Selective Mutism

Selective Mutism

Children who don’t speak in certain situations or around some people tend to develop an anxiety disorder called selective mutism. They will be very talkative at home but very quiet at school. It is found to be frustrating for them as well as others.

 

Signs of selective mutism: 

The signs of selective mutism will be noticeable only when the child is around 3-4 years old. They are as follows:

• Very talkative at home or in any other places but remains silent (completely non-verbal) only in school.
• Inability to speak even to parents in the presence of teachers, students or strangers
• Finds it difficult to interact with peers.
• Tend to use facial expressions and gestures when there is a need for them to speak verbally.
• This lasts for a month (does not include the first month of school since they may be shy and don’t talk right away).
• Does not have a speech and language problem which might stop him/her from talking.

 

How to overcome selective mutism:

The efficacy of treatment depends on

• Duration of him or her having selective mutism
• Presence or absence of additional communication or learning difficulties or anxiety problem
• Involvement of family members and others in their education and family life

The treatment focuses first on reducing the anxiety associated with speaking situation or speaking to a person and then on improving their ability to communicate in their feared speaking situations. That is, it starts by eliminating the pressure on him or her to speak. They should gradually progress from staying relaxed in different social situations to expressing single words and sentences to a person before asking them to speak freely to others in all social situations.

First a positive environment should be created for them by

• They shouldn’t be aware that the parent is anxious
• Giving them reassurance by saying that they can speak when they are ready
• Focusing on having fun
• Reinforcing the child for the efforts taken by them to join in and interact with others
• Not looking surprised when he or she speaks; instead respond warmly like how you would to any other child.

 

Several behavioral therapy techniques which are used to treat selective mutism are listed below:

These can be used by family members, teachers and other individuals under the guidance of Speech Language Pathologist or Psychologist.

 

Stimulus Fading:

The child with selective mutism is made to communicate with his/her family member (with whom he/she can communicate at ease) when no one else is there. Slowly introduce another person into this situation. When the child starts to communicate with that person, slowly the parent should withdraw from that situation. This new person can keep including more people in this similar manner.

 

Reward progress but don’t give punishment: 

Reward the child when he/she initiates to communicate with others but do not punish them when they are silent. Child with selective mutism will not overcome the fear of speaking through punishment.

 

Desensitization:

This technique involves reducing their sensitivity to hearing other individuals’ voice by sharing their voice or video recordings of them speaking. For example, progressing from sending emails or texts to exchange of video recordings or voice texts and then to direct communication (e.g., telephone or video call conversations)

 

Shaping:

This technique facilitates them to slowly express that’s similar to the desired behavior. For example, progress from reading aloud to taking turns to read and then gradually progress to interactive reading games, structured talking activities and lastly, two-way communication.

 

Graded Exposure:

In this technique, tackle first the situations that causes least anxiety. The anxiety associated with these situations can be reduced to manageable level with realistic targets and repeated exposure.

 

Tips for Parents:

• Do not add pressure or bribe them to speak
• You can make them aware that you know that they are scared to speak in certain situations. You can motivate them by asking them to take small steps when they feel ready and give them assurance by saying that talking will get easier day by day.
• Praising the child in-front of others would embarrass them. Reinforce their achievement when they are alone.
• Reassure them by saying that nonverbal communication such as smiling and waving would be fine until they feel better to talk.
• Do not avoid social gatherings but make necessary environmental changes to the situation for them to feel comfortable.
• Friends, relatives and other individuals can give them time to warm up by indulging them in fun activities rather than making them to talk first.
• Give them love, support and patience along with verbal reassurance.

 

The speech language pathologist will also work with your child on any speech or language problems that he or she have. This includes facilitating him or her to say the sounds clearly or helping them to say the words loudly, facilitate them to use words to ask questions or express their thoughts, will be more motivated to talk to others when they feel better about how they sound. They will also work with others in situations (includes child’s teachers, coaches or relatives) where your child finds it difficult. The ultimate goal is for them to be comfortable in all speaking situations.

 

Source:

American Speech & Hearing Association

NHS – UK