Selective Mutism: Diagnosis, Consequences, and Course of Action

16th August 2020by Raveena Singh0

Selective Mutism is the inability to speak in certain situations or around certain people. It is an anxiety disorder that occurs mostly in children around the age of 5. Some signs may show up earlier, such as separation anxiety or inhibited temperament but may not always be apparent and signs or difficulties may only show up when the child is required to speak in a different social setting. Some children may be able to develop social skills and non-verbal communication and even actively participate in non-verbal activities but the mutism remains in those situations. They might also be able to whisper to one or two friends. It can also be caused by a Sensory Processing Disorder in which the child is highly sensitive to light, sound, touch, smell and the inability to process sensory stimuli effectively can result in high levels of anxiety. In certain instances, selective mutism may serve as a compensatory strategy to decrease anxious arousal in social encounters.

There is limited research on this particular condition and it can often go misdiagnosed due do misinformation. Selective Mutism can differ a lot in every child that shows related symptoms, which is another reason for misdiagnosis or a lack of diagnosis. Mostly, the child is able to speak at home or in other such comfortable social settings among family members and friends and may even be “chatty” in these conditions, while unable to speak in situations that are new and have an expectation of speaking. This is the most important marker for Selective Mutism as opposed to mutism or mutism due to trauma in which the child is not able to communicate verbally in any situation. Another factor for misdiagnosis is concerned with children who are bilingual. Sometimes the child may not be comfortable speaking in his/her second language and it is important to rule out this factor while making a diagnosis. It is imperative to the diagnosis that the knowledge of the language is not causing the impairment.

It is common to attribute the mutism to shyness or something that the child will “grow out of”. It can even be regarded as oppositional or defiant while it is an actually inability on part of the child to speak. It is also important to differentiate from, and rule out the possibility of, autism, other speech, developmental or hearing impairments. Mostly, the child will show consistent behavior across all settings in any of the above as opposed to selective mutism and there will be several other distinguishing markers present, all of which need to be reported completely and accurately to the professional making the assessment or carrying out therapy.

Functional concerns of selective mutism include social isolation, possible academic impairment due to inability to communicate needs, negative experiences with peers such as teasing or bullying. These conditions usually have a chance of increasing in higher grades due to increased social demands and can cause damage to the child’s self-image and even lead to depression.

Course of Action

  • It is important to carry out a holistic plan in which teachers, doctors, parents, therapists, special educators are involved so that the child gets consistency. The earlier the signs are noted and worked upon, the better the chances of improvement are; and in this particular condition, the difficulties might be completely managed by developing effective coping mechanisms.
  • It is important to start slow and in a non-threatening way. Thus therapies like art-based therapy, Dance/Movement therapy, music therapy etc. are effective ways of building a relationship with the child and encouraging expression in a non-verbal manner. Through these methods, the child can learn how to build and form relationships and trust oneself, the environment and the people in it. Further, it can help the child express his anxiety and learn how to effectively manage it
  • Behavioral therapy also works well with anxiety and possible signs of depression that child can develop if the load of the condition increases with age. Systematic desensitization and cognitive behavioral therapy are some techniques that can be used with the child to overcome anxiety and other negative feelings
  • The application of therapy progress and skills in real world is the most important aspect of the treatment. Practicing learned skills in simulated situations is one way to go about it
  • Medication might be required in some cases and must only be given after proper review and consultation from a psychiatrist, tapering in and out to minimize side effects
  • When the child is ready, increasing socialization to levels tolerable by the child will help the child overcome anxiety and practice the application of his coping skills
  • Schools should be on board to implement individualized education programs (IEP) and make the necessary amendments as required by the child
  • Parents should learn more about the condition and keep in touch with the activities the child is doing and progressing in and reinforce those behaviors around the house
  • Encouragement, praise and unconditional positive regard are extremely important for the child developing new skills and self-esteem

Most importantly, the results will not show up in a matter of days or maybe even weeks. It is important to show patience with the child and celebrate the small victories. Breaking goals into small, tangible, manageable pieces will build confidence in the child and make the improvement more apparent for everyone.

Raveena Singh

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