Selective mutism
Overview
Selective mutism is an anxiety disorder where a person is unable to speak in certain social situations, such as with classmates at school or to relatives they do not see very often.
Symptoms
Selective mutism can start at any age, but most often starts in early childhood, between age 2 and 4. It's often first noticed when the child starts to interact with people outside their family, such as when they begin nursery or school. The main warning sign is the marked contrast in the child's ability to engage with different people, characterised by a sudden stillness and frozen facial expression when they're expected to talk to someone who's outside their comfort zone. They may avoid eye contact and appear: nervous, uneasy or socially awkwardrude, disinterested or sulkyclingyshy and withdrawnstiff, tense or poorly co-ordinatedstubborn or aggressive, having temper tantrums when they get home from school, or getting angry when questioned by parents More confident children with selective mutism can use gestures to communicate – for example, they may nod for "yes" or shake their head for "no". But more severely affected children tend to avoid any form of communication – spoken, written or gestured. Some children may manage to respond with a few words, or they may speak in an altered voice, such as a whisper.
Causes
Experts regard selective mutism as a fear (phobia) of talking to certain people. The cause is not always clear, but it's known to be associated with anxiety. The child will usually have a tendency to anxiety and have difficulty taking everyday events in their stride. Find out more aboutanxiety in children. Many children become too distressed to speak when separated from their parents and transfer this anxiety to the adults who try to settle them. If they have a speech and language disorder or hearing problem, it can make speaking even more stressful. Some children have trouble processing sensory information such as loud noise and jostling from crowds – a condition known as sensory integration dysfunction. This can make them "shut down" and be unable to speak when overwhelmed in a busy environment. Again, their anxiety can transfer to other people in that environment. When mutism occurs as a symptom ofpost-traumatic stress, it follows a very different pattern and the child suddenly stops talking in environments where they previously had no difficulty. Having selective mutism does not mean you're autistic, as these are two separate conditions. But you can have selective mutism and also be autistic. Autism has other signs and symptoms, such as repetitive behaviour and sensory issues, as well as difficulties with communication. Find out more about the signs of autism
Treatment
Cognitive behavioural therapy (CBT)helps a person focus on how they think about themselves, the world and other people, and how their perception of these things affects their thoughts and feelings. CBT also challenges fears and preconceptions through graded exposure. Behavioural therapy concentrates on helping combat current difficulties using a gradual step-by-step approach to help conquer fears. Medicine is only really appropriate for older children, teenagers and adults whose anxiety has led todepressionand other problems. Medicine should never be prescribed as an alternative to environmental changes and behavioural approaches. Though some health professionals recommend using a combination of medicine and behavioural therapies in adults with selective mutism. However,antidepressantsmay be used alongside a treatment programme to decrease anxiety levels, particularly if previous attempts to engage the individual in treatment have failed.