Selective mutism in children
Childhood and the chatter
Most growing children and adolescents love being in groups, talking, chatting, sharing their experiences, asking questions, generating answers, expressing opinions, and being part of their peer cluster. However, sometimes we see that some children are shy and take a much longer time to warm up in social situations. They speak very little whenever they are around people, particularly in school, although they may use normal language and speech at home. This behavior can intrigue most parents when they get repeated complaints from teachers at school that their kids do not communicate or answer questions in class. Such children have ‘Selective Mutism’ well understood as refusal to speak in select situations
It is important to not confuse speech delay with selective mutism. All children and adults with selective mutism are capable of speaking and understanding language; they only fail to do so in certain situations, more specifically when it is expected of them to be open and social. Sitting quietly in a meditation session may be acceptable but being silent and unresponsive when spoken to in front of the class seems like inappropriate and rude behavior at times. It is important to first rule out any speech development delay and then identify whether the deficit represents general speech and language delay or selective mutism.
Shyness versus Mutism
It is critical to determine, wherever possible, why a child who can speak would refuse to do so in some situations. These could vary from extreme shyness, timidity; fear of rejection and low confidence; to cognitive disability, language impairment, or emotional distress. Although research has repeatedly shown that 100% of selectively mute children have a co existent diagnosis of social anxiety, there is speculation over the explanation. There is a category of children with social anxiety who tend to reduce their stress in social settings by withdrawing and becoming mute. The outcome in all cases is a child who seems to be uninvolved and wishes to fade in the background in social settings. These children:
- Are withdrawn, engrossed within themselves and seem exceptionally quiet while at school
- Do not speak much with teachers and classmates, often they do not communicate at all
- Do not participate in verbal or non-verbal classroom activities; they try to be invisible
- May appear anxious or nervous in specific situations and then seem normal in others
- Are usually well accepted by peers, who tend to speak for them and mask their mutism
It can be quite bad
Studies have revealed a stepwise progression of mutism in children. Some children seem to be engrossed in social activities and appear normal but don’t speak, others speak only to fellow children but not to grown-ups, many speak short words or sentences to adults when asked questions but never to their peers, and still others speak to no one and partake in few, if any, activities offered to them. A severe form is known as “progressive mutism” where the child gradually speaks to nobody at all, not even close family members. These children have psychogenic obstinacy which is typically repressed and emerges through rigid mutism.
Mutism to frustration
The reasons for the willful and deliberate lack of speaking will most likely determine the nature of intervention. In the absence of cognitive impairment, these children have high irrational fears. They are afraid of something, but are not sure why. They differ from other children in their personality, temperament, academic capability and communication style; sometimes parents can misunderstand them. This leads to frustration in the parent and child both; and may contribute to behavior problems like anger, defiance and stubbornness.
Urgency of intervention
It is important to initiate intervention early with selectively mute children; failure to do so may have long-term negative ramifications in later childhood, adolescence, and adulthood. An appropriate intervention is usually successful, resulting in social and academic improvement for the child. MINDFRAMES offers psychological assessment using projective techniques to assess the root of anxiety. Medication is prescribed if necessary. Audiological examination and speech therapy for stuttering or articulation problems are also provided if needed. Observable change occurs, but slowly; hence parents need to be very patient