Spotting Selective Mutism: A Brief Guide for Families & School Professionals
One of the most common things I hear from parents when they bring their child into the office for treatment of selective mutism is: “I hadn’t even heard of this!” or “We’ve had them in speech therapy this whole time, even though they speak perfectly at home!” This is largely due to a misunderstanding of selective mutism and a lack of overall awareness of the disorder. Many caregivers as well as healthcare and school professionals haven’t heard of selective mutism and attribute a lack of speaking to the fact that a child is “shy.”
On top of the lack of conversation surrounding selective mutism, parents and caregivers alike are often befuddled to find out their child is not talking at school or an extra-curricular activity. Often children with selective-mutism are extremely outgoing or chatty in their home environments, and thus it is difficult to understand what is happening with their child.
In addition to all of the above considerations for how selective mutism often goes unnoticed or brushed off, there is a common misconception that children will grow out of their selective mutism, just as some children grow out of being shy. Unfortunately, the nature of selective mutism is such that the other adults and children in the “quiet environment” will notice a child with selective mutism’s discomfort with communication, and begin to accommodate them such that they’re no longer being challenged to speak at all. This may mean that they do not require the child to participate in activities that induce fear or distress and make broad assumptions about the child’s comfort level. Often other children will jump in and try to communicate for the child or discount them as playing partners, mistaking their quiet demeanor for disinterest. With growing accommodations in the environments that induce the anxiety, selective mutism strengthens, relying on others to make changes for the child’s anxiety instead of making room for the child to rise to the occasion and utilize their voice.
With so much to consider, it can be difficult to determine if a child is shy or if they’re experiencing selective mutism. Language and communication deficits should always be ruled out prior to suspecting a selective mutism diagnosis. Thus, if your child is talking to you at home with age appropriate development (which can be consulted about via your child’s pediatrician or a speech language pathologist) it may be something worth seeking a professional mental health provider’s opinion on. Another important consideration that treatment providers will ask is if the lack of talking has been taking place for a period of 6 months or more in a specific environment (school, extracurricular, other areas typically outside of the home). If you’re a teacher and notice early on that a student in your class is not speaking (to you or to classmates), note this with the parents immediately so that conversations and assessments for speech, language and comprehension can occur and any necessary rule outs take place early on. It is often difficult to get the news that a child does not speak at school and hearing this after several months of schooling can add an additional element of surprise and further stress.
If appropriate rule-outs have occurred and a family or school are waiting on a formal diagnosis, it is important to keep in mind that selective mutism is an anxiety disorder that impacts a child’s ability to communicate and their perception of social situations, seeing them as, for lack of a better word, dangerous. Thus our approach to communicating with a child who has suspected selective mutism may be different from our approach to talking to other children.
When interacting with a child who has suspected selective mutism, the adult should continue to make efforts towards connection with the child even if it feels fruitless. This could include giving them compliments and consistently communicating with them without asking direct questions. As the child begins to demonstrate more comfort and connection, they can be engaged in quiet, 1:1 conversations with those that they have connected to. Adults in their life can ask questions softly and ask them “forced-choice” questions such as “do you like chocolate or vanilla best?” The adults should wait at least 5-10 seconds prior to saying anything else, giving the child the opportunity to work up courage, decide their answer and choose whether or not to communicate it.
If a child does not answer, that’s okay! Tell them that, and that you can’t wait for them to whisper it to you when they do decide which is their favorite! Continue to make those efforts and demonstrate sincere interest to hear from the child in the future. If the child does answer the question, repeat what they said back, “Wow, you like chocolate better than vanilla! I love hearing you tell me things you like.” If possible, rewarding the child either with continued special 1:1 connection or an extrinsic reward.
In therapy, your child’s therapist will work with you and your child to elicit verbal communication in a setting outside of the home, often utilizing forced choices (as demonstrated above) and rewards for when a child is able to verbally communicate. Some parents are weary at the idea of rewarding their child for speaking, particularly when they know them to be able to speak at home. However, it is important for your child’s learning to make positive associations with communicating their likes, wants and needs. From there, you will work with your child’s therapist to educate the other supportive adults in your life and develop a support plan for the areas where communication is a struggle.
The best news is that selective mutism is treatable and children often develop confidence quickly once they begin speaking even one or two words in their quiet environment. It can be difficult to know how to support a child experiencing selective mutism and thus employing the help of professionals and ensuring those who interact with your child on a daily basis are aware of the basics of the disorder are two of the most important steps in seeking treatment.
On a final note, there are many resources out there that promote that selective mutism is often the result of a traumatic experience. Although this may be true for some, it is not the case for the majority. The etiology of selective mutism is still being researched and though there are a multitude of factors that have been found to be correlated with selective mutism, causation is not definitive nor has it shown to be consistent across subjects. So parents, if you take nothing else from this article, please know you are NOT to blame for your child’s selective mutism AND know that there is help available.
Therapy for Selective Mutism at Austin Anxiety and OCD Specialists
We hope that our blog will be a helpful resource for parents of children experiencing selective mutism. We also recognize that additional support is sometimes necessary. Early intervention is especially important for children with selective mutism, and it may be important to seek support from a psychologist or therapist. Many of our therapists at Austin Anxiety and OCD Specialists have specialized training in selective mutism. Austin Anxiety and OCD Specialists provides individual and group therapy to children with selective mutism who live in the greater Austin area (Westlake, Buda, Kyle, Round Rock, Cedar Park, Leander, Georgetown, Pflugerville, Liberty Hill). We provide in-person therapy sessions at our three Austin area offices. If you are interested in scheduling an appointment or learning more about therapy for selective mutism please contact us at hello@austinanxiety.com or 512-246-7225.