure, the anxiety associated with these situations decreases to a manageable level. Older children and adults are encouraged to work out how much anxiety different situations cause, such as answering the phone or asking a stranger the time.

In stimulus fading, the person with selective mutism communicates at ease with someone, such as their parent, when nobody else is present. Another person is introduced into the situation and, once they're included in talking, the parent withdraws. The new person can introduce more people in the same way. Shaping involves using any technique that enables the person to gradually produce a response that's closer to the desired behaviour. For example, starting with reading aloud, then taking it in turns to read, followed by interactive reading games, structured talking activities and, finally, 2-way conversation.

Positive and negative reinforcement involves responding favourably to all forms of communication and not inadvertently encouraging avoidance and silence. If the child is under pressure to talk, they'll experience great relief when the moment passes, which will strengthen their belief that talking is a negative experience. Desensitisation is a technique that involves reducing the person's sensitivity to other people hearing their voice by sharing voice or video recordings.

For example, email or instant messaging could progress to an exchange of voice recordings or voicemail messages, then more direct communication, such as telephone or Skype conversations. Medicine is only really appropriate for older children, teenagers and adults whose anxiety has led to depression and other problems.

Measure content performance. Develop and improve products. List of Partners vendors. Selective mutism SM is a childhood anxiety disorder characterized by an inability to speak or communicate in certain settings. The condition is usually first diagnosed in childhood. Children who are selectively mute fail to speak in specific social situations, such as at school or in the community.

The first described cases date back to when German physician Adolph Kussmaul labeled children who did not speak as having "aphasia voluntaria. Selective mutism can have a number of consequences, particularly if it goes untreated. It may lead to academic problems, low self-esteem, social isolation, and social anxiety. If you believe that your child may be struggling with selective mutism, look for the following symptoms:. While these behaviors are self-protective, other children and adults may often perceive them as deliberate and defiant.

Although selective mutism is believed to have its roots in anxiety, it was not classified as an anxiety disorder until the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders DSM-5 published in The use of the term "selective" was adopted in , prior to which the disorder was known as "elective mutism.

The primary criterion for a diagnosis of selective mutism is a consistent failure to speak in specific social situations in which there is an expectation of speaking e.

In addition to this primary symptom, children must also display the following:. Children who stop talking temporarily after immigrating to a foreign country or experiencing a traumatic event would not be diagnosed with selective mutism.

Because the condition tends to be quite rare, risk factors for the condition are not fully understood. It was once believed that selective mutism was the result of childhood abuse, trauma, or upheaval. Research now suggests that the disorder is related to extreme social anxiety and that genetic predisposition is likely.

Kids who develop the condition:. Kids who have had SM for longer will be accustomed to not speaking in public, and their parents, teachers and other caregivers will have adapted to working around their avoidance. To combat these long-standing habits, clinicians will need to put in place a very robust treatment plan, likely using intensive behavioral therapy. Kids who are older and have had a longer history of SM are also more likely to be prescribed medication to help them participate in therapy.

Finally, older kids with selective mutism are also more likely to have other disorders, such as social phobia and other anxiety disorders or depression.

Selective mutism is more common among children who speak a second language. Some bilingual kids may only be silent when they are expected to speak in their second language. Diagnosing children who use a second language should be done carefully. Children should not be diagnosed with SM if their failure to speak can be explained by difficulty understanding or using a second language.

Bilingual children also typically begin developing language slower. Paying attention to when a child is having trouble communicating helps determine if she has SM or something else. While a communication disorder will be apparent in all situations, symptoms of selective mutism are only noticeable in specific social situations. Likewise, kids with autism will have problems interacting socially in all circumstances, not just around certain people or in certain settings. But what we do know is that treating it becomes much harder the older a child is, so it is extremely important not to put off treatment.

Even when a child is in treatment, it can sometimes be hard to get her to talk in front of a teacher she has a history of not talking around. The more she is used to not talking in a particular setting, the more ingrained it will be. If you do decide to switch classes or schools, it is best to have strategies and techniques in place before she makes the change.

Ideally a new teacher would also be trained in what selective mutism is and how to help kids who have it. Kids with selective mutism are often unable to speak around some extended family members, which can be stressful for everyone involved, particularly if the SM is mistaken for stubbornness or oppositional or manipulative behavior. Explaining to relatives what selective mutism is and sharing how they can help is important. Some clinicians meet with grandparents and other important members of the extended family to coach them in how to help the child.