HEALTH

Is your child just shy? Understanding and Managing Selective Mutism

Is your child bubbly and chatty at home but very quiet in other settings?

Selective mutism is a form of childhood anxiety disorder where children are unable to speak in specific social situations, such as with peers at school or distant relatives. However, these children do not have trouble speaking normally and freely with familiar people in familiar settings such as close family members at home.

Children with selective mutism are often thought to be ‘shy’. At times, their unwillingness to engage in social interactions may even be misinterpreted as a form of rebellion. Yet, selectively mute children experience or endure overwhelming anxiety in social settings. This anxiety hence triggers a freeze response, causing them to be unable to speak in these situations.

When is it a concern?

It is common and normal for children to take some time to adjust to a new school or setting, to warm up to strangers, to feel comfortable about talking to an unfamiliar figure. However, if a child consistently displays the inability to speak to teachers and peers even after an extended period of time, parents may consider seeking an assessment on the child.

The key indicator is the dramatic difference in the child’s ability to engage with different people. Children with selective mutism may consistently display the following signs in specific settings:

  • Ψ Avoid making direct eye contact, freeze or stare blankly
  • Become anxious, uneasy, or socially awkward
  • Engage in poor mannered and sulky behaviours
  • Become shy and withdrawn
  • Become still, tense or poorly co-ordinated
  • Act stubbornly or aggressively, such as throwing temper tantrums when they get home from school, or becoming enraged when questioned by parents

 

Risk Factors of Selective Mutism

Many factors are thought to contribute to selective mutism. They include:

 Ψ Child or adolescent’s temperament

Children who are born with anxious, inhibited or shy temperaments have higher risks to developing an anxiety disorder, including selective mutism.

Ψ Developmental difficulties, particularly in the area of language

Children that have problems with speech, or language development are more prone to selective mutism. Learning disabilities are also risk factors. The added stress of the speech and language disorder, or learning disability, may cause the child to feel much more overwhelmed and anxious in situations where there is an expectation to speak.

Ψ Genetic predisposition to Anxiety

Genetic factors could also be a risk factor to selective mutism. Children whose parents have increased anxiety, or anxiety disorders, have a greater chance of developing anxiety disorder, including selective mutism.

The Importance of an Early Diagnosis

It is important to have your child diagnosed as early as possible. Early treatment often returns a quicker response to treatment, resulting in a better overall prognosis. If a child remains mute for years, his or her behaviour can become a difficult habit to overcome as the child becomes conditioned and accustomed to being selectively mute.

Additionally, selective mutism can have far reaching effects on their academic, social and emotional development. Selectively mute children are more likely to develop poor self-esteem or suffer from social isolation as a result. Thus, if you notice signs of selective mutism in your child, it is recommended to have your child to be assessed by a professional such as a registered psychologist.

Managing Selective Mutism

Selective mutism can be treated with psychotherapies such as Behavioural Therapy, Cognitive Behavioural Therapy, Play Therapy and Speech Therapy.

Ψ Behavioural Therapy

Selective mutism is most commonly treated using a behavioural approach. The therapy will focus on increasing speaking behaviours and decreasing freezing behaviours in social settings. The intervention strategy often begins with easy speaking tasks and gets progressively harder.

Children would be asked to complete goals that are easily attainable. This success should then be encouraged or reinforced with praise and small prizes. In time, children learn to not avoid social settings and that the anxiety they feel in these settings eases. Consequently, they will feel more comfortable in being part of social settings and interacting with others.

Ψ Cognitive Behavioural Therapy (CBT)

Helping the child or adolescent to identify anxious thoughts contributing to mute behaviour can help child to problem solve and regulate their anxiety that causes selective mutism to persist. Cognitive approaches are most useful for children at age 7 and older, when they have developed the ability to become aware of their thoughts.

Techniques include identifying obvious symptoms of anxiety, addressing dysfunctional underlying beliefs and preparing a coping plan to alleviate distress.

For example, many selectively mute children have anxious thoughts revolving around people teasing their voice or judging what they say. Cognitive behavioural therapy helps the child to understand that those thoughts are not real threats and guide them to engage in positive self-talk instead.

Ψ Play Therapy

Through play, children can learn about emotions, develop coping skills, and gain self-confidence.

The child psychologists at Annabelle Kids are experienced in helping the child learn and develop these skills by engaging the child in self-directed play, art, or other activities. This creates a safe environment where talking is not initially required. For example, materials such as games and colouring books are utilised to allow the child to feel at ease without the need to interact.

Playing becomes a way for a child to express himself and make sense of his or her experiences. The goal of the treatment is to gradually improve a child’s speaking abilities, starting with a sign system, verbal signals, one-word responses, and finally complete sentences. The therapy for each unique individual progresses at their own pace.

Ψ Speech Therapy

Speech Therapists target speaking difficulties and speech disorders. Speech therapy can involve articulation therapy, language intervention activities and others. The speech therapist at Annabelle Kids  will interact with the child through talking and playing, using books and visual images to enhance language development. During play, the child will learn how to make certain sounds through modelling. Home programmes are also developed to allow

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