WHAT IS SELECTIVE MUTISM?

Selective Mutism – A Comprehensive Overview
BY DR. ELISA SHIPON-BLUM

PH: (215) 887-5748 | E: SMartCenter@SelectiveMutismCenter.org

Selective Mutism is a circuitous babyhood anxiety disorder characterized by a child'due south disability to speak and communicate effectively in select social settings, such as school. These children are able to speak and communicate in settings where they are comfortable, secure, and relaxed.

More 90% of children with Selective Mutism too have social phobia or social feet. This disorder is quite debilitating and painful to the child. Children and adolescents with Selective Mutism have an actual Fear of speaking and of social interactions where there is an expectation to speak and communicate. Many children with Selective Mutism accept great difficulty responding or initiating communication in a nonverbal fashion; therefore, social engagement may exist compromised in many children when confronted past others or in an overwhelming setting where they sense a feeling of expectation.

Not all children manifest their anxiety in the aforementioned way. Some may be completely mute and unable to speak or communicate to anyone in a social setting, others may be able to speak to a select few or peradventure whisper. Some children may stand motionless with fear as they are confronted with specific social settings. They may freeze, exist expressionless, unemotional and may be socially isolated. Less severely affected children may look relaxed and carefree, and are able to socialize with ane or a few children but are unable to speak and finer communicate to teachers or almost/all peers.

When compared to the typically shy and timid child, near children with Selective Mutism are at the extreme cease of the spectrum for timidity and shyness.

Why does a child develop Selective Mutism?
The bulk of children with Selective Mutism have a genetic predisposition to anxiety. In other words, they have inherited a trend to be anxious from one or more family members. Very often, these children show signs of severe feet, such equally separation anxiety, frequent tantrums and crying, moodiness, inflexibility, sleep problems, and extreme shyness from infancy on.

Children with Selective Mutism often have severely inhibited temperaments. Studies bear witness that individuals with inhibited temperaments are more than prone to anxiety than those without shy temperaments. Most, if not all, of the distinctive behavioral characteristics that children with Selective Mutism portray tin be explained past the studied hypothesis that children with inhibited temperaments accept a decreased threshold of excitability in the almond-shaped surface area of the brain called the amygdala. When confronted with a fearful scenario, the amygdala receives signals of potential danger (from the sympathetic nervous organisation) and begins to set off a series of reactions that will help individuals protect themselves. In the instance of children with Selective Mutism, the fearful scenarios are social settings such every bit birthday parties, school, family gatherings, routine errands, etc.

Some children with Selective Mutism have Sensory Processing Disorder (DSI) which means they have problem processing specific sensory information. They may be sensitive to sounds, lights, touch, taste and smells. Some children have difficulty modulating sensory input which may affect their emotional responses. DSI may cause a child to misinterpret ecology and social cues. This can lead to inflexibility, frustration and feet. The feet experienced may cause a kid to close downward, avoid and withdraw from a situation, or it may cause him/her to act out, take tantrums and manifest negative behaviors.

Some children (20-30%) with Selective Mutism have subtle speech and/or language abnormalities such equally receptive and/or expressive language abnormalities and language delays. Others may have subtle learning disabilities including auditory processing disorder. In well-nigh of these cases, the children have inhibited temperaments (prone to shyness and anxiety). The added stress of the speech/language disorder, learning disability, or processing disorder may cause the child to feel that much more anxious and insecure or uncomfortable in situations where there is an expectation to speak.

More studies are necessary to fully assess speech/language abnormalities and Selective Mutism as well as processing disorders and Selective Mutism. Information technology is important to note that there are many children with Selective Mutism who are early speakers without whatsoever oral communication delays/disorders or processing disorders.

Research at the Selective Mutism Feet Research and Handling Eye (SMart Middle) indicates that in that location is a proportion of children with Selective Mutism who come from bilingual/multilingual families, accept spent time in a foreign country, and/or have been exposed to another linguistic communication during their formative language development (ages 2-4 years sometime). These children are usually temperamentally inhibited by nature, only the boosted stress of speaking another language and being insecure with their skills is enough to cause an increased anxiety level and mutism.

A small percentage of children with Selective Mutism do not seem to be the least flake shy. Many of these children perform and do any they can to get others attending and are described equally professional mimes! Reasons for mutism in these children are not proven, but preliminary research from the SMart Heart indicates that these children may have other reasons for mutism. For example, years of living mute and therefore have ingrained mute behavior despite their lack of social feet symptoms or other developmental/speech communication bug. These children are literally stuck in the nonverbal stage of communication. Selective Mutism is therefore a symptom. Children are rarely "simply mute." Emphasis needs to be on causes of the mutism and propagating factors of mutism.

Studies have shown no evidence that the cause of Selective Mutism is related to abuse, fail or trauma.

What is the divergence between Selective Mutism and traumatic mutism?
Children who suffer from Selective Mutism speak in at to the lowest degree one setting and are rarely mute in all settings. Almost have inhibited temperaments and manifest social anxiety. For children with Selective Mutism, their mutism is a ways of fugitive the anxious feelings elicited by expectations and social encounters.

Children with traumatic mutism unremarkably develop mutism of a sudden in all situations. An example would be a child who witnesses the death of a grandparent or other traumatic effect, is unable to process the result, and becomes mute in all settings.

It is of import to sympathize that some children with Selective Mutism may start out with mutism in school and other social settings. Due to negative reinforcement of their mutism, misunderstandings from those around them, and perhaps heightened stress within their environment, they may develop mutism in all settings. These children have progressive mutism and are mute in/out of the abode with all people, including parents and siblings.

