What is Selective Mutism

girl-looking-downSelective mutism, formerly called elective mutism, is a complex psychological disorder with an unknown origin. It is a widely misdiagnosed childhood anxiety disorder which is now known to be genetically linked. The term Selective Mutism is somewhat misleading in that the term leads many to believe the child "selects" where to speak and is therefore, defiant. The opposite is actually the case. The child certainly wants to speak, but may be literally physically unable due to the severe anxiety. A better term would be "Anxiety Induced Mutism".

Generally, selective mutism is called shyness for several years until a child enters school and does not function verbally in school and most social situations outside of school. Parents and teachers become very concerned and seek further assistance and diagnosis. These children have the ability to speak and understand language, develop age appropriate skills, and function normally at home with most family members. However, if the mute behavior lasts for a period of time, it becomes a learned pattern and is difficult to overcome, because the longer a child is silent, the more entrenched the behavior becomes.

Most school personnel do not have the expertise or experience to deal with a child having this disorder which is caused by anxiety and avoidance. The numbers of children identified who are suffering with the disorder have risen sharply in the past few years. A letter from a parent asking for help was published in a parenting magazine a few years ago, and many cases have since surfaced. The school system in which I worked has had four selectively mute children within five years. This has occurred in just one small suburban school district.

Many medical personnel are not aware of selective mutism or they have found that traditional psychotherapy has been disappointing and often medication is prescribed. Past treatment of the condition has focused on trauma and many treating professionals have labelled SM as post-traumatic stress disorder. However, recent research shows that selective mutism is very rarely caused by trauma and there is a difference between selective mutism and traumatic mutism.  Michelle Cottle (The New Republic, August 2, 1999) reports that research indicates one in every eight persons may have a social phobia; and, even though pharmacological intervention is widely advocated, the relapse rate is 50 percent within six months of stopping medication.

Today, newer more effective strategies are being used to treat selective mutism including cognitive behavior modification, play therapy, self-reinforcing, self-regulation, stimulus fading, sliding in technique, video feed forward, response initiation and exposure therapy. These types of strategies may be employed by a psychologist, school personnel or a combination of both.

It is crucial that an intervention and accommodations for a selectively mute child be provided within the school because the group setting enhances the child’s fear of speaking. Unfortunately, many teachers and school professionals are hesitant to work with a child who has a psychological condition. Therefore, it is my purpose in this book to describe my experience as an elementary school educational specialist in providing individual accommodations to a selectively mute child. Also described is the process that followed in his overcoming the disorder, after five years of being mute in school and all social situations. His ability to overcome the disorder was accomplished without the use of medication. I do not guarantee that these activities will work with all children or any other child, but would hope that if the information could be of help to one psychologist, teacher, child or parent, my goal would be accomplished.