Memoirs of a Psychologist: Selective Mutism in Children - What Is It, What Are the Causes and Treatments?

The following is a piece on pre-teen parenting tips, co-authored with psychologist Robert Erdei. We partnered with Dr. Erdei to create a series of blog posts geared specifically toward the difficult parenting challenges we were experiencing ourselves. We call this series, "Memoirs of a Psychologist". We hope you enjoy this piece and please don't hesitate to leave a comment below with your thoughts.

Selective mutism is one of the most perplexing disorders of communication, at least from a psychologist’s perspective. When a child has selective mutism, he or she does not speak outside the home or family environment.

It is a relatively rare disorder, but its current occurrence shows an upward trend. 1 in 1000 children is affected and it is more likely to occur in girls. (Standart, Le Couteur, 2003) What is selective mutism and what can you do as a parent?

It is a relatively rare disorder, but its current occurrence shows an upward trend.

Chosen muteness - when families are in the dark.

Here is the scenario: the child is perfectly healthy and has no problems with hearing or speech whatsoever. Everything is fine at home, but in public places it's another story. Parents and other family members are rarely the first to realize there's anything out of the ordinary - chosen mutists typically have a high level of intelligence and they have do have the ability to speak.

It is usually the outside community that notices the difference in the child. The child spends some time there, but no one heard her voice. The months and later the years go by, but still no word can be heard. Parents often do not understand the concerns: she is talking at home non-stop. She comes home every day with stories of what happened in her kindergarten class. Interestingly, the child is not only very talkative at home, but she is prone to have temper tantrums.

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The big concern for parents: school.

It is a very hard decision to allow children to go to school without being able to speak in a foreign environment. Teachers will face great difficulties in evaluating the performance of the child; it is impossible to tell whether she is able to read properly and teachers should not expect verbal responses by any means. When the teacher accepts to evaluate only the written performance of the child, she may show surprising progress.

Children are able to form an intimate and confidential relationship with their teacher, which might elicit some answers whispered to the ear of the teacher. Mutist children do not show any significant differences to their peers in academic achievement, measured by tests or teacher ratings. (Cunningham et al, 2004)

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What causes selective mutism in children?

To be honest, no one knows. There are several assumptions, like the attitudes of the parents, for example. Parents, who are rigid and show no affection and love are considered (by some) to be responsible for this kind of behavior. Others suspect the opposite: over-anxious and over-worrying parents might be the cause of mutism. Research results did not find a significant effect of parenting style, but they found that mutest children are less cooperative. (Cunningham et al, 2004)

According to another opinion, mutism is caused by the parental model to stress and tension. When the parent reacts to stressful situation with silence and suppressed tension, the child automatically learns this kind of behavior. Mutism is believed to be associated with anxiety and oppositional behavior. (Cunningham et al, 2004) Children often generalize their traumatic experiences, for example, the separation from the parents in kindergarten. Their heightened level of anxiety makes them frozen in that moment. (Bork, Harwood, 2010)

Selective Mutism's symptoms explained for parents.

Your child will be able to perform in school, but it definitely helps to have a teacher who is supportive and patient. The child will be able to find friends and has no more chance to be abused or bullied than other children. (Cunningham et al, 2004) The child will in most cases start to speak in out-of-home environments as well, it is very-very rare that they maintain their chosen muteness indefinitely. Nevertheless, there is no easy way to deal with selective mutism (at least not that I know of). As a parent, you might face a long way to find a solution and to reach certain goals.

How can selective mutism be treated?

Good question. Literature suggests various methods to treat the condition, such as psychotherapy, cognitive behavioral therapy, medication or speech and language therapy (Standart, Le Couteur, 2003). Systematic desensitization is suggested by research results as an effective way to treat the disorder. (Kearney, Vecchio, 2007)

I have a patient, an eight-year old boy, who is a prime example of mutism. He went to kindergarten for years (in Hungary children visit kindergarten for three or in some cases four years), but he refused to speak to anyone. When it was about time to start school, the parents started to worry about the future and the kindergarten teachers decided that something needs to be done. I came to the picture, but the treatment of the child was (and still is) a very lengthy process. He was not cooperative, did not explore the environment, did not answered questions, just sat on her mother’s lap and grumbled when I came too close. To cut a long story short: the child now speaks. Not everywhere, but he speaks with everybody in school and progresses well with his academic achievement.

What is the secret? I do not know. The most important factor was probably my persistence and patience. Plus, the secret weapon, a room with large open spaces, a trampoline and balls, lots of colored balls. He liked that room and he wants to go there every time he visits me. It was not an instant success; we struggled for almost a year to break the ice. It succeeded, so there is hope.

The bottom line? Your child just needs someone he or she learns to trust.

References:

  1. Standart, S., Le Couteur, A. (2003): The Quiet Child: A Literature Review of Selective Mutism, Child and Adolescent Mental Health, Vol. 8, No. 4, 154-160
  2. Cunningham, C., McHolm, A., Boyle, M. H., Patel,S. (2004): Behavioral and Emotional Adjustment, Family Functioning, Academic Performance, and Social Relationships in Children with Selective Mutism, Journal of Child Psychology and Psychiatry, 45:8, 1363-1372
  3. Kearney, C. A., Vecchio, J. L. (2007): When a Child Won’t Speak, The Journal of Family Practice, Vol. 56, No. 11
  4. Bork, P., Harwood, D. (2010): Transient ≠ Persistent: Determining the Best Approach to Selective Mutism Intervention, The International Journal of Interdisciplinary Social Sciences, Vol. 5, No. 3

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What do you think? Do you have experience with selective mutism in children? We'd love to hear your thoughts in the comments below.

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