Imagine this scenario: Abby and Beth both talk to their siblings about their favourite toys and can ask their parents for their choice of snack. When they get to school, they both feel shy at first and don't want to speak.
Abby starts to get comfortable after a few minutes and she eventually joins in with the other students, talking and playing easily. Beth stays silent for the entire day despite the efforts of teachers and students. In fact, Beth never speaks at school, only communicating at home with her family.
Beth isn't just being stubborn or feeling shy from time to time – she may be experiencing Selective Mutism.
What is it?
Selective Mutism is a severe anxiety disorder where a child cannot speak in certain situations that cause them fear or stress (e.g. at school, a park, soccer practice, etc.), but they're capable of speaking when they feel relaxed (e.g. at home). It's "selective" because it doesn't occur in all situations. They're not staying silent to gain control over the situation or cause frustration – they're refusing to speak to protect themselves from the anxiety they're experiencing.
A child with Selective Mutism might also:
look panicked or frozen when spoken to by others in uncomfortable situations
use gestures such as nodding or pointing to communicate their needs without actually having to speak
struggle to say simple things like "hello", "goodbye" or "thank you"
have other anxiety disorders shown through difficulties being away from parents, social anxiety, or bed wetting
As you might assume, Selective Mutism eventually gets in the way of forming friendships and participating in classroom activities or extracurriculars which is why it's important to seek intervention. For younger children, it can result in speech and language delays.
*Selective Mutism also shows up in some adolescents or adults, but it usually would have begun in childhood. The longer a person has gone without treatment, the more likely they are to be impacted socially and academically. While it is more difficult to treat Selective Mutism in older individuals, help is still available through specific interventions for social skill development, Cognitive Behaviour Therapy (CBT), psychotherapy for related disorders such as anxiety or depression, and prescribed medication.
How is it diagnosed?
Selective Mutism typically shows up for the first time when the child starts school, but it can appear earlier than that. A child with Selective Mutism will show the behaviours above for at least one month (not including the first month of school since children might take time to get comfortable) without having a speech or language problem that would cause them to stop speaking.
If you have concerns that your child has Selective Mutism, you should see your doctor to ensure that there are no developmental delays. You can also ask your doctor to refer you to a Child Psychologist or Psychotherapist to evaluate any other anxiety disorders. A Speech Language Pathologist can perform an assessment of Selective Mutism which may include:
talking with you about your child's development and medical history
screening your child's hearing (through an Audiologist)
evaluating the movement of your child's articulators (e.g. tongue, lips, jaw)
testing how well your child understands what others say to them
screening for developmental concerns (atypical social communication, play or behaviour)
evaluating how well your child can produce sounds, answer questions and talk about their thoughts (*If the child does not speak to the Speech Therapist, a video of them speaking at home may be requested)
How is Selective Mutism treated with Speech Therapy?
It may seem strange to go to a Speech Language Pathologist for a child who already knows how to speak, but Speech Therapy can help with many areas of communication as a whole. Rather than working on how to produce specific sounds, Speech Therapy with a child experiencing Selective Mutism focuses on taking steps to overcome anxiety and feel more confident in speaking situations. There are a number of approaches to treating Selective Mutism that will depend on the individual.
Stimulus Fading – This strategy starts by having the child speak with someone they are comfortable with in a familiar environment. Another communication partner is slowly introduced by taking small steps to increase the child's comfort level until they are having a full conversation with the new person.
Shaping – All attempts at communication are encouraged by the Speech Therapist, including pointing or other gestures, mouthing a word, or whispering. Using a lot of positive reinforcement, the goal is to get the child more and more comfortable working towards verbal communication.
Self-Modelling – This method uses videos of the child speaking effectively in a comfortable situation to increase their confidence. The goal is that by reassuring the child that they are capable of communicating well through their speech, they will start generalizing this behaviour to new speaking situations.
A child with Selective Mutism may also benefit from CBT with a Psychotherapist to develop ways to cope with negative thoughts or medication for their anxiety.
What can I do to help?
Seeking early treatment for a child with Selective Mutism is the best way to help them overcome their anxiety, but you can also be supportive of their journey outside of Speech Therapy in a number of ways.
Look for activities that promote conversation – Playing board games, building with blocks or Legos, or reading books gives children many opportunities to share their thoughts and feelings with you. This is a great time to practice eye contact and conversation.
Give your child opportunities to speak in public settings – Take small steps to encourage your child to practice their skills. For example, instead of ordering food for your child at a restaurant, they could start by pointing at menu items and replying "yes" or "no" to questions you ask them in front of the server.
Create a safe space – Talk openly about your feelings to let the child know it's okay to share their emotions. Whenever your child tells you how they're feeling, be sure to acknowledge it to make them feel heard and supported (e.g. "It sounds like that made you pretty angry,"; "I can see how that made you upset").
Don't make it a "big deal" when your child speaks – Of course we want to reinforce communication from the child, but it shouldn't be jarring or embarrassing to the child (e.g. clapping, loud praise in front of others). Calmly acknowledge what they said, maybe with a warm smile, a touch, or a quiet word. When you have a moment later, you could say something like: "You spoke very politely to the cashier at the grocery store. I think he appreciated that."
Don't force them to speak – It can be frustrating when you really want your child to communicate with someone and it feels like they're intentionally making things difficult, but forcing your child to speak is not going to help. This will only create more anxiety around future speaking situations.
We hope this post has helped you understand Selective Mutism and how it can be treated. Everyone's path to communicating freely will look different, so some individuals might take longer than others or have to move back to easier steps before continuing on – and that's okay! Trying new things and working to manage anxiety takes a lot of courage, so be sure to celebrate all the small successes along the way.
Do you know a child experiencing Selective Mutism? We can help! Get in touch with a Speech Language Pathologist to find out how to get started.
Sources:
American Speech-Language-Hearing Association. (n.d.). Selective Mutism. ASHA. https://www.asha.org/public/speech/disorders/selective-mutism/.
The Children's Hospital of Eastern Ontario. (2012). Helping Children and Youth with Selective Mutism: Information for Parents and Caregivers. Ottawa, Ontario; Mental Health Information Committee at the Children's Hospital of Eastern Ontario.
Andalusia Speech Therapy has multiple clinics across Ontario and offers virtual therapy to anywhere in the world. Contact us more for information.