Selective Mutism
A child's silent scream
by Jonathan Berent, LCSW, ACSW

PARENTGUIDE NEWS April 2007

•Mikey, age 7, an intellectually gifted child, never spoke in school. The school recommended speech therapy. This proved useless as the problem was selective mutism, which is a very specific form of social and performance anxiety.

•Ashley’s mother hoped that she would be able to overcome her shyness in kindergarten. When summoned to the school about “a problem,” the mother, with her own anxiety, watched Ashley standing frozen, motionless and speechless in the playground, while the other children played around her.

•David earned good grades, but had no friends or outside interests at age 18. His parents assumed that would change when he went to college. Instead, David stayed at home and worked stocking shelves overnight at the electronics store. He never received treatment for his selective mutism and felt he was bound to fail in college, since “he didn’t have anything to say.”

These cases illustrate an often misdiagnosed disorder in children— selective mutism (SM). SM is a severe form of social anxiety. Because it is complex and its origins unknown, it is difficult for parents to find appropriate help. Left untreated, SM can produce a cycle of academic, social and emotional repercussions and a cascade of additional problems in adulthood such as social phobia, depression, relationship problems, career dysfunction and substance dependence. I describe selective mutism as an addiction to the avoidance of speaking.

Since 1978, my staff and I have worked with thousands of individuals with social anxiety and hundreds who have the debilitating anxiety of selective mutism. If properly diagnosed, there are a number of ways parents can help to resolve the problem.

More Common Than Autism
SM was thought to be rare, affecting about one child in 1,000. But a 2002 study in The Journal of the American Academy of Child and Adolescent Psychiatry put the incidence of SM closer to seven children in 1,000, making it almost twice as common as autism.

A child’s intense shyness may be misinterpreted as something he or she will “outgrow.” This is the most common mistake that is made. Sometimes it is labeled as innate stubbornness, obstinacy or a deliberate act not to speak. What is puzzling and adds to difficulty in diagnosis, is that children affected with SM have the ability to speak and understand language, develop age-appropriate skills and often speak normally at home with immediate family members— although a syndrome of excessive whining, temper tantrums and histrionic behavior is often present. SM was once thought to be the result of severe trauma, but further study has conclusively shown that SM is not related to abuse, neglect or trauma.

Characteristics may include:
•Does not speak in select places such as school or at other social events.
•Does not speak to select people.
•Can speak normally in at least one environment; usually in the home.
•Inability to speak interferes with functioning in educational and/or social settings.
•Mutism has persisted for at least one month.
•Mutism is not caused by a speech disorder.

The Education System
The typical scenario within the school environment is to refer the selectively mute child to speech therapy. In most cases, this is not productive as the problem is an anxiety disorder, not a speech disorder.
Well-meaning teachers usually learn to accommodate the problem by investing in the belief and attitude that the child will not speak so why bother to treat the child like a regular student. Expectations regarding verbal performance become minimized or non-existent. This approach lessens the discomfort of the teacher, but the accommodation turns into “enabling” which worsens the problem. In addition, school psychologist-facilitated strategies involving reward systems backfire because the attention on the SM child becomes negative pressure.

Recommendations
Parents must be educated about the signs and symptoms of SM, and institute “empowering, non-enabling” parenting strategies as soon as possible. In addition, school personnel should be educated. It is productive for parents to learn how to advocate for the child with the school, and as a bottom line, parents should become aware of a 504 plan.

The problem worsens with time as the anxiety insidiously works its way into the personality creating avoidant and dependent characteristics. I believe that medicine should only be used when “corrective parenting” strategies are in effect and the child remains overly inhibited or paralyzed with speech. The objective of the medicine is to create a sense of ease in the brain. The longer term objective is to not need the medicine.

Jonathan Berent, LCSW, ACSW, has pioneered psychotherapy for social anxiety and selective mutism since 1978. He is the author of Beyond Shyness: How to Conquer Social Anxieties (Simon& Schuster). He has been featured extensively in the media including Oprah, CNN, ABC, CBS, NBC, FOX, The New York Times, Newsday and much more. Berent offers free diagnostic tools and information about SM on his Web site, www.socialanxiety.com. A free CD with excerpts from families where the problem has been resolved is available.