Fear of Talking (Selective Mutism)

What is selective mutism?

Selective mutism is disorder where your child does not speak in social situations even though he can speak and understand spoken language. It used to be called elective mutism.

The disorder occurs in about 1 in every 1,000 children. It is more common in girls than boys.

What are the characteristics?

You may notice your child is overly shy when she enters school and seems unable to talk to other children. Your child may have had a small group of people she would talk to before starting school.

Many parents are confused by this behavior because their child is often very outgoing at home. Some children will talk easily on the phone to people they are unable to talk to face-to-face.

Your child may have selective mutism if:

• Your child continues to not speak in social situations where talking is expected (such as school, play groups), but can talk at home to family members.
• The problem starts to cause problems at school and with social development.
• The problem lasts longer than a month.
• Your child has no other problems with language, such as understanding language or stuttering.
• Your child often seems shy, afraid, or anxious.

What is the cause?

The cause of selective mutism is not clear. Over the years, experts have suggested that an unpredictable environment might be a cause. Being a witness to a family conflict, experiencing a trauma before age 3, or being overly attached to one's mother may cause the mutism. More recently, researchers think it could be a sign of an anxiety disorder.

Social phobia is an anxiety disorder in which people fear situations where they might say or do something embarrassing. People with this disorder often fear speaking in public or to strangers. People with social phobia often report being fearful of speaking when they were very young.

What is the treatment?

Some children get over the problem on their own. They are able to begin speaking in public places without special help. If the problem has lasted at least 6 months, parents should get professional help.

Your child's health care provider may refer you to a therapist who knows about the disorder and has treated it before. It is important that the therapist get a very thorough medical, social, and psychological history from the child and family. Any treatment plan must involve the parents and include ways of dealing with this behavior at home.

It is also important to include teachers in the treatment plan. Many times teachers are unable to find out how much the child is learning. Often the treatment plan includes an education program for the teacher as well as specific recommendations for increasing the number of people your child will talk to.

Therapy

A number of treatments have been used by speech therapists, social workers, psychologists, and psychiatrists. The best results have come from behavioral therapy. Behavioral therapy is a treatment that helps families identify the problem and then plan a way to change it.

Many treatment plans begin by having the therapist watch your child through a one-way mirror while she plays with you. This is a good way to check if there are any problems with language development that are causing the problem. The therapist "fades-in" slowly to become included in the family group. When your child is talking freely with the therapist, then the therapist can start to help your child slowly expand the number of people with whom she is able to talk. Often a reward system of some type is used as well.

Medicine

In some cases in which anxiety is a problem, medicine has been used along with behavioral therapy. This treatment should only be considered if other therapies have not worked. Medicine should be prescribed by a child psychiatrist familiar with the problem.

How can I help my child?

1. Provide many opportunities for your child to watch you talking in a relaxed manner in a number of different situations such as in the neighborhood with friends, at school gatherings, and while ordering at fast food restaurants.
2. Always reinforce any attempt your child makes to speak in a public place by gently patting his or her shoulder or providing verbal praise in a soft voice.
3. Don't force your child to talk or ridicule your child for not speaking. This is usually unsuccessful and often makes the child more anxious.
4. Don't talk about your child's problem to relatives or friends when the child is present. This also may make the child more anxious.
5. Provide many chances for your child to speak where she is comfortable. Usually that means in small groups of people that your child knows. If your child is more comfortable at home, it may be helpful to invite friends over frequently to encourage talking.
6. Many children who are shy begin to speak in new places after they have become familiar with the teacher, new children, or the place. If this does not happen and the shyness begins to affect a child's ability to progress in school and socially, it is time to seek help.

Resources

Selective Mutism Foundation
http://www.selectivemutismfoundation.org