Selective mutism is a type of anxiety disorder that is characterized by the inability of individuals, mostly children, to speak in certain situations or with certain people. Such individuals are normally capable of speech. Selective mutism is often accompanied by social anxiety which can sometimes be severe in nature as well as shyness.
Adults and children afflicted by selective mutism can understand language as well as communicate freely, but usually are unable to speak in certain environments. A child may be completely silent in school, but speak a lot at home.
Selective mutism can be varied in its form in different individuals. Some children may actively participate in activities and be very social but refrain from speaking; some may speak to peers but not to adults; some may answer in short sentences when adults ask questions and not speak to peers while some others may participate in very few activities and speak to no one.
In an extreme form of the disorder called ‘progressive mutism’, the child may eventually stop speaking to all, including the family members.
Symptoms of selective mutism
Some of the signs and symptoms of selective mutism are listed below:
- The individuals tend to speak in most situations, but may consistently fail to speak in certain social situations which require communication, such as school activities.
- Such speech disruptions may interfere with social interaction or with occupational and educational accomplishment.
- The speech disturbance is not associated with any form of communication disorder such as stuttering, neither is it a side effect of any progressive developmental disorder, schizophrenia or other types of psychotic conditions.
- The children affected with selective mutism do not lack the knowledge of the spoken language nor do they have any discomfort with the language.
- The speech disturbance is not a part of the autism spectrum disorders. Autistic children not only become mute in certain situations, but also show characteristic motor movements such as excessive hand flapping, recurrent behaviors, etc.
- Children may experience selective mutism in conjunction with ADHD or it may result in the diagnosis of ADHD in children. Children with ADHD have deficient attention span and usually tend to show little or no attention to others. Children with selective mutism may also exhibit behaviors wherein they are in a world of their own. Hence, it can be misconstrued as ADHD in children.
- Some children may have additional disorders like social phobia and other anxiety disorders such as panic attacks and obsessive compulsive disorder
- Children affected by selective mutism do not choose to keep silent in certain situations, but are unable to speak in such social situations.
Besides, speech disturbances individuals with selective mutism may elicit the below mentioned symptoms:
- Problems in keeping eye contact
- Difficulties in smiling and blank expressions
- Body movements that are awkward and stiff
- Problems in the expression of emotions and feelings
- Fear of social humiliation, increased shyness and/or social withdrawal or isolation
- Increased tendency to be more worried than similarly aged individuals
- Affinity for routine and dislike towards changes
- Affliction to crowds and noise
- Difficulties in sleeping
Causes of selective mutism
Some of the causes of selective mutism are as follows:
- A family history of anxiety disorders can increase the vulnerability to the condition.
- Abnormalities in the amygdale can lead to its over-excitability which results in inhibited temperament. This causes the deflated and muted response to social situations
- The presence of sensory integration dysfunction can result in children having problems in processing certain sensory information. This results in increased levels of anxiety and being overwhelmed by social situations, which in turn leads to “muting” in the affected children.
- In some cases, the presence of language or speech disorders can add increased stress in social situations where the child is expected to speak, thereby increasing the susceptibility to develop selective mutism.
Selective Mutism Treatment
Selective mutism is not a condition that improves with age. On the contrary, it can sometimes be a self-reinforcing disorder. Hence, it is important to get the disorder treated as early as possible.
The treatment for selective mutism is dependent on several factors such as age, the presence of mental disorders, etc. Some of the treatment methods are given below:
- Stimulus fading is a method wherein a child starts talking to a person whom he/she is comfortable talking. Then, in such an environment strangers are added one by one at regular intervals to desensitize the patient to social phobia or fear.
- Desensitization is a method wherein the patient communicates with a person of whom he/she is afraid to converse, via other means such as emails, letters, video recordings, etc. The affected child can then slowly get used to the idea of communicating with that person thereby alleviating his/her fears.
- Shaping encourages an affected child to communicate and then reinforces each act of communication. The communication can start with non-verbal actions and graduate towards sounds and complete sentences.
- Medications such as antidepressants can be prescribed as per the age to alleviate the symptoms of anxiety. However, such drugs should only be prescribed after thorough examination by a physician.