What is Selective Mutism?
I met a 4-year-old child at a birthday party and said, “Hi! What’s your name?”; the child stares back at you, but does not answer… You ask a different question, “Are you having fun?”, but still — nothing. Many may automatically attribute this lack of response to shyness; however, what if it’s something more? The child’s mom comes into the room and says to me, “At home, she is a chatterbox! But as soon as we leave the house… I can’t get her to say anything”. My mind starts connecting the dots about a disorder I had learned about: selective mutism. Could it be? Selective mutism is an anxiety disorder in which children who are talkative at home, are unable to speak in other settings.
Signs of Selective Mutism
- Verbal at home; non-verbal in other settings
- Appearing fearful or “paralyzed” in public settings
- Inability to speak to familiar adults in public settings
- Some use of gestures to communicate (e.g., nodding, pointing); however, some also do not use gestures
Debunking Myths of Selective Mutism
- Selective mutism is not shyness; children with selective mutism are “frozen with fear”
- Selective mutism is not that the child is refusing to speak, it is that the child is unable to speak
- Not usually secondary to trauma; those who become mute after trauma will typically not speak in all settings (e.g., home, public settings, etc.). Those with selective mutism are typically only mute in social settings
Treatment for Selective Mutism
It is very important to have your child receive a comprehensive evaluation, if your child is presenting with signs of selective mutism. Unfortunately, the longer a child does not speak, the more difficult it will be to treat the anxiety. Without the right help, he/she may miss out on important academic and social events.
It is important to not push a child to speak, as it can only increase anxiety. The standard treatment for selective mutism typically involves behavioral therapy, which prompts speech and reinforces speaking experiences with specific praise and encouragement.
It is essential to build a right team of professionals (e.g., speech therapist, teacher, parent, psychologist), so that the child can bring his/her speaking skills to the “real word” (e.g., school classroom, restaurants). The partnership is critical for carryover in all settings because if not, one professional may be making progress with a child in one office setting; however, progress is not being translated into all other settings; thus, treatment is missing the mark. Everyone must be on the same page.
Tips to help children talk:
- Provide extended wait-time for child to answer –
- Provide 5+ seconds for child to respond to a question/sentence
- Specific Praise –
- Provide praise when your child uses words, “Great job using your words to tell me!”, so that he/she knows exactly why he/she is receiving praise
- Ask open-ended questions –
- Instead of “yes/no” questions (“did you have fun?”), utilize open-ended questions to encourage verbal responses (“what should we play next?”)
- Avoid asking too many questions
- Do not ask too many questions at once, as this will place pressure on your child. Instead, opt for sentences that encourage responses and talk about what your child is doing (“Oh! I love how you’re drawing a flower”)
- Avoid “rescuing” child by answering for him/her
- It is common for well-intended parents to answer questions for the child; however, this unfortunately reinforces selective mutism
- Be patient
- Remember to be patient. If your child is not talking, it is not because he/she does not want to – it is because he/she feels unable to. If you as the parent/professional are calm, the child will be more likely to mirror that emotion
If you live in Florida and feel that your child is displaying signs of selective mutism, or perhaps another communication difficulty, please reach out to Exceptional Speech Therapy. With selective mutism, as with all communication difficulties, our goal is to help build each child’s confidence by accumulating successful speaking experiences.
Andrea Scola, M.S., CF-SLP
Exceptional Speech Therapy Blog Writer