Helping children and parents to understand, manage, and treat this childhood anxiety disorder.
Going num in particular situations, mostly in a classroom, is the core element of this disorder. Children suffering from selective mutism are able to use normal language fluently in a familiar and comfortable setting, but they go completely silent under specific circumstances. Selective mutism, hence, is believed to be related to anxiety related disorder.
Selective Mutism in Children -SIGNS AND SYMPTOMS
This anxiety disorder in children may begin before the age of 5 but it may come to clinical attention only after the kid enters a school where they are expected to speak or read aloud.
Some of the clear warning signs for selective mutism in children are:
- Constant inability to speak in a specific social setting like school, despite speaking fluently in other situations
- Academic achievement is affected
- Failing to speak is not because of a lack of knowledge about that language
- Increasing use of gestures, non-verbal cues like nodding or facial expressions instead of verbal interaction
- Avoiding eye contact
- Excessively shy or socially awkward
- Isolation and withdrawn
- Throwing temper tantrums
- Still, stiff or tense
- Clingy to caregivers or parents, etc.
Some children with less severe anxiety may use single-syllable communication or whisper what they want to convey.
CAUSES
Home and school interactions:
Overprotection for the child by the parents or anxiety disorders in parents may lead to behaviours of selective mutism in children. It can also be because of social pressure at school. Additionally, there is another phenomenon called traumatic mutism caused by early emotional or physical trauma.
Speech-related factors:
Some children with a history of speech and language delays have found to develop anxiety-related refusal to speak.
Genetic factors:
As this disorder is related to social anxiety disorder, there may be shared genetic factors.
CONSEQUENCES
Selective mutism can interfere in various aspects of the child’s life and impair it significantly. Some of the marked repercussions are:
- Struggle in social interaction
- Failure in asserting their needs outside home
- Academic problems
- Social isolation
- Deteriorating self-esteem
- Difficulty in making friends or lasting bonds in school
- Trouble in engaging in fun activity, etc.
However, the positive news is that a child can successfully overcome selective mutism with appropriate and proper help and treatment.
TREATMENT of Selective Mutism in Children
The treatment for selective mutism in children is focused on reducing the anxiety underlying this disorder. Some of the psychological interventions effective for selective mutism are cognitive behavioral therapy and behavioral therapy. These therapies include techniques like:
- Stimulus fading – This technique helps the child improve social interaction with new people. Here, the child first communicates with a parent when no one else is present and then another new person joins the situation. They are included in the interaction and once the child starts communicating with them, the parent withdraws. Like this, gradually more and more people are introduced to the child.
- Contingency management – Small steps in the desired direction are rewarded like initiating communication, speaking out loud, etc.
- Graded exposure – Here, situations that are least anxiety-provoking are managed first wherein with gradual and repeated exposure, the anxiety is reduced.
- Systematic desensitization – Children are exposed to situations where they feel anxious gradually and are given emotional support, guidance, and coping strategies alongwith relaxation techniques to help them deal with the situation and indulge in desired behaviors slowly and steadily.
- Shaping – The child is rewarded and reinforced for gradually producing a response that is closer to the expected behavior.
- Cognitive reframing – The anxious thought patterns that the child experiences are identified and contrasted with positive alternative thought patterns.
- Social skills training – The child practices various social communication skills with the therapist or in group therapy with other kids to reduce the anxiety when faced with real-life interaction.
Interventions that are also focussed on building self-esteem can help the children with selective mutism. Sometimes, medication is also prescribed for older children whose anxiety has resulted in depression and other related problems.
TIPS AND ADVICE FOR PARENTS/CAREGIVERS having Mutism in Children
It will benefit the child more if the family and the child’s educators work together to create a positive environment for him/her. Some things that can help are –
- Remove the pressure to speak. It can be a gradual process from feeling relaxed at school, to uttering single-syllable words, then short sentences to one person, and then it can be transferred to more people and more settings.
- Reassuring them constantly that they can speak whenever they are ready,
- Praising and rewarding small wins, even the small efforts the child is putting in, but not publicly which can cause embarrassment for the child,
- Responding warmly when the child speaks,
- Ask questions that include choices – like, ‘do you want to wear the yellow tee or the white tee?’ or asking open-ended questions like, ‘what do you want to play now?’ instead of close-ended or yes or no questions where they can nod their heads to answer.
- Appreciate and try to understand the child’s non-verbal communication,
- Ask relatives and peers of the child to give the child space and time to progress at her/his own speed and not force him/her to talk,
- Never stop giving them love, support, and handling things with patience. Anger and force would do more harm and can backfire into them avoiding communication at home too.
Remember, the child is NOT behaving in this manner wilfully, but it is driven by their anxiety. So, be mindful of that and do not blame the child for their behavior.
References –
- American Psychiatric Association. (2013). Anxiety Disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596.dsm05
- Sadock, B.J., Sadock, V.A., & Ruiz, P. (2015). Child Psychiatry. In Synopsis of psychiatry: Behavioral Sciences Clinical Psychiatry (11th ed.). New York: Wolters Kluwer.
- Whitbourne, S. K., & Halgin, R. P. (2014). Anxiety, Obsessive-Compulsive, and Trauma – and Stressor-Related Disorders. In Abnormal psychology: Clinical perspectives on psychological disorders (7th ed.). New York, NY: McGraw-Hill.
- https://childmind.org/guide/parents-guide-to-sm/
- https://www.nhs.uk/conditions/selective-mutism/
- https://www.psycom.net/selective-mutism-kids
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