Selective Mutism

Selective mutism is an anxiety disorder that is categorised by a child’s inability to talk in one or more social settings. A child who has selective mutism can still speak comfortably in other settings where they feel secure and relaxed. Children who have selective mutism are at risk of reduced educational achievement and psychosocial well being.

Speech and language therapy can help to identify the cause of the communication difficulty, and provide appropriate intervention and therapy to increase the child’s comfort with talking.

Selective mutism is both a communication and a mental health disorder. Selective mutism is not the result of normal shyness, defiant behaviour or routine separation e.g. starting school. Often selective mutism is related to chronic social anxiety. Children with selective mutism may present as being unable to speak in certain situations and settings. Children may speak in certain situations and social settings with a select amount of adults or children who they feel secure and comfortable with. In other situations, they may not be able to speak at all, to these select people, as they fear they may be overheard by others.

The cause of selective mutism is not always clear in children. There can be many factors that can add to the child’s fear and anxiety around speaking such as:

Predisposing factors:

• Anxiety.
• A family history for excessive shyness, psychiatric illness, anxiety or selective mutism.
• Speech or language difficulties.

Perpetuating factors:

• Success in communicating non –verbally.
• Negative models of communication in the child’s family or environment.
• Social isolation.
• Over acceptance of the child’s mutism.
• Reinforcement of mutism through increased attention or affection.
• Being part of an ethnic minority or a linguistic minority.
• Lack of appropriate management or intervention.

Precipitating factors:

• Teasing or bullying.
• Negative reactions from others.
• Starting school or nursery causing separation from parents.
• Separation, loss or trauma.
• Frequent moves or migration.
• Self-awareness of speech and language difficulties present within the child.

Recent research suggest that selective mutism is becoming more prevalent in children, it is estimated that 1 in every 150 children have selective mutism. Selective mutism commonly affects more girls than boys. Children who have other family members who are excessively shy, anxious or struggle with social relationships are more likely to have selective mutism. Prevalence of selective mutism is more common in children who come from socially isolated families.

Selective mutism is frequently associated with other behavioural, social and psychological conditions and behaviours. Speech and language therapy can help to reduce some of the behaviours by providing support and helping to increase communication.

Selective mutism is often associated with the following conditions and behaviours:

• Social phobia
• Social anxiety
• Psychiatric disorders
• Delays in speech and language
• Excessive shyness
• Fear of social embarrassment
• Aggressiveness
• Stubbornness
• Social awkwardness
• Social isolation
• Negativism
• Uneasiness
• Seriousness
• Clinging type behaviour

Selective mutism can have a great impact on a child’s life. It does not only affect the child’s daily activities but their development in different areas too. Some ways selective mutism impacts a child’s function includes:

• Difficulties with academic achievement.
• Difficulties with social and emotional development.
• Difficulties with making and maintaining friendships and relationships.
• Increased chances of being bullied or teased.
• Low self-esteem.
• Difficulty with taking part in activities that require verbal participation.

Selective mutism can significantly affect a child’s life, if it is left untreated it can carry on into adulthood and cause social anxiety disorder. Our speech and language therapists can provide support and help to increase your child’s communication through therapy and adjusting the environment.

Speech and language therapists work as part of a multi-disciplinary team made up of a paediatrician and a psychologist when diagnosing children with selective mutism. Our speech and language therapists work alongside the child, their family and their teachers to create a holistic picture of the child, their background, personality and abilities.

When diagnosing a child with selective mutism as advised by the Diagnostic & Statistical Manual of Mental Disorders, 5th Edition (DSM-V) professionals look for the following symptoms:

• Consistently being unable to speak in certain social situations when they are able to speak in other situations.
• The disturbance decreases educational and social functioning.
• The mutism in certain situations lasts at least one month (this cannot be from the first school month).
• The mutism is not caused by a lack of knowledge of the language used in a specific situation.
• The mutism is not caused by a lack of comfort with the language used in a specific situation.
• It is not due to another communication disorder.

The role of the speech and language therapist in the assessment process includes the following assessments:

• Background information through case history with parents, carers and teachers.

• Oral-motor examination.
• Expressive language assessment - done by watching videos of the child speaking in environments they are comfortable in.
• Receptive language assessment - done by using assessments that do not require speech.
• Assessment of non-verbal communication.
• Observation of play.

Speech and language therapy can help children with selective mutism to increase their communication skills in a comfortable manner.

Speech and language therapy takes a behavioural approach to treatment for children with selective mutism, this includes:

• Desensitisation.
• Positive reinforcements.
• Creating an appropriate environment.
• Self-modelling.
• Therapy for specific speech and language difficulties.

Benefits of speech and language therapy:

• Increased expressive ability in different situations.

• Increased academic achievement.
• Increased social development.
• Increased emotional development.
• Better quality of life and well being.
• Increased confidence and self esteem.

Our speech and language therapists can provide an individualised therapy programme for you child that works to their pace to gradually increase their communication in environments they struggle to speak in. This will help to improve your child’s progression in other developmental areas.