Symptoms | Causes | Diagnostic Criteria | Treatments

Selective mutism is an anxiety disorder found in children that is characterized by an inability to speak when asked due to fear. This mental illness typically co-exists with social anxiety and shyness. A child’s selective mutism may greatly impede on their ability to successfully coexist with their peers, as well as effectively engage with their teachers at school. This may also negatively affect their self-esteem as well.

For children suffering with this condition, they are fully capable of speaking to authoritative figures, but will often resist this as the expectation for them to speak when asked is enough to give them an influx of overwhelming anxiety at the mere thought of it. The feeling of expectation is very difficult for children suffering from this illness as they may find it very challenging with initiating conversation with others.

Advertisement

When encountering other individuals in social interactions, children with selective mutism do not initiate speech or reciprocally respond when spoken to by others. Lack of speech occurs in social interactions with children or adults.

Children with this condition will speak in their home in the presence of immediate family members but often not even in front of close friends or second-degree relatives, such as grandparents or cousins. The disturbance is often marked by high social anxiety.

Children with this disorder often refuse to speak at school, leading to academic or educational impairment, as teachers often find it difficult to assess skills such as reading. The lack of speech may interfere with social communication, although children with this disorder sometimes use non-spoken or nonverbal means (e.g., grunting, pointing, writing) to communicate and may be willing or eager to perform or engage in social encounters when speech is not required.

Symptoms of Selective Mutism

Associated features of selective mutism may include excessive shyness, fear of social embarrassment, social isolation and withdrawal, clinging, compulsive traits, negativism, temper tantrums, or mild oppositional behavior.

Although children with this condition generally have normal language skills, there may occasionally be an associated communication disorder, although no particular association with specific communication disorder has been identified.

In clinical settings, children with this condition are almost always given an additional diagnosis of another anxiety disorder–most commonly, social anxiety disorder.

Selective mutism may result in social impairment, as children may be too anxious to engage in reciprocal social interaction with other children. As children with selective mutism mature, they may face increasing social isolation.

In school settings, these children may suffer academic impairment, because often they do not communicate with teachers regarding their academic or personal needs. Severe impairment in school and social functioning, including that resulting from teasing by peers, is common. Here are some additional symptoms of selective mutism:

• Intense anxiety when asked to speak
• Avoiding situations where they may be asked to speak
• Avoiding certain people who may ask them to speak
• Extreme shyness
• Feeling pressured to speak or deliver
• Quiet around certain individuals
• Difficulty expressing themselves
• Unable to cope with their anxiety
• Shakiness, sweating, and increased heart rate

Advertisement

Causes of Selective Mutism

Temperamental, environmental, genetic & physiological factors are all likely to play key roles in the development of this mental illness. Individuals with a family history of selective mutism may be at risk for developing it themselves. In fact, researchers have found that several parts of the brain, as well as biological processes, play a key role in fear and anxiety.

The onset of this condition is usually before age 5 years, but the disturbance may not come to clinical attention until entry into school, where there is an increase in social interaction and performance tasks, such as reading aloud.

The persistence of the disorder is variable. Although clinical reports suggest that many individuals “outgrow” selective mutism, the longitudinal course of the disorder is unknown. In some cases, particularly in individuals with social anxiety disorder, selective mutism may disappear, but symptoms of social anxiety disorder remain.

Genetics and one’s environment may both play significant roles in the development of this condition. This is typically the case with virtually every mental disorder. For instance, a child who has a family history of anxiety disorders may have an increased chance of developing this condition due to them possibly having a genetic predisposition for it.

Advertisement

Diagnostic Criteria

To get properly diagnosed with selective mutism, you will need to go through a psychiatric evaluation with your psychiatrist, psychologist, or other accredited mental health professional who can legally diagnose mental disorders. Psychiatric evaluations typically entail getting asked questions about your symptoms, such as how intense and frequent you experience them.

According to the DSM-5, some specific criteria for diagnosis is having consistent failure to speak in specific social situations in which there is an expectation for speaking, such as at school, despite speaking in other situations, failure to speak is not attributable to a lack of knowledge of, or comfort with, the spoken language required in the social situation, among several other criterion.

Advertisement

Treatments of Selective Mutism

There are many different forms of treatment that may be advantageous for someone suffering with this illness. Some of these treatments include desensitization, self-modeling, stimulus fading, spacing, shaping, mystery motivators, as well as pharmacological treatment, among others. Cognitive behavioral therapy (CBT) may also be beneficial as well.

All of these different forms of treatment are meant to help the child feel more comfortable with speaking. Though some of them will give the child more acute anxiety, such as with desensitization for example, the goal will be for them to improve their ability to speak to others with much less stress and anxiety overtime.

A low dose of an anti-anxiety medication or an antidepressant may be able to help your child suffering from this condition also, but this is something that you will want to first discuss with your child’s doctor.

If you think you may be suffering from some of the symptoms of this condition, then you may benefit from therapy. Feel free to reach out to your doctor or local mental health clinic to see what your available options are and to see if there is any sort of discount or promo code available to help you with the costs of treatment, as well as if your health insurance will cover treatment costs.

References:

• https://www.selectivemutism.org/

• https://selectivemutismcenter.org/whatisselectivemutism/

• https://childmind.org/guide/selective-mutism/

• https://www.asha.org/public/speech/disorders/selective-mutism/

• https://medlineplus.gov/ency/article/001546.htm

• https://kidshealth.org/en/parents/selective-mutism-factsheet.html

• https://www.selectivemutismfoundation.org/

• https://www.nami.org/Blogs/NAMI-Blog/January-2017/Selective-Mutism-Frozen-in-Silence

• https://adaa.org/understanding-anxiety/additional-disorders/selective-mutism

• Diagnostic and Statistical Manual of Mental Disorders (DSM-5) https://www.psychiatry.org/psychiatrists/practice/dsm

Advertisement