What Is Selective Mutism?

Selective mutism in children and teenagers

What Is Selective Mutism?

Children with selective mutism can’t speak in certain places, with certain people or during certain social activities.

Most commonly, children don’t speak at preschool or school. But at home, they can comfortably speak with you and others in your immediate family.

Selective mutism is an anxiety disorder. Children with selective mutism don’t choose to be silent. They want to speak and try to speak, but their anxiety stops them.

All children feel anxious sometimes. But children with selective mutism have anxiety that is longer lasting and gets in the way of learning, making friends and other important aspects of daily life and development.

Signs and symptoms of selective mutism

You might first notice signs of selective mutism when children start going to preschool or school, at 3-6 years of age. You might notice behaviour or physical signs, or your child might tell you about these signs.

Behaviour signs
If your child has selective mutism, you might notice that they:

  • can’t speak or respond with speech to people outside your immediate family, including grandparents, carers, teachers and classmates
  • can’t speak to you in places where others might see or hear them speaking
  • look away when they think others are looking at them or speaking to them, lower their voice or whisper, use fewer words, or look at you when they speak to other people
  • find it hard to join in play or activities with other children and make friends
  • avoid doing things where they’re the focus of attention – for example, having their photo taken, giving something to a teacher or playing sport in front of people
  • find it hard to ask for help with things – for example, telling someone they’re hurt or asking to go to the toilet
  • seem distracted or seem to have trouble thinking clearly, paying attention or concentrating.

Physical signs
If your child has selective mutism, you might notice some physical signs when other people expect them to speak. For example, your child might:

  • ‘freeze’
  • seem restless
  • look tense
  • tremble and blush
  • say they have a racing heart, clammy hands or a sore stomach.

If your child is old enough, they might tell you when or why they feel anxious. For example, your child might feel anxious when they don’t know what to say or are worried about making a mistake. They might think their voice sounds funny or not people looking at them. But often children don’t know why they don’t speak.

It's common for children with selective mutism to have another anxiety disorder social anxiety, separation anxiety or generalised anxiety. Some children with selective mutism might also have language delay, communication disorders or autism.

Does your child need to see a health professional about selective mutism?

If your child doesn’t speak outside your home for more than three months, they need professional help. It’s also important to get help if your child’s selective mutism is affecting their learning at school and their ability to socialise and make friends.

You can get help from:

Children who get professional help in their preschool and early school years often recover from selective mutism more quickly than those who don’t. Without professional help, there’s a chance that problems with speaking might not completely go away or might persist into adulthood.

Diagnosing selective mutism

To diagnose selective mutism, your mental health professional will look at the way your child behaves and communicates in different situations, as well as their anxiety symptoms.

Your child might have a hearing or speech assessment to check whether your child also has language delay.

Therapies for selective mutism

The stepladder approach and other graded exposure therapies are an essential part of treatment for selective mutism. The stepladder approach involves your child starting with ways of communicating that are easier for them, nodding their head or pointing. Then your child gradually builds up to activities that require speech.

The stepladder approach requires regular practice sessions at your child’s preschool or school. This means you’ll need to share your child’s treatment plan with your child’s teacher and work with them to implement the approach.

If your child is older, your child’s mental health professional is also ly to use cognitive behaviour therapy. CBT can help your child identify any worries and build more confident self-talk and positive social skills.

If your child has language delay, they’ll get speech therapy to build their language skills. This might not happen until later on when your child is more comfortable using their voice.

Medication is sometimes prescribed for children who take a while to improve with cognitive behaviour therapy.

Supporting your child with selective mutism: tips

If your child has selective mutism, they need your support to build speaking skills and confidence. There are many things you can do:

  • at home with your child
  • during everyday conversations
  • when working with people in your child’s support network.

At home

  • Acknowledge your child’s anxiety about speaking. Let your child know that they won’t get in trouble if they don’t speak when they’re away from home or you.
  • When you’re alone with your child, praise their efforts and achievements in speaking, especially as they reach different milestones.
  • Model positive and confident behaviours in social situations. For example, smile at people, say hello and ask how people are when you meet them.
  • Talk to your child about times that you felt anxious and how you managed it with calm breathing, positive self-talk and giving things a go. This will help your child understand that it’s OK to talk about anxious feelings.
  • Read books with your child that are about nervous, scared or shy feelings or that have characters who overcome their speaking problems. These can help your child understand their own feelings and problems and give them ideas about how to overcome them.
  • Focus on any efforts your child makes to speak, be patient with your child’s progress, and try to keep any frustration to yourself. This will help your child build the confidence they need to speak.

Everyday conversations

  • Instead of answering for your child, encourage your child to use non-verbal communication so they can be part of conversations. For example, if someone asks your child how old they are, you could say, ‘Sarah, you’re five years old’, and hold up your hand with five fingers. Your child can respond with a nod or speech.
  • Give your child time to respond to questions. If they do respond, continue on with the conversation. If they don’t respond, try rephrasing the question as a yes-or-no question or a simple choice. This way your child can respond with a gesture or by saying or pointing to one of the choices.
  • Help your child practise communicating in places outside your home, but make sure your expectations match what they’re capable of. For example, if your child is still building up to using words outside your home, they might be able to point to an item on a menu.
  • Give your child time to warm up their voice and join activities gradually. For example, chat to your child on the side while you watch other children play. Gradually move closer to the children so your child can join them.
  • If someone asks you why your child doesn’t speak, let the person know it’s something your child is working on. For example, ‘Jin talks a lot at home. He’s learning to feel brave about speaking in other places’.

Your child’s support network

  • Tell teachers, relatives, family friends and other carers that your child has selective mutism. Let them know the best ways to interact with your child. This might include some of the conversation tips above.
  • Work with your child’s teachers to plan your child’s preschool or school transitions. For example, at the start of a new school year, ask for your child to be put in a class with familiar children. Or take your child on a tour of a new classroom and ask to meet their new teacher and spend some time playing a nonverbal game.
  • Organise playdates at home with your child’s friends. Set up activities that help your child relax, bubbles, ball games or trampolining. The longer the playdate, the more ly your child will start communicating.

With regular practice at home, at school and in the community, children with selective mutism can overcome speaking difficulties. But it can take time – up to several years.

Even when your child does start to speak, they’ll need support to build speaking confidence in all situations.

It’s important to monitor how much your child speaks, and talk with your child’s health professional if you have any concerns.

Financial support for children with selective mutism

Your child might be able to get Medicare rebates for up to 20 mental health service sessions from a mental health professional each year.

If your child under seven years is showing delays in their social skills and learning, they might be eligible for NDIS early childhood early intervention support.

Causes of selective mutism

We’re still learning about what causes selective mutism but it’s common for it to run in families. This suggests that there’s a genetic link.

Источник: https://raisingchildren.net.au/guides/a-z-health-reference/selective-mutism

Selective Mutism

What Is Selective Mutism?

Some children are shy and do not to talk to people they don’t know. They usually start talking when they feel more comfortable. However, some children will not talk at certain times, no matter what. This is selective mutism. It is often frustrating for the child and others. Help is available.

On this page

  • About Selective Mutism
  • Signs
  • Causes
  • Testing
  • Treatment

About Selective Mutism

Does your child talk at home or with friends but refuse to talk at school? A child with selective mutism will talk at some times and in some places, but not in others. This might start when your child goes to school. Sometimes, it starts when a child is younger.

Signs of Selective Mutism

If your child has selective mutism, you may notice that:

  • She will not speak at times when she should, in school. This will happen all of the time in that situation. Your child will talk at other times and in other places.
  • Not speaking gets in the way of school, work, or friendships.
  • This behavior lasts for at least 1 month. This does not include the first month of school because children may be shy and not talk right away.
  • Your child can speak the language needed at that time. A child who does not know the language being used may not talk. This is not selective mutism.
  • Your child does not have a speech or language problem that might cause her to stop talking.

Causes of Selective Mutism

Selective mutism is in the Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition, or DSM-5. Doctors and others use the DSM-5 to help diagnose social and mental problems. In the DSM-5, a child with selective mutism may:

  • Have an anxiety disorder.
  • Be very shy.
  • Be afraid to embarrass themselves in public.
  • Want to be alone and not talk with friends or others.

Testing for Selective Mutism

Talk to your doctor if you have concerns about how and when your child talks. Your child should also see a psychologist or psychiatrist to see if he has a problem anxiety. A speech-language pathologist, or SLP, can test your child's speech and language. These experts may work with your family and your child's teacher if there are problems at school.

Speech and language testing may include:

  • Talking with you about your child’s development and medical history.
  • Having your child’s hearing screened.
  • Seeing how well your child’s lips, jaw, and tongue move.
  • Seeing how well your child understands what others say to him.
  • Listening to how well he says words, answers questions, and talks about his ideas.

Some children will not talk to the SLP. If that happens, the SLP may ask if you have a video of your child talking.

Treatment for Selective Mutism

Each person with selective mutism needs to work on different skills. Your doctor may suggest medication, which works for some people. SLPs will work to get your child comfortable talking in all situations. Your child may need to work to change how she behaves at those times when she won’t talk. Or, she may need to work on her speech and language.

To help change your child’s behavior, the SLP may use:

  • Stimulus fading. Your child may be with someone they talk to easily at first. Then, a new person may slowly join in. This will help your child get comfortable with new situations.
  • Shaping. The SLP will praise or give rewards to your child for trying to communicate. Your child may first only point or use other gestures. Then, he may mouth a word, which means saying it silently, or whisper. The goal is for your child to speak in all situations.
  • Self-modeling technique. Your child may watch videos of herself talking in a comfortable situation, at home. This may help her feel more confident about how she speaks. She may then try speaking in other situations.

The SLP will also work with your child on any speech or language problems that he may have. This may include helping him say sounds clearly or helping him say words loudly. The SLP may also help him use words to ask questions or talk about his thoughts. Your child may be more willing to talk to others once he feels better about how he sounds.

The SLP may also work with others in the places where your child has trouble. This may include your child’s teachers, counselors, coaches, or family members. The goal is for your child to be comfortable talking in any situation.

See ASHA information for professionals on the Practice Portal’s Selective Mutism page.

To find a speech-language pathologist near you, visit ProFind.

Источник: https://www.asha.org/public/speech/disorders/selective-mutism/

Selective Mutism in Kids — Tips For Parents Dealing With This Anxiety Disorder

What Is Selective Mutism?

Selective mutism is a childhood anxiety disorder characterized by a child’s inability to speak and communicate effectively in social situations. Children with selective mutism do not initiate speech or respond reciprocally when spoken to by others in social settings. This can occur in settings that involve both children and adults.

Children with selective mutism are able to communicate clearly and effectively in settings where they feel comfortable, secure, and calm. These children will speak at home in the presence of immediate family members or with close friends.

Selective mutism usually begins before a child is five-years-old, but may not come to clinical attention until the child enters school, where there is an increase in social interactions and performance tasks. Children with selective mutism struggle with reading out loud, speaking in front of the class, or working in large groups. This can make school feel an exercise in survival on a good day.

Symptoms of selective mutism

Selective mutism is characterized by lack of speech in certain situations and can interfere with social and academic functioning:

  • Consistent failure to speak in specific social situations in which there is an expectation for speaking, despite speaking in other situations.
  • Interferes with educational or occupational achievement or with social communication.
  • Lasts at least one month – not limited to the first month of school.
  • Failure to speak is not due to lack of knowledge about or comfort with the spoken language. 1

Other symptoms of selective mutism can include the following:

  • excessive shyness
  • social isolation
  • fear of embarrassment in front of a group
  • clinging to caregivers
  • temper tantrums
  • oppositional behavior
  • compulsive traits
  • negativity.

Prevalence

Selective mutism is a relatively rare disorder. According to the DSM-5, the occurence of this condition ranges between 0.03% and 1%, depending on the setting.2 Selective mutism is more ly to appear in children than adults, but does not seem to vary gender or race/ethnicity. The average age of onset is before five years old, but many children are not diagnosed until they enter school.

Causes of selective mutism

Given that selective mutism is fairly rare, the risk factors are not well known. There are a few triggers that can be linked to the disorder:

  • Temperamental factors: Watch for behavioral inhibition, negative affect, and parental history of shyness, social isolation, and social anxiety. Children diagnosed with selective mutism might also have receptive language difficulties.
  • Environmental issues: Parents who exhibit social inhibition model the behavior for children. Overly controlling or overprotective behavior on the part of the parents can also be a risk.
  • Genetics: Due to the overlap with social anxiety, there might be a shared genetic component between the two disorders. 3

Co-morbidity with other disorders

The most common co-morbidity for selective mutism is with other anxiety disorders, including social anxiety disorder, separation anxiety disorder, and specific phobia.

Functional consequences of selective mutism

Selective mutism can negatively impact children in a number of ways, as children with this disorder struggle to engage in reciprocal social interactions, participate in classroom discussions and activities, and fail to assert their needs outside of the home.

Selective mutism can result in the following functional impairments:

  • Academic problems: When kids with selective mutism fail to speak up about their struggles or lack of understanding in the classroom (or with homework), they can fall behind academically.
  • Social isolation: Kids with selective mutism struggle to engage in reciprocal social interactions in some situations, and this makes it difficult to make and maintain friends.
  • Low self-esteem,
  • Social anxiety.

Treatment of selective mutism

Treatment of selective mutism can involve a combination of psychotherapy and medication, though psychotherapy is generally the first recommendation. Some children with selective mutism have a co-occurring speech and language disorder. Although this is not always the case, it is a good idea to get a speech and language assessment to rule out communication disorders.

Behavioral strategies and Cognitive Behavioral Therapy (CBT) are the most widely supported therapeutic treatments for selective mutism. Using a wide variety of strategies aimed at reducing the anxiety beneath the behavior, these therapeutic interventions help kids learn to gradually engage in more speaking behaviors.

Behavioral interventions should be tailored to the specific child, but examples can include the following:

  • Contingency management – positive reinforcement for verbal behavior working from whispering and pointing to verbalizing out loud
  • Shaping – reinforcement is provided for approximations of the desired behavior
  • Stimulus fading – gradually increasing the number of people and places in which speech is rewarded
  • Desensitization – Kids are gradually exposed to anxiety-producing situations in which speech is expected but are given emotional support and guidance with relaxation exercises to help them work through it
  • Cognitive reframing – kids are taught to identify anxious although patterns and come up with positive alternative thoughts
  • Social skills – in both groups and in individual work, kids can practice social interaction skills to reduce anticipatory anxiety related to engaging in reciprocal interactions. Examples include slipping in and groups, entering a group at play, and using and understanding nonverbal communication (e.g. eye contact, body language.)

Building self-esteem through talk therapy and engaging in areas of interest can also benefit children with selective mutism. It’s important to follow the child’s lead and find groups and classes that interest. In doing this, kids will feel greater comfort in a new environment.

Although it might sometimes feel the behavior of children with selective mutism is willful in nature, it is driven by anxiety. Early treatment can help kids with selective mutism learn to speak up more frequently and improve their academic and social outcomes as a result.

  1. American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, American Psychiatric Publishing, Washington, D.C., 2013: Pages 195-197.
  2. Ibid.
  3. Ibid.

Источник: https://www.psycom.net/selective-mutism-kids

What maintains selective mutism?

Imagine a scene where a mother and her daughter, Suzy, are at the grocery store. The mother runs into a friend that she has not seen in a long time. The friend asks, “Wow! Who is this little cutie? What’s your name?”  Suzy freezes, looks scared, tearful, and clings to her mother’s arm.

She is unable to respond to this seemingly easy question and a few seconds of silence occur. The friend feels horrible. She never meant to scare Suzy. The mother becomes irritated and embarrassed that Suzy is not answering the question and quickly jumps in to rescue her by saying, “Her name is Suzy.

” The friend says, “Hi Suzy, so nice to meet you. You’re so cute and shy.” Suzy didn’t have to answer and everyone feels better. This scenario is common for a child with selective mutism and illustrates how not speaking due to anxiety is often reinforced by people in the child’s environment (parents, teachers, peers).

The child learns that if s/he keeps quiet that others will talk for her.  For children with selective mutism, this scenario happens multiple times per day. It can happen at school, in extra curricular activities, when running errands, and when relatives come over.

With each “rescue” the child temporarily feels better because s/he is relieved from the anxious feelings. However, very quickly a cycle of anxious avoidance takes hold.

Within a few short months this cycle becomes an ingrained habit for the child, and for the close adults in his or her life, the cycle becomes harder and harder to break with each passing day.

How is selective mutism diagnosed and treated?

If you think that your child might have selective mutism talk to your family doctor or pediatrician to make sure that there are no developmental issues (e.g., hearing or speech delays).

The next step is to ask your doctor to refer you to a psychologist or psychiatrist who will help confirm a diagnosis of selective mutism by specifically looking at where your child is verbal and non-verbal as well as evaluating for any other mental health diagnoses that may be present (e.g., other anxiety disorders.)

The main treatment for selective mutism is behaviour therapy. Behaviour therapy involves gradually exposing a child to increasingly difficult speaking tasks in the context of a supportive relationship.

Practice begins with easier steps, and gets progressively harder – climbing a ladder. Children are asked to complete tasks that they will meet with success. Success is rewarded with praise and small prizes.

In time, children learn that the anxiety they feel when they are asked to speak decreases without having to avoid the situation in order to feel better.

Selective mutism in adolescence

As children get older, selective mutism becomes harder to treat because they become better practiced at anxiously avoiding situations that involve talking. The longer children miss out on important academic and social learning opportunities, the more ly they are to be impacted.

Specifically, older children and teens may have difficulties with peer relationships, additional anxiety disorders such as social or generalized anxiety disorder, or depression. Older teens may also start to self-medicate with alcohol or drugs in order to ease anxious feelings.

Despite the fact that it is harder and more complicated to address, excellent help can still be available. Older children and teens may need:

  • Intensive and robust behavior therapy.
  • Some evidence suggests that cognitive behavior therapy can be helpful with older kids with selective mutism.
  • Specific interventions aimed at social skill development.
  • Interventions to address other disorders, such as generalized anxiety disorder and depression, which are unly to go away on their own.
  • Prescribed medication to help them participate in therapy.

MAP is designed to provide children/teens struggling with anxiety with practical strategies and tools to manage anxiety. To find out more, visit our My Anxiety Plan website.

Источник: https://www.anxietycanada.com/disorders/selective-mutism/

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