Not all children are “incorrigible whys.” Some people prefer to remain silent because they are shy. And this is normal - when a child relaxes and gets used to the environment, he communicates without problems with peers and adults. But in some cases, a child’s complete silence in a given situation is not a consequence of low self-esteem. This is selective mutism.
The child babbles happily at home, but does not make a sound in kindergarten or school. Or vice versa - he communicates normally with his peers, but in front of his mother and father he becomes silent, so that words cannot be questioned. Situations familiar? Your child may need help speaking.
Selective mutism: what is it?
Selective mutism is also called selective muteness. According to medical references, it is a disorder characterized by a persistent inability to speak in certain situations, despite the preserved ability to speak normally in other situations. Selective mutism in the ICD-10 (International Classification of Diseases) is called selective mutism and is included in the section “emotional and behavioral disorders, usually beginning in childhood and adolescence.”
The topic of selective mutism is not very popular. And often children with this disorder cannot receive quality help for a long time - either parents do not attach importance to the child’s “strange” behavior, or doctors make erroneous diagnoses.
They started talking about selective mutism more loudly thanks to environmental activist Greta Thunberg. She was diagnosed with Asperger's syndrome and obsessive-compulsive disorder at the age of 11.
According to Greta Thunberg, selective mutism for her is a reason to speak only in cases “when it is absolutely necessary.” And indeed, Greta is quite emotional behind the podium, but at home she is mostly silent.
How does selective mutism manifest?
In adults, selective mutism is extremely rare. As a rule, the disorder makes itself felt at the age of 2-5 years. However, it often remains unrecognized until the child enters kindergarten or school.
The main complaint of parents of children with selective mutism: “my child is very capable, he speaks and reads at home, but in school the teacher cannot get a word out of him.” At the same time, adults cannot accurately indicate the age when their baby began to have problems with communication. Parents often say that their child has “always been like this”—anxious, withdrawn, shy.
The main symptom of selective mutism in a child is his inability to speak in a given situation. As a rule, these are large crowds of people and communication with adults. At the same time, the baby’s speech, when he is still not silent, may not have any defects at all.
According to the findings of Priscilla Wong, a pediatrician at the Department of Pediatrics in Washington, DC, children with selective mutism often exhibit other symptoms in addition to speech impediment:
- shyness;
- fear of large crowds of people;
- difficulty maintaining eye contact;
- difficulty expressing your feelings;
- sensitivity to noise and crowds;
- reluctance to smile.
Children with selective mutism are afraid of making mistakes and do not like to be the center of attention. Selective muteness is a kind of shield for the baby, which helps him remain invisible, so as not to suddenly attract attention to himself. But psychologists say that children with selective mutism often have high intellectual abilities and love art. But their development is hampered by difficulties in communication.
Types of selective mutism
As already mentioned, in children this disorder can be:
- passing (transient) – provoked by psychotrauma;
- constant (continuous or continuous) – psychologically determined.
There is also a classification based on the characteristics of the course of selective muteness:
- Passive-aggressive – a “weapon” to influence others.
- Phobic speech. Silence is accompanied by ritual actions and fear of hearing one’s voice.
- Symbiotic. A strong connection with one of the parents (relatives), a manipulative, subordinate attitude towards the others.
- Reactive. A complication from stress and resulting depression.
Reasons for the development of selective mutism
Scientists have so far refrained from identifying specific reasons for the development of selective mutism. But experts often associate the appearance of the disorder with increased anxiety in the child. In children diagnosed with selective mutism, the medical history in most cases is burdened by various anxiety conditions and social phobias.
Scientists have identified cases in which selective mutism syndrome developed after a child suffered psychological trauma. Little patients withdrew into themselves, stopped speaking in certain situations or were completely silent all the time.
Psychologists do not abandon another theory that would explain the development of selective mutism - heredity. It is believed that the disease can appear in children whose parents have anxiety disorders.
About 20-30% of children diagnosed with selective mutism have speech impairments, which only adds stress to situations in which the child must speak.
But doctors have not yet discovered a connection between autism and selective mutism. A child can have both diagnoses, but neither of them provokes the development of the other.
Selective mutism or just very shy?
It's difficult to differentiate because embarrassment is a common trait among these children, but there are certainly some differences. Shyness is not constant, usually the child hides behind his mother or is silent only for a short time and later, and does not refuse to play with peers.
In other words, a shy child quickly gets used to the situation and begins to communicate. A child with selective mutism will not speak even after an hour or two, he may nod his head and leave it at that.
“Like a lump in the throat”: how children with selective mutism explain the inability to speak
To further study selective mutism, children with the disorder are often asked what prevents them from speaking in a given situation.
The answers are very different. “I can’t start talking, because then everyone will immediately pay attention to what I’m doing,” this is how a teenage girl explained her condition at an appointment with an American psychologist who was treating her.
Some older children describe the feeling of a large lump in their throat that prevents them from speaking.
Treatment of selective mutism
When parents attribute a child's complete silence in certain situations to shyness and withdrawal, they miss the opportunity to take timely measures to help their child communicate normally.
Clinical psychologist and ABA therapist Ekaterina Olegovna Matsapura explains how selective mutism in children is treated.
“If the disorder is not corrected, selective mutism will continue to develop into adulthood. It is very important to understand: mutism is not a temporary phenomenon; it cannot be “outgrown”!
What should parents do if their child suddenly stops speaking in kindergarten, school, or with some relatives? First of all, we need to conduct a mini-diagnosis in order to make sure that we are dealing with mutism and not another disorder similar to it. Observe your child's behavior.
- Assess what situation causes silence and whether this behavior is permanent for her. For example, you know for sure that at home the child learned this verse and told it to you perfectly, but at school or kindergarten he simply cannot utter a word.
- See how the child behaves in a comfortable situation, when he is alone or with loved ones. Is he involved in games, can he support and initiate dialogue?
- Does the inability to speak interfere with a child’s normal adaptation to society?
- The inability to speak lasts at least a month and is situation-specific.
- The inability to speak is not a consequence of other mental and behavioral disorders, such as autism spectrum disorder.
If these diagnostic criteria reflect your situation, it's time to intervene.
Only you yourself, your hard work, and inclusion in therapy completely and completely can help your child. Under no circumstances should you wait for a magic pill. Even the most qualified specialist will not “fix” a child without proper parental support.
Because the nature of the disorder is unclear, treatment for selective mutism is best approached through psychotherapeutic behavior modification. For example, ABA therapy, cognitive behavioral therapy and direct behavioral therapy.
The emphasis in correcting the disorder is precisely on changing the behavior of parents and a supporting group of people - teachers, speech therapists, educators, nannies. A child with selective mutism is most often afraid of any attention to himself, as this causes him to feel severe anxiety. Therefore, it is most painless and effective to teach parents new behavior strategies.
It is important that loved ones can promptly and delicately encourage the child’s behavior and retreat when necessary. The basis of behavioral intervention is the gradual elimination of unwanted behavior through reinforcement and training in replacement behaviors.
With prolonged exposure to selective mutism, other mental disorders may occur - anxiety, depression, phobias. And therefore you should seek medical help from a psychiatrist. This is especially important for children with advanced mutism, as well as for adults with this disorder. Pharmacotherapy helps alleviate the condition, increasing the chances of successful psychotherapy.
The effectiveness and result of assistance will also depend on the coherence of the team. All adults around him should participate in the child’s adaptation and teaching him to “speak.”
Make a diagnosis - how to do it correctly and quickly?
The phenomenon of mutism is extremely difficult to separate from other psychopathology precisely because of childhood, when the difficulty arises with the question: is this a true disease, the whim of a stubborn child, or his mental retardation?
The transition of the syndrome into a protracted and chronic course is often facilitated by the child’s parents themselves, who expect that the child will “outgrow” his muteness, but for now he is “simply embarrassed to speak.”
To establish the truth, it is necessary to collect information about the child’s entire previous life, including:
- features of the course of the intrauterine period;
- shocks and tremors suffered by the pregnant mother (mental and physical trauma);
- the child’s reaction to vaccinations;
- features of the dynamics of its development.
Particular attention is paid to fears and phobias that are inherent in a particular child: fear of the dark, being alone, panic fear of punishment for a committed offense, because the feeling of guilt in such a child is often completely incommensurate with the method of punishment used.
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In the case of the presence of another, concomitant pathology of the psyche and personality, the task of the diagnostician becomes even more complicated - an error in diagnosis can result in the loss of precious time and delay in treatment of the true cause of mutism.
In addition to monitoring the patient’s psyche, it is also necessary to study the organ that determines its strategy and tactics - the brain. No less important attention should be paid to the study of the general physical development of the body.
Since we are talking about diagnosing neurosis (or a mental disorder), laboratory and instrumental research methods should come to the aid of the doctor:
- craniogram (x-ray of the skull), which gives an idea of the volume of the brain and the features of its structure;
- MRI and CT , which perform the same task more accurately and layer-by-layer;
- EEG , which tells about the level of electrophysiological processes occurring in the brain;
- blood and urine tests , which allow us to determine the degree of maturity and development of the body based on the level of hormones in these biological fluids.
Other, appropriate methods of “investigation” are also appropriate, often similar to a criminal mystery of a case and the involvement of other specialists in it.
How parents can help their child
Do not put pressure on your child, do not force him to speak!
It is better to support your child and talk to him about topics that concern him, showing in every possible way that you are on his side.
Encourage your child to communicate by changing the environment. Visit places that resonate with your child more often. Focus on pleasure. Let him talk excitedly about the movie he watched or his trip to the water park.
Play with your child, learn to receive positive emotions and give them. Praise for interacting and playing with other children.
Praise delicately! Selective mutism does not tolerate aggressive encouragement. It is better to change the usual verbal praise into tokens or stickers. Create a reward system at home that will be clear to your child. Answered today at school - keep the chip. Collected 7 chips in a week? Get the ice cream! Be sure to ask the little person what he would like as a reward for his own work.
Create a visual schedule so your child knows what to expect during the day. Write it down in as much detail as possible, especially paying attention to those situations in which it is difficult for the child. Try to be neutral in your description, showing only the facts and giving the child ways to cope with the situation. For example: “if you want to leave the class, raise your hand, wait for the teacher’s question and ask if you can leave.” These measures will help reduce anxiety.
Don't be too emotionally surprised when your child does speak. Let this be the norm. Don't focus on the fact that there was something "wrong" with him.
For older children, individual support and approach are recommended, since mutism at this age is strongly mediated by the environment. In this case, it is imperative to consult a psychologist.”
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Experts: Ekaterina Olegovna Matsapura
