Teachers of preschool-aged and school-aged children often report to the parents that their child isn't talking in class. The concerned parents approach an SLP (Speech Language Pathologist) saying "my child talks fine at home, he doesn't talk at all in class."

It is a telltale sign of selective mutism.

What Is Selective Mutism?

Selective mutism is a childhood anxiety disorder that is usually diagnosed in children.

It is a rare childhood anxiety disorder that occurs among only 1% of children. One of the first reported cases dates back to 1877 when Dr. Adolph Kussmaul referred to children with selective mutism as having "aphasia voluntaria."

DSM-5 states that since it is not a matter of choice of a child, it is not an elective behavior. Selective mutism (SM) was classified as an anxiety disorder back in 2013 in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

Diagnosis – The Signs and Symptoms of Selective Mutism

The primary diagnostic criterion is the failure of the individual (child) to speak in certain social situations. These situations may include a classroom, playground/playgroup, or daycare, where there's pressure on the child to speak and interact. However, the child can talk and communicate in other situations, such as at home.

Is your child shy or is it selective mutism? A child with selective mutism typically meets the typical rate of speech development for children their age, at home. Nonetheless, they are silent in school and other public settings.

Here’s a checklist for selective mutism in children that you may consider if you think your child is exhibiting selective mutism -

  • The child understands spoken language.
  • S/he can speak and communicate in some situations. For example – in familiar environments (home).
  • Their lack of speech interferes with the child’s education and/or social functioning.
  • The child talks to one or two people/friends freely without any signs of selective mutism.

A child who has moved to a new country or experienced a jarring event will NOT be diagnosed with selective mutism. However, in both cases, the child may need the help of a counselor to be able to integrate into the normal flow of life.

What Causes Selective Mutism?

Recent studies show that some children may have a genetic predisposition towards anxiety. However, like all mental health problems, selective mutism likely has multiple causes.

Children who develop selective mutism are generally –

  • Very shy
  • Anxious
  • Prone to embarrassment

Psychiatrists and speech-language pathologists (SLPs) note that selective mutism occurs with other disorders such as –

  • Depression
  • Developmental delays
  • Anxiety
  • Obsessive-compulsive disorder (OCD)
  • Language disorders
  • Panic disorder

What is the Treatment of Selective Mutism?

Treatment for selective mutism is most successful when it's detected early. Is your child silent at school? Has your child not spoken for two months in class? In such cases, it is of utmost importance to begin selective mutism treatment as soon as possible.

Since selective mutism may have multiple causes, treatment usually consists of two or more approaches.

Psychotherapy For Selective Mutism

The most common and effective approach for treating selective mutism in kids includes behavior management programs or psychotherapy.

Sessions may include techniques, such as positive reinforcement and desensitization exercises at home and school.

The child needs to be under the supervision of the psychologist. The parents need to communicate with the psychologist to provide regular feedback.

Medication for Selective Mutism

Some children with chronic anxiety disorders require medication. However, children must be evaluated by a child psychologist or psychiatrist before they can begin anxiolytics.

Parents should also consult the child’s pediatrician before beginning medication for selective mutism.

The choice of medication should depend on the child's health, medical history, and history of anxiety.

How can parents Help A School-Going Child with Selective Mutism?

Psychotherapy and medication are indispensable to treat selective mutism. Nonetheless, parents can help the child cope in different social situations that may reduce anxiety and symptoms of selective mutism.

Here’s how to help a child with selective mutism –

Inform Their Teachers and Peers

When a child "refuses" to talk in class or playgroups, the adults involved and their peers may become frustrated, irritated, or angry.

It is imperative to understand and explain that the child in question isn't actually refusing to talk. S/he is unable to speak in social situations.

As a parent, it is your responsibility to ensure that your child’s teachers know that they have selective mutism. Their silence is not intentional.

Discuss positive reinforcement with the child’s teachers with help from their psychologist. You can work with their teachers to offer your child a comfortable and positive environment, where they feel encouraged to express themselves.

Pick Activities They Like or Enjoy

Children typically feel more confident if they engage in activities that exhibit their skills. Instead of forcing your child to engage in social situations, you can choose activities like solving puzzles, art, and craft, or building blocks.

Pick activities that do not require verbal communication. Strengthen your child’s confidence and self-worth. It is one way to help a little one who has social anxiety.

Avoid Negative Reinforcement

Conditioning is a significant portion of the treatment of selective mutism in children. The psychologist will guide the parents and the child. Parents will learn how to offer positive reinforcement.

Parents should also learn what constitutes negative reinforcement so as to  avoid it at all costs while interacting with their child who has selective mutism.

Parents must remember that their child cannot overcome social anxiety or selective mutism through punishment or pressure.

Can selective mutism be cured? Well, selective mutism is a treatable disorder that requires understanding, compassion, and patience. Parents should not pressurize  their children if they are not making significant progress.

Instead, speak to their psychologist and speech-language pathologist (SLP). They may suggest minor changes in your child's activities and play therapy for a better outcome.

Does Bilingualism Cause Selective Mutism?

Selective mutism occurs more commonly in children who speak two languages than those who speak just one.

Although bilingualism and selective mutism share a direct relationship, the former does not cause the latter. However, children who are already prone to anxiety may experience selective mutism, when they are expected to speak in a language they are less comfortable with.

In some cases, bilingual children may exhibit mutism when they are expected to speak only in their second language. In other cases, the social anxiety and fear of speaking may not be restricted to language. So, bilingual children may remain silent even when expected to speak in their native language.

Bilingual children demand careful observation and analysis of their mutism. If they can't converse due to the lack of understanding of a second language, then it's not a case of selective mutism.

Sometimes, children learning the lexicons of multiple languages have a "silent period." These are intervals where they are acquiring or learning a new language. So, parents and clinicians must be careful not to interpret these learning intervals as a sign of selective mutism.

How Can Speech Therapy Help Children With Selective Mutism?

If you think your child is showing signs of selective mutism, it's necessary to consult their pediatrician and look for a child psychologist and speech-language pathologist.

A speech therapist will play an integral role in the treatment of selective mutism. Speech therapists can assist your child’s selective mutism diagnosis by providing them with evaluations and assessing their speaking skills.

After diagnosis, a speech therapist can design personalized therapy ideal for your child. Therapy typically addresses the complexity of the language used and the purpose of the same. Therefore, the speech therapist can help your child understand and learn new vocabulary, types of responses, appropriate responses in social situations, social cues, and pragmatic language.

Selective mutism speech therapy activities also teach children how to ask questions, take turns in conversations, and communicate non-verbally.

A speech therapist also provides much-necessary encouragement during sessions. They also teach parents different ways to offer reinforcement to their children and boost their confidence.

Speech therapists should work with the child psychologist or psychiatrist to determine the best route for selective mutism treatment. Most importantly, they should provide pertinent information to the parents regarding diagnosis, therapy methods, prognosis, and progress.