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Selective Mutism: What it is and What it is NOT

You may have opened up this blog post thinking “What on earth is Selective Mutism?”  Before we get started, I want you to imagine the following:

You are a child, lively and creative.  You have a good sense of humor, you are playful, and you love to learn.  At home with family, you feel completely free to be who you are without reservation.  When you meet a stranger, however, you find yourself frozen.  Unable to speak.  The stranger says, “What’s your name?” and you freeze further.  The stranger then says “Oh, you’re a shy one, aren’t you?” and further tries to coax you into conversation.  Panic alarms are going off inside your mind and all you want to do is escape, but you are frozen.  You look to your parents as a plea for help… a rescuing.  The stranger moves along, and your anxiety slowly starts to decrease in their absence.

I encourage you to keep the above scenario in mind as you read the following.

What is Selective Mutism?

Selective Mutism (SM) is an anxiety disorder that begins early in a child’s life, where the child consistently feels unable to speak to certain people or in certain situations in which speaking is expected (such as at school or in the community), while speaking freely in other settings (such as at home). 

What is the risk?

Asking for help is often one of the biggest challenges for someone with Selective Mutism.  As a result, these children may wet their pants because they are afraid to ask to use the restroom and may not tell anyone about this accident.  Someone with SM may also be unable to ask for help when lost.  With greater SM impairment, there is often a higher risk for danger, such as a child that may break his or her arm and not tell anyone.

What Selective Mutism is NOT: Debunking the Myths

SM is NOT shyness or social anxiety.  If you were to watch a video of a classroom with the volume muted, a child with SM would often look just like the other children—engaging in play and following classroom routine.  It is only when the volume is up that the child with SM stands out.  A shy child or a child with social anxiety, however, may be seen on the video playing alone or being behaviorally and socially timid with peers or teachers.  While often mislabeled as “shy,” many parents of children with SM would say just the opposite because at home, children with SM seem just like every other kid—playful and talkative.  Many times, children with SM are rambunctious or hyperactive in the home because they have pent up energy from not speaking for much of their day.  This can be especially true for children who are unable to speak in school.

SM is NOT Oppositional or Defiant Behavior.  Sometimes children with SM are viewed as “defiant” or “oppositional” due to a perceived refusal to speak.  Because these children may not look anxious, but may stare blankly and look “frozen” when expected to speak, they may then get in trouble for their “refusal.”  This, of course, further increases their anxiety.

SM is NOT a result of trauma.  It is common to hear a story about a child who had a bad experience in preschool or kindergarten, and that was the first time the child stopped speaking to others.  While it may be true that this child had a bad experience, how do we explain the other children who shared this same experience but did not develop Selective Mutism?  This tells us that there is a genetic component to SM.  After all, Selective Mutism is an anxiety disorder and anxiety tends to runs in families.

SM is NOT Autism.  In response to their lack of verbalization in certain settings, many children with Selective Mutism are misdiagnosed as being on the Autism Spectrum.  One of the differences between Selective Mutism and an Autism Spectrum Disorder is that the perceived social deficits in the person with SM seem to “disappear” when the child is at home.  This is why it is very important for anyone diagnosing SM to ask to see a video of the child in their home environment so they can get an idea of the child’s communication abilities when anxiety is not a limiting factor.

SM is NOT a result of a Speech and Language Disorder or difficulty in understanding a second language.  Children with SM often score lower in classes and on academic testing in which verbalization is required.  Unless a learning disorder or developmental delay is also present, these low scores tend to be a result of their anxious inability to speak in certain settings.  The evidence here, once again, is in the child’s performance when in a safe and relaxed environment (such as the home), where we would see developmentally appropriate speech.  SM is not limited to a certain language.  Therefore, if the child speaks freely in various settings in his native language, but not in his second language, this is not SM.

SM is NOT something the child will simply “outgrow.”  While I refer to children throughout this post, let it not be assumed that adults do not struggle with SM.  While some are able to overcome their SM over time, it is not without much hard work.  As with other anxiety disorders, the more time the person spends avoiding their anxiety, the greater the anxiety often becomes.  This is also true for SM, especially when friends and family have made habit of speaking for the person.

What to keep in mind when diagnosing Selective Mutism

In order to make an accurate diagnosis of Selective Mutism, it is best practice for the assessing professional to ask to see a video of the child with SM speaking freely in a comfortable environment, in addition to performing a face-to-face evaluation with the child and family.

Although SM is a consistent failure to speak in social situations where speaking is expected, these situations may look different for each child.  For example, many children with SM have difficulty speaking in school, though this is not the case for all.  Some children with SM feel comfortable speaking in school but “freeze” when speaking with extended family members or people in the community.  Though each person with SM may have a different presentation, the failure to speak must interfere with social communication, or with educational or occupational achievement.

In order to reach a diagnosis of Selective Mutism, the consistent failure to speak must be ongoing for at least one month.  That being said, Selective Mutism cannot be diagnosed within the first month of school because that is a sensitive period where many children are slow to warm up and speak in class.  After the first month of school, however, if a child is still not speaking to teachers and/or peers, an evaluation should be considered.

Selective Mutism cannot be diagnosed if the child’s failure to speak is a result of difficulty using or understanding the language, so one must be careful in diagnosing SM In a child who speaks a second language.  In the same light, a diagnosis of SM would not be appropriate if the failure to speak could be explained by a communication disorder.  Last, SM does not occur exclusively during the course of autism spectrum disorder, schizophrenia, or another psychotic disorder.

If you or someone you know has Selective Mutism, Pinnacle Counseling and Testing Center can help.  We not only provide treatment with the individual diagnosed with SM, but also with the families, schools, and other important people in the person’s life.  This is because at Pinnacle, we know that treatment doesn’t just happen in session.  The best outcomes stem from collaboration and implementation of skills across all settings.

 - Clarissa Gosney, PsyD, Licensed Psychologist (PSY 29633)

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