Childhood Anxiety: Selective Mutism Disorder

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The last article, Childhood Anxiety: What Types of Disorders Do Children Have to Deal With, I covered in more detail, Generalized Anxiety Disorder and Social Anxiey. This article will cover the next disorder, Selective Mutism. We learned that most anxious children have a combination of at least three of the six types of conditions including generalized anxiety disorder, social anxiety, selective mutism, separation anxiety, obsessive-compulsive disorder and phobia.

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In an effort to gain more awareness of childhood anxiety and the need for parents and individuals working with children to be more cognizant for early signs of childhood anxiety, more education needs to be provided with emphasis on early detection and intervention. Children must be given more opportunities to have a happy, safe and fully functioning life. This series is making an attempt to provide some education in this disabling disability that goes unrecognized by so many. We need to do a much better job to help these children.

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Selective Mutism

Children tend to be more out-going at home but at school these same children are more reserved. This is considered a normal trait. But there are some children where the difference between home and school is so severe that it is a torturous experience for them to be out in public. This condition known as selective mutism, where the child has the inability to speak in certain social types of situations, was thought to be either unstable or abused for many years. It wasn’t until more recently that research has disproven this assumption.

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I’ll Try Tomorrow
Here I am! I wanted to say
The girl that comes here everyday
I wanted to talk and be a part of you
And show you everything that I can do
But I sat here quietly day after day
Not knowing why I can’t ask you to play
I wish I had the strength to try
But, it was just too hard (I was too shy)
You used to ask me many times to play
But I couldn’t answer I turned away
I wanted to smile and join in the fun
But I remained silent (I wanted to run)
I know I’m different but I want to be like you
But it’s the hardest thing for me to do
Now the day is over and my heart is filled with sorrow
For I couldn’t speak again today, I guess
I’ll try tomorrow…

-Fil Wickman, sufferer of selective mutism

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According to the Jewish Press (http://www.jewishpress.com/sections/family/parenting-our-children/the-burden-of-silence-understanding-selective-mutism) selective mutism is a disorder that generally occurs during childhood. These Individuals are capable of speech and understanding language but when they are expected to speak, they can’t. It has been found that Children with selective mutism are often very well-adjusted but simply cannot speak in certain social situations. Not too long ago, selective mutism used to be called elective mutism which implied the it was a choice on part of the child to willfully speak or not speak in different social situations. But in truth these children are unable to speak even if they want to due to extreme anxiety.

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The American Speech-Language –Hearing Association lists the following symptoms of selective mutism:

• Consistent failure to speak in specific social situations – such as in school or with neighbors.
• This inability to speak interferes with educational or occupational achievement.
• The length of the inability to speak lasts more than one month (excluding the first month of school).
• The failure to speak does not stem from a lack of knowledge or comfort with the language required for the situation.
• Selective mutism usually occurs before a child is five years old and is generally first noticed when a child starts school.

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SMartCenter (https://selectivemutismcenter.org/whatisselectivemutism/) said the more than 90% of children with selective mutism also have social phobia or social anxiety. They said that this disorder is quite debilitating and painful to the child because it is an actual FEAR of speaking in a social interaction, especially when there is that expectation to speak and communicate. The majority of children with this disorder do have a genetic predisposition to anxiety and very often show signs of separation anxiety, frequent tantrums and crying, moodiness, inflexibility, sleep problems and extreme shyness. SMartCenter stressed that parents and teachers have to understand that the physical and behavioral symptoms the child may display are due to anxiety and treatment needs to focus on helping the child learn the coping skills to combat anxious feelings.

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SMartCenter listed all the Common Characteristics of Children With Selective Mutism as follow:

• Temperamental Inhibition: Timid, cautious in new & unfamiliar situations, restrained, separation anxiety as a young child.

• Social Anxiety Symptoms: Uncomfortable when introduced to people, teased or criticized, being the center of attention, perfectionist, eating issues.

• Social Being: Wants and needs friends.

• Physical Symptoms: Mutism, tummy ache, nausea, vomiting, joint pains, headaches, chest pain, shortness of breath, diarrhea, nervous feelings , scared feelings.

• Appearance: Have a frozen-looking, blank, expressionless face, stiff, awkward body language with lack of eye contact when anxious. Frozen and stiff body language.

• Common Symptoms: Picky eater, bowel and bladder issues, sensitive to crowds, lights, sounds, touch and heightened senses. In the classroom the child may show the following: withdrawal, playing alone or not playing, hesitation in responding, distractibility, difficulty following a series of directions or staying on task, difficulty completing tasks.

• Behavioral: Inflexible, stubborn, moody, bossy, assertive and domineering at home. May also exhibit dramatic mood swings, cry spells, withdrawal, avoidance, denial and procrastination. In school and social situations some may act silly or act out negatively.

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According to the American Speech-Language-Hearing Association (http://www.asha.org/public/speech/disorders/SelectiveMutism) treatments differ depending on the needs of the child and his/her family. The Speech-Language Program will create a behavioral treatment program that may include:

• Stimulus fading: a technique where a child is in a relaxed setting with some someone who they able to talk freely with and on a very gradual basis a new person is introduced into the setting.

• Shaping: using a structured approach to reinforce all the efforts made by the child to communicate (e.g., gestures, mouthing or whispering) until audible speech is elicited.

• Self-modeling technique: child watches himself/herself performing the desired behavior like communicating effectively at home to foster the child’s self-confidence and thereby facilitates carry over of this into the classroom or social setting.

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Other treatment approaches can be focusing on what is making the mute behavior worse, using role play activities to give the child the ability to gain confidence to speak to different listeners in different settings, and helping the children who don’t speak because they feel that their voice sounds funny.

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“The greatest mistake we make
is living in constant fear that we will make one.”
–John C. Maxwell

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The Speech and Language therapist will also work with the child’s teacher to encourage communication and lessen the anxiety about speaking, forming small, cooperative groups that may be less intimidating to the child, helping the child communicate with fellow students in a group in an initial non-verbal method and then gradually adding tasks that lead to speech, and finally working with the child, family and teachers to generalize learned communication behaviors into other speaking situations.

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Selective mutism is one of the six childhood disorders that can occur in a young child. It is a relatively uncommon disorder in childhood that occurs in only 0.3 to 1.8 children per thousand. This particular anxiety disorder can go unrecognized until the child reaches school age which can be difficult to make early detection which is the goal. Early intervention is the key to dealing more successfully with childhood anxiety disorders so it is imperative to teach parents, caregivers and teachers about signs and symptoms of childhood anxiety.

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“Be gentle with yourself, you’re doing the best you can.”
– Unknown

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I will continue with the remaining 3 anxiety disorders in my next few articles. Thank-you for joining me in this journey about Childhood Anxiety. If you would like to follow me, please check HERE.

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These are my previous articles on Childhood Anxiety if you are interested in reading it:

Childhood Anxiety: The Anxious Child (https://steemit.com/steemiteducation/@cabbagepatch/childhood-anxiety-the-anxious-child)

Childhood Anxiety: What Types of Disorders Do Children Have to Deal With (https://steemit.com/steemiteducation/@cabbagepatch/childhood-anxiety-what-types-of-disorders-do-children-have-to-deal-with)

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