What behavior characteristics does a kid with Selective Mutism portray in social settings?
It is important to realize that the majority of children with Selective Mutism are equally normal and as socially appropriate as whatsoever other child when in a comfortable environment. Parents will often annotate how boisterous, social, funny, inquisitive, extremely verbal, and even bossy and stubborn these children are at dwelling house! What differentiates most children with Selective Mutism is their astringent behavioral inhibition and inability to speak and communicate comfortably in about social settings. Some children with Selective Mutism feel as though they are on stage every infinitesimal of the day! This can be quite center-wrenching for both the child and parents involved. Often, these children testify signs of feet before and during virtually social events. Physical symptoms and negative behaviors are common earlier school or social outings.

Information technology is important for parents and teachers to understand that the physical and behavioral symptoms are due to anxiety and handling needs to focus on helping the child learn the coping skills to combat broken-hearted feelings.

It is mutual for many children with Selective Mutism to have a blank facial expression and never seem to smile. Many have stiff or awkward body language when in a social setting and seem very uncomfortable or unhappy. Some will turn their heads, chew or twirl their hair, avoid eye contact, or withdraw into a corner or away from the group seemingly more than interested in playing lonely.

Others are less avoidant and practice not seem as uncomfortable. They may play with 1 or a few children and exist very participatory in groups. These children will still be mute or barely communicate with well-nigh classmates and teachers.

As social relationships are built, and a child develops one or a few friendships, he/she may interact and even whisper or speak to a few children in school or other settings but seem to be disinterested or ignore other classroom peers. Over time, these children learn to cope and participate in certain social settings. They usually perform nonverbally or by talking quietly to a select few. Social relationships get very hard every bit children with Selective Mutism abound older. As peers begin dating and socializing more, children with Selective Mutism may remain more aloof, isolated, and alone.

Children with Selective Mutism oft accept tremendous difficulty initiating and may hesitate to respond even nonverbally. This tin can be quite frustrating to the child equally time goes past. The kid'due south nonverbal communication may become on for many years, condign more than ingrained and reinforced unless the kid is properly diagnosed and treated. Ingrained behavior often manifests itself by a child looking and acting usually merely communicating nonverbally. This detail kid cannot merely first speaking. Handling needs to eye on methods to help the child unlearn the nowadays mute behavior.

What are the most common characteristics of children with Selective Mutism?
Nigh, if not all, of the characteristics of children with Selective Mutism can be attributed to anxiety.

  1. Temperamental Inhibition: Timid, cautious in new and unfamiliar situations, restrained, usually evident from infancy on. Separation feet as a young child.
  2. Social Anxiety Symptoms: Over ninety% of children with Selective Mutism take social anxiety. Uncomfortable being introduced to people, teased or criticized, being the center of attention, bringing attention to himself/herself, perfectionist (afraid to make a mistake), shy bladder syndrome (Paruresis), eating problems (embarrassed to consume in front of others).
  3. Social Being: The majority of children/teens with SM have age appropriate social skills and are on target developmentally, although some do not.  Most children on the autism spectrum struggle with spoken communication/language skills, social skills and have developmental challenges.
  4. Concrete Symptoms: MUTISM, tummy ache, nausea, vomiting, articulation pains, headaches, chest hurting, shortness of breath, diarrhea, nervous feelings, scared feelings.
  5. Appearance: Many children with Selective Mutism have a frozen-looking, blank, expressionless face and stiff, awkward trunk linguistic communication with lack of center contact when feeling anxious. This is especially truthful for younger children in the beginning of the school yr or then suddenly approached past an unfamiliar person. They ofttimes announced like an animal in the wild when they stand motionless with fearfulness! The older the child, the less likely he/she is to showroom stiff, frozen body language. Also, the more comfortable a child is in a setting, the less likely a child will wait anxious. For example, the young child who is comfortable and adapted in schoolhouse, notwithstanding is mute, may seem relaxed, but mutism is still present. One hypothesis is that heightened sympathetic response causes muscle tension and vocal cord paralysis.
  6. Emotional: When the child is immature, he/she may not seem upset near mutism since peers are more than accepting. As children age, inner turmoil often develops and they may develop the negative ramifications of untreated feet (encounter below).
  7. Developmental Delays: A proportion of children with Selective Mutism take developmental delays. Some accept multiple delays and have the diagnosis of an autistic spectrum disorder, such every bit Pervasive Developmental Disorder, Aspergers, or Autism. Delays include motor, communication and/or social development.
  8. Sensory Integration Dysfunction (DSI) symptoms, Processing Difficulties/Delays: For many children with SM, sensory processing difficulties are the underlying reason for being 'close downward' and their mutism. In larger, more crowded environments where multiple stimuli are present (such as the classroom setting), where the kid feels an expectation, sensory modulation specifically, sensory defensiveness exists. Anxiety is created causing a 'freeze' mode to take identify. The ultimate 'freeze way' is MUTISM.
  9. Mutual symptoms: Picky eater, bowel and bladder problems, sensitive to crowds, lights (hands over eyes, avoids vivid lights), sounds (dislikes loud sounds, easily over ears, comments that it seems loud), touch (being bumped by others, hair brushing, tags, socks, etc), and heightened senses, i.e., perceptive, sensitive, Cocky-regulation difficulties (act outing, defiant, disobedient, easily frustrated, stubborn, inflexible, etc).
  10. Common symptoms within a classroom environment: Withdrawal, playing alