If your child has been diagnosed with selective mutism, or if you suspect there's something more to your child's intense shyness around others, this information may give you more clarity.
While not well known by parents and even teachers, selective mutism is an issue in children which can have a big impact on a child's quality of life.
No doubt you want to support your child as best as possible. So it's important to understand what selective mutism is, and where to go from here.
But don't forget, you need support too. It's not something you've likely heard about before and these sorts of things can leave you feeling lost as a parent.
My daughter was diagnosed with selective mutism at approximately three or four years of age. She's now 15, and while she's made huge progress, she still lives with social anxiety (with issues similar to when she was younger), which can be crippling at times.
The reason I mention this is so you know this article has been written someone who not only knows about selective mutism, but also understands it.
Firstly, here are some basics about selective mutism.
What Is Selective Mutism?
Selective mutism is a fear of speaking in certain situations or environments, and is viewed as an anxiety disorder. The majority of children with selective mutism also have a social phobia.
Just like adults may have a fear of heights or spiders, selectively mute children have a fear of speaking, and are crippled by their anxiety of being put on the spot or having any attention drawn to them, especially where there is an expectation to speak.
Selective Mutism Symptoms
The first symptom carers, teachers or parents tend to notice is a child with selective mutism is immensely shy. This is not the typical child that needs a bit of time to ‘warm up’ to someone. It's ongoing. Eye contact is minimal or does not exist.
Parents may notice their child will act out or tantrum when going somewhere, when someone is visiting them, or when they are doing something their child fears. This can be due to overwhelming anxiety.
Children with selective mutism do not feel comfortable speaking in certain situations – hence the word ‘selective'. This is usually when they're in the care of others, for example at kindergarten, childcare or school, yet speak freely at home. This is why selective mutism can be so confusing to parents, because when their child is at home, these children can talk a whole lot. So much so, they even wish they would speak a little less! Perhaps it's how they make up for a day of keeping to themselves. That's how I understood it anyway.
Studies say that selectively mute children are most likely to speak at home, less likely to speak out of the home (e.g. supermarket) and least likely to speak at school.
Children with selective mutism usually do not speak to teachers, principals, teaching assistants and other students, at least initially. Selectively mute children typically feel comfortable speaking to their peers before they can comfortably speak to teachers.
When selectively mute children are placed in a situation where they are expected to speak (creating a rush of anxiety), they often look down or away, bite their lip, blush, freeze up, hide behind their hair or display other signs of anxiety.
They may make non-verbal gestures as a way to communicate, for example pointing or nodding, and they avoid making any noise which may draw attention to themselves, for example, laughing or coughing. These children become so clever at communicating non-verbally that teachers and carers can often work out or know what the child wants by the expression used by the child.
Because selectively mute children fear speaking and being put on the spot, they can easily feel embarrassed and humiliated. It's very important not to force them to speak or call them out in front of others. You'll only trigger further anxiety. You wouldn’t tell someone with a fear of heights to go skydiving and get over it, and you certainly can’t tell a child to just speak and get over it.
The underlying cause needs to be dealt with, and you’ll make much better progress when you demonstrate understanding and kindness.
When Do Children Commonly Display Signs Of Selective Mutism?
The symptoms of selective mutism typically present around three years of age, although some parents do say that they believe their child has been that way from birth. With the introduction to kindergartens and increased social exposure, selective mutism is more likely to be picked up at this age. Of course, many cases of selective mutism are not picked up, and these children continue onto school.
Signs are usually well present by the age of five, but parents may not be able to recognise them until their child is in school, when it is harder to treat. The earlier it's addressed, the better.
Selective Mutism Treatment
As a mother of a child with selective mutism, this is something I found very confusing, at a time when I was already overwhelmed with the idea that my daughter had this condition. I researched on the internet, and there were speech therapists saying it's their domain, with psychologists saying the same. I didn’t even know where to start.
However to save you much confusion, start with a children’s clinical psychologist (as opposed to a regular child psychologist – clinical psychologists have Masters Degrees and have greater depth of training and experience in general for children with anxiety disorders) making sure that they have good experience with selective mutism. They can then establish if the selective mutism comes from a speech problem, requiring a speech therapist. But children like my daughter who are very confident with language and speak clearly to those close to them, do not need a speech therapist.
Another challenge is that very few professionals are experienced in the treatment of selective mutism. I had to contact many psychologists and ask about their experience with selective mutism before I found the right person. The majority of responses were, ’I’ve heard of it, but not worked with it,’ or, ’I’ve worked with one or two children who had it.’ So it’s very hard to track down professionals with this experience. But it’s so important to do your homework as it can make a huge difference in your child’s improvement.
The Progress of Selective Mutism in Children
According to the book, Helping Your Child With Selective Mutism by McHolm et al, the following ten step ‘Conversational Ladder’ exists for children with Selective Mutism as they progress.
- Stage 1: Complete Mutism. Child speaks at home but is silent at school/kinder. Appears anxious at school and may resist going to school.
- Stage 2: Relaxed Nonverbal Participation. Child speaks at home but not at school. Begins relaxing and participating nonverbally in classroom activities. May begin to talk positively about school.
- Stage 3: Speaks to Parent At School. Child speaks at school when alone with a parent in a place where students and teachers cannot hear or see, often in a whispered voice.
- Stage 4: Speaking Observed By Peers. Child speaks at school, usually to a parent. Peers observe but do not hear the child speaking since he typically whispers so quietly as to be inaudible to observers.
- Stage 5: Speaking Overheard By Peers. Child speaks audibly at school, usually to a parent. Other children observe and hear the child speaking. Child does not speak directly to other teachers or peers.
- Stage 6: Speaking Through Parent To Peers. Child speaks to parent who conveys message to another classmate sitting closeby. The classmate may overhear the child and respond directly.
- Stage 7: Speaking to Peers. Child speaks at school to one peer, often on the playground. Child does not speak to teachers.
- Stage 8: Speaking to Several Peers. Child speaks to several children at school. Child does not speak to teachers.
- Stage 9: Speaking to Teacher. Child begins speaking to teacher and speaks to several peers.
- Stage 10: Normal speaking. Child speaks to most adults and peers in a normal conversational tone.
How Long Does It Take To Treat Selective Mutism?
It's an ongoing process to treat selective mutism and can take months or years. So be prepared to be in for the long haul and in conjunction with a psychologist, inform yourself through books which are available on the topic (see below).
How Common Is Selective Mutism?
Doctor Elizabeth Woodcock of the Selective Mutism Clinic in New South Wales, Australia, says approximately 1 in 100 children in the first three years of school are thought to have selective mutism. This rate is comparable to other disorders such as depression, and higher than for autism.
Around one third of children with selective mutism also have language impairments, and there is an increased prevalence in bilingual families.
It's slightly more common in females than males.
A proportion of children are suggested to have a transient form of mutism that tends to remit without treatment, however, for other children the failure to speak can persist into adolescence or early adulthood. Parents and schools often delay seeking treatment due to the common expectation that the child will outgrow the behaviour. Thus, treatment is often sought after the child has failed to speak for four to five years, at which time the child may experience secondary social and emotional problems and treatment is much more difficult.
Research also suggests that of those children who do begin to speak without treatment, a proportion continue to experience clinically significant levels of anxiety as well as social and academic difficulties and communication deficits.
Selective Mutism At School
The most difficult environment for selectively mute children is at school (specifically reading to or speaking to teachers) as there is an expectation that they must speak.
I gave handouts to my daughter’s school (making sure the individual teacher had the handouts in her file), and my daughter’s therapist even came to the school for one of the teacher meeting nights, and gave a talk about selective mutism.
I donated a couple of books to the school, which were designed for teachers and school children, including My Friend Daniel Doesn’t Talk and The Ideal Classroom Setting for the Selectively Mute Child.
A book which may be helpful to give to the school/teacher is Helping Children with Selective Mutism and Their Parents: A Guide for School-Based Professionals.
However for parents at home, I recommend Helping Your Child With Selective Mutism by McHolm et al.
Dealing With Unsupportive Or Judgemental Adults
It can be very difficult when your child has selective mutism – it surprised me how many adults took it upon themselves to come to their own conclusions.
I had family members tell me that it was my fault for not socialising her enough. I had already tried baby swimming lessons, Gymbaroo and attended mothers groups, but this didn’t help — of course!
My in-laws (at the time) thought she needed to get over it, and wanted her to be a flower girl at an upcoming wedding. It just wasn't going to happen.
Other parents at her kindergarten saw it as a challenge to make her talk.
Of course, all of these things can be very stressful for parents who constantly feel inadequate (especially when you don't know much about it yourself), as well as the child.
When you’re doing the best you can, and those around you believe there is no excuse for your ‘naughty’, ‘manipulative’ or ‘stubborn’ child, it can be upsetting. Try to spend time around those who are most supportive, and less time around those who are not. It isn't always easy, but it will make the world of difference.
You can try to educate those around you as best you can, if they are willing. Provide handouts designed for teachers or family, or you might like to organise a family therapy session with your child’s psychologist.
Getting in touch with families going through the same thing can be such a huge relief and support. When my daughter was diagnosed, I researched and found a forum based in the US, and started chatting with parents. To my complete surprise, I ended up connecting with a mother whose daughter went to the very same kindergarten my daughter did. This was way back when social media wasn't common and getting in touch wasn't so easy.
Tips For Parents With Selectively Mute Children
- Don’t force your child to speak or punish them for not speaking. They need your understanding and are not being difficult, they may be frozen with anxiety or fear.
- Inform yourself; read books, research on the internet, join forums – find out as much as you can about it, as the more you know, the easier life will be for all of you.
- Inform your child’s teacher/carer by giving them information. You can download some information for teachers and others at the selectivemutism.org website.
- Avoid speaking about your child’s selective mutism in front of them. I find the more I talk about it in front of others, its seems the more she feels she has to live up to that expectation. When I say less, she takes bigger steps.
- Seek help. I would not have coped without the constant support of our child psychologist, who was there to reassure me as a mother. Because things can be a little different, it’s easy to doubt yourself and if you are doing the right thing.
- Prepare your child for changes ahead of time, i.e. when they will be around people they are not familiar with or comfortable with. If you are due to have visitors, let your child know ahead of time. If you are going to visit someone else, again, let them know so they know. Sometimes I would set up something for my daughter to do so she could be kept busy without the expectation to interact, e.g. get out some colouring books and pencils, puzzles etc – away from the visitors.
- Don’t blame yourself. It’s nothing to do with your parenting skills or who you are. Some children are just more prone to anxiety (makes sense in my family – both my partner and I have suffered anxiety as children and I have postnatally), so just like any other condition or problem, they can have the genes for it. All you can do is to work with it and not let your child see that Selective Mutism is creating anxiety for YOU!
Recommended Resources & Reading For Selective Mutism
My recommended self-help book for parents is:
Helping Your Child With Selective Mutism by McHolm, A. E., Cunningham, C. E., & Vanier, M. K.
The description is as follows:
“This book is the first available for parents of children with selective mutism. It offers a broad overview of the condition and reviews the diagnostic criteria for the disorder. The book details a plan you can use to coordinate professional treatment of your child’s disorder. It also explains the steps you can take on your own to encourage your child to speak comfortably in school and in his or her peer group. All of the book’s strategies employ a gradual, ‘stepladder' approach. The techniques gently encourage children to speak more, while at the same time helping them feel safe and supported.”
Dr. Woodcock recommends that parents use the book only in conjunction with receiving help from a professional that is experienced in the treatment of selective mutism.
Dr Elizabeth Woodcock of the Selective Mutism Clinic practices in Sydney – you can visit her website at selectivemutism.com.au.
Finally, there was a documentary on selective mutism several years ago on Channel 4. You Can now watch it instantly, thanks to YouTube. See below – it's in four parts.
All the best for your family's journey with selective mutism.