Selective Mutism in Children: All About Anxiety
When I am not blogging on Daily Strength or working in my private practice, I work as a clinical supervisor at a non-profit agency working with children and adolescents in the Los Angeles Unified School District. Over the last few years we have seen a dramatic increase in children referred for selective mutism. Typically, we would have seen maybe one case a year. But currently, nearly every therapist on staff has at least one case. It has left us all scratching our heads. Not only wondering why the sudden increase but also selective mutism (SM) is a very confusing issue for many therapists to treat. Many therapists that I supervise have seen this so rarely, that when referred a client we all struggle trying to figure out the best course of treatment.
Fortunately, last week I attended a workshop on the topic which enlightened my perspective and validated some of my thoughts on selective mutism. Dr Esther Hess founder of The Center for the Developing Mind in Los Angeles is an authority on the topic. One of the most interesting points Dr Hess brought up was that SM is anxiety based and not a result of acting out or manipulative behavior. She explained that when a child does not know how to self regulate properly they shut down. So if a child is flooded with feelings (good or bad) they become overwhelmed and to feel more in control of themselves they shut down by not talking.
Another important point was that Selective Mutism is not a physical condition. Again it is a way for children to calm themselves down when they feel overwhelmed. Often children with SM will talk in situations that are not stressful. It is common to find some children that do not talk at school freely talking at home or with certain friends that they trust.
In fact, trust and security are key factors in treatment. Typically SM is not something fixed with a pill. It's all about relationships. Dr. Hess suggests that treatment involves the family and strengthening those relationships. She never negotiates with a child to speak but encourages the child to explore issues related to not speaking. Treatment is successful when a child and their parents gain self-awareness and new tools to cope with anxiety and self regulation.
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21
As an English as a Second Language teacher, I have seen a couple of students with SM. It usually took a year or two for students to openup. I found that engagting them with physical commands really helped them participate in school without forcing them to talk. I also found that they were more inclined to 'whisper' into my ear or mouth the answer with encouragement.
Believe it or not, i had one student who after a year and a half, we met with her parents. Unfortunately, her father threatened that if she didn't start talking in class they would take her to the doctor to check her throat. She was talking the next day and hasn't stopped since. The others just took their own time. (I wouldn't recommend such extreme threats btw)
I have not seen any lasting effects on any of these students and would generalize that with the right teacher and gentle pressure your children will be fine.
By tkimbley November 10, 2008 11:57am
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Dear Julie
I found your article about "selective Mutism" and wanted to thank you for writing it to educate people who may have never heard about it.
My son suufers from SM and I also have the pleasure to know Dr Esther Hess. Her work is absolutelly amazing and she is a very kind and nurturing person.
I have created a support group for the LA area and wanted to share this news with you. The group has been created nearly a year ago and we already have 19 members. We try to meet monthly and always have a great time. Anyone who needs to vent, get its frustration out, share its energy, wants to learn more about SM or share their excitment about helping their children, is welcomed. Please join us! http://selectivemutism.meetup.com/56/
Take care
Pascale
By pascaleberoy October 30, 2008 4:27am
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I'm so glad you posted this. My son did this once at school. I kind of figured it out... that he'd shut down because he was overwhelmed. I took him out of school shortly thereafter and he has not quit talking since! LOL! But that was a very scary moment for me and it's good to finally understand. I know that when I'm experiencing high anxiety, I kind of want to quit talking myself. I don't because I have the tools to more or less control things and get through the anxiety. But I definitely understand why it could happen. Thanks again for posting this.
By clutteryermind October 9, 2008 2:38pm
18
Hi everyone, I'm new to this site and newly diagnosed. I am glad to read your blog Julie, as this is a symptom I have been having since I had a severe psychiatric trauma (not in childhood). I am a mature adult though. It isn't continuous and has only happened under very severe and overwhelming experiences when i have had to make decisions when feeling fearful. I cannot remember it happening in childhood and the person who assessed me for my condition said that my life had been so structured that my symptoms did not show severely and was able to learn and build a good amount of coping mechanisma and have always been told I have a calming influence, so having this mutism under certain situations is intreging. I know that my condition now really shows due to me losing many of my coping mechanisms that was built up over the years and also living within a very poor environment, so I am now in new territory that I have never had before in my whole life.
