Many years ago, early in my clinical training, a couple brought their 7-year-old daughter to see me. The parents were perplexed. The girl, whom I'll call Emily, was rambunctious at home, but would never utter a word anywhere else.
Emily had an unremarkable developmental history. She had experienced no unusual traumas. At home, she was a very happy child. At school, whenever anyone would speak to her, she would hang her head and her hair would fall forward, obscuring her face.
Some of my colleagues thought she might have autism. I gave her a non-verbal intelligence test and she clearly was quite bright. Even though she did not speak, she somehow was very engaging.
My clinical supervisor suggested the child might have elective mutism. Very little was known about this childhood disorder at the time, but it was assumed that for some reason, the child refused to speak. Even though Emily's behavior patterns clearly fit the descriptions in the literature, I couldn't buy the implication that she was being obstinate. Nothing in her behavior at home, or in her mannerisms that I observed, suggested that she was oppositional.
Today, Emily would be diagnosed with selective mutism. The subtle, but significant, change of words from elective to selective represents a major advance in how we think about the condition. Selective mutism is a variant of social anxiety disorder in which a child, who is normally capable of speech, is unable to speak in given situations, or to specific people.
Emily made progress even though I knew very little about what I was doing at the time. She had wonderful parents who accepted her struggles while also helping her gradually take tiny steps out of her comfort zone.
October is Selective Mutism Awareness Month, and I thought this would be a good time to discuss briefly some facts and myths about the disorder:
- We now know that children with selective mutism desperately want to speak. Some children have described feeling that their vocal chords "freeze up."
- It is not a matter of will or stubbornness; it involves an underlying anxiety disorder that literally prevents speech in certain circumstances.
- Children with this disorder tend to have shy, inhibited temperaments. They frequently are "highly sensitive persons."
- They may also have auditory processing or sensory integration difficulties.
- Specific behavioral treatment approaches have proven to have a fair degree of effectiveness. Medication is sometimes helpful. The most important component of any therapy, though, is the recognition that the problem stems from anxiety.
- There is no evidence to suggest that any trauma is involved; however, stressful events certainly may exacerbate the condition.
- The disorder is much more common that we previously believed. Several epidemiological studies suggest a prevalence rate of 7 per 1,000 children.
- Selective mutism is still not widely understood. It is often misdiagnosed.
- Selective mutism is not a phase that kids will grow out of. It is best recognized and treated early.
I will be writing more about selective mutism in the near future. For now, though, here are some additional resources on this topic:
Good Morning America segment
Selective Mutism Group/Childhood Anxiety Network
The Silence Within (a teacher's experience of helping a child with selective mutism)
The Selective Mutism Center (Dr. Elisa Shipon-Blum)
Copyright 2011 Barb and Greg Markway
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