What might be causing mine is a lack of structure and my trauma symptoms and people trying to control me through what they think is best, which isn't any good at all, so making it harder and harder for me to communicate what i know i need as it is very tiring to try and explain things, so tiredness is also a big key. I am also very isolated at mo and under severe distress, due to a new trauma on top of my origninal trauma, so probably the combination of severe anxiety and also losing some of my ability to communicate due to being isolated is a big key to my problem right now. It seems that it isn't a problem just in childhood. Thanks for your blog, its made me feel better now I have been informed.
By steadyeddy October 9, 2008 12:18pm
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I failed to mention that I am mildly autistic. Yes, anxiety plays a huge role in selective mutism. . .but it also has to do with the fact that as one with autism, certain situations can be so incredibly confusing, it's like walking in a dream (more like a nightmare). kind of like when people talk to you, all you hear is murmering. Charlie Brown comes to mind. It's like the sound you hear when his teacher would talk and the audience just hears "wha wha wha wha wha wha."
By naturegrl23 October 1, 2008 10:16am
16
I had selective mutism as a child and still to this day am occasionally affected by it. Contrary to what the name implies, it was hardly something I chose. My brain just wouldnt work or communicate with my mouth and I would become totally silent. What made it worse was that my mother would punish me if I didnt speak up and be polite, so the next time it would actually be worse because I knew what was coming afterwards. My parents are the type that dont believe in "psycho-babble" even though I have an autistic older cousin and autistic niece, but they are more obviously autistic. . .at least to the layman that doesnt know the signs.
By naturegrl23 October 1, 2008 10:07am
15
My daughter started preschool about a month ago. She won't talk to her teachers and other kids. It's painful. For years prior to going back to work full time, I took her to every little kid social event. She saw someone. I would not say it's a family problem. In my state, preschools are allowed to have 20 kids in a class. I think it is too much. I told to give her another month. I am considering stopping to use a daycare center and to find a smaller one ran by a family.
By dorothiec September 26, 2008 8:58pm
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My daughter has been dx. with this along with some other things, I copied off the report on it to give to the school pych, he was sayingshe was doing it to manipulate. when she get's nervous or is a new situtation, she shuts down, no eye contact or talking. thank you for bringing this into the site,
By jillybugsmom September 26, 2008 11:36am
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P.S. I hope you & yours are well. I'm watching clips of the train wreck on TV, and I hope you, your friends, and family are well.
By Crikey September 13, 2008 6:36pm
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Could selective mutism be positively correlated with the increase in autism, and perhaps the missed diagnosis of autism, especially mild cases, among children? Since it is being associated with anxiety, does it make sense that the mutism is a result of anxiety associated with an overwhelming social environment and/or too many attentional requirements? And, last, but not least, would it stand to reason that SM individuals might benefit from video modeling interventions? Thanks!
By Crikey September 13, 2008 6:30pm
11
I am mildly autistic and had bad selective mutism as a child. I've been told that there's no link but now my niece is very autistic and exactly like I was only on a grander scale. What is your opinion on this?
By naturegrl23 September 12, 2008 8:14pm
10
Hello: I'm a survivor of CSA/Incest/Exploitation ... from the age of approx. 6 to about the age of 12 I did not speak, no one heard me say a word for almost 6 years ( now, I was speaking sporadically to a younger brother, but he had Downs Syndrome and was non-verbal and he was safe, safe to us ). We didn't start speaking until we had been removed from the biological parent's home and had been living with another family for about a year, even then, it was only 1 or 2 word responses. It took a few years after being removed from that particular situation before I began to feel safe enough to speak, and then it was only to the foster/adoptive mother ... again it was limited, it took years before we got to a point where I felt safe enough to begin speaking in more than 1 or 2 word responses. I was well into secondary school before anyone heard an actual sentence come out of my mouth. It wasn't safe enough, for a very long time, to speak. We originally stopped speaking after a teacher slapped us for innocently and unknowingly disclosed something that was occurring in the home ... she slapped us across the face, berrated us for saying such a thing regarding the father ( who, according to her was a wonderful man ) and promptly turned around,phoned the father and informed him about what we had said. We payed dearly for that innocent comment when we got home that afternoon. No one heard me speak again for 6 years or more. It wasn't safe, it made life too unpredictable. As an adult now ... I continue to find myself in situations where I will stop speaking if it's stressful or I am distressed, it's not an intentional decision to stop speaking, it's like the throat clamps shut and speach will not escape. I know it has a lot to do with anxiety and feeling threatened in some way, but it's extremely frustrating to find oneself needing/wanting to express oneself and not being able to. At one time it may have been a conscious decision to stop speaking but it eventually turned into not being able to speak even when we wanted to be able to do so.
By hivin September 12, 2008 6:47pm
9
I am a Speech-Language Pathologist who has worked with one girl who had selective mutism. The only person this 9 year old would speak to is her father. There was a history of physical abuse and I have heard this is common in young children with SM. This floored me, but her father refused to get her psychological services. Over the course of about a year, this young girl came to me for speech-language therapy one day a week and she actually started to open up when we were playing games that required no speaking (board games). She began to make silly noises during the games and she even said one word during 2 or 3 sessions. After the therapy began to go well, her father started sitting in on the sessions and she completely stopped vocalizing with me. It was a very sad case. I am so happy that you're shedding light on SM, because people do believe that it's a behavioral issuue, when it is really not!! Keep up your good work!
By marym35 September 12, 2008 4:13pm
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My bf's half sis was diagnosed with this and she has never talked 2 me directly and wont talk to the family member her mother doesnt like. Her own grandmother. Is it common of children of divorce 2 sick up on a parents hostility n is that a factor?
By SarahLynn September 12, 2008 2:25pm
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I am studying to become a speech-language therapist (just beginning) and I remember reading about this. I can imagine that the approach to helping people with SM would require tremendous sensitivity. It's good to see this thread as a reminder of what sort of concerns people have when they seek out help. Thanks for raising my awareness.
By striving4balance September 11, 2008 2:00pm
6
There is an anxiety to speaking, because those of us who understand, know that people will not be able to figure out what we are trying to get across half the time, or even bother to try to pretend that we actually said anything at all, so we stay silent, then that anxiety changes. When we finally do say something, everyone is so shocked, that they're going to stare, or I can feel that frog in my throat from being silent so long, that I'm going to sound funny when I do say something, and people will laugh. I remember going for days without saying anything to anybody,not even at home, in high school.
By SigS September 11, 2008 8:42am
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Hi Julie,
I suffer something similar to this but to a lessor degree. I m an excessive talking AS. In certain circumstances in a conversation I get over stressed with people and verbally shut down. I pull faces and make hmmmm and grunt noises. Only lasts for a short time but freaks people out. When I was young and in a verbal confrontation I sometimes shut down would occur, so I would attack them physically out of frustration.
By Rigil13 September 11, 2008 7:48am
4
I believe SM is what I did (have) for many years. I thank God every day for bringing me out of it. Now I try to help others with these type of problems that effect us socially, among other issues on a site Help.com. I hadn't ever heard of SM until recently, Although I don't particularly like labels it was nice to have a name to put with the issue. Long story short, Thank you for this article.Im sure it will help others to have some peace with it. What brings me to comment is Im not real sure exactly what self-regulate means. I have an idea - maybe finding balance? The other thought which is most important is I think this ( SM) is the reason so many ( cut ) or self-injure. Im always looking for the root of the problem and in this article Im hearing it has to do with relationships. But what is it in the relationships that is causing it and what is it were NOT doing that we were doing before for it to be on the rise. I dont know if anyone can answer or share with me here on this matter since Im fairly new to the site but if not I can be reached at Help.com as Mama Bear { Felicity}. I welcome any comments etc.. or just stop and say HI, I will get back to you ASAP. Thank you and God Bless Us ALL :D
By Kimkriss September 11, 2008 3:25am
3
My brother started the first grade in September 1957. Our mother died
in August of 1957. My brother did not speak in school for the entire
year. The teachers thought he was retarded. My Dad spanked him and
punished him; but could not get him to speak. My brother did speak to
us: his siblings. We were the only ones he would speak to. That was
so long ago, I do not know if the term Selective Mutism even existed.
I was enlightened to read this article. I knew he did not speak because
he was grief-stricken, confused, and lost. Thank you for writing about
this subject.
By matteste September 10, 2008 5:12pm
2
I feel I had or have SM. I used to be crippled by the idea that I must try to speak or read in school or in the general public. It was and is horrible.I was once categorized as retarted by a school teacher beause I wouldn't speak. I am anxious to this day with OCD to boot. If I could get any more information about this subject please let me know.If there are any questions I could answer for you I would love to help.
nightraptor
By nightraptor September 9, 2008 11:17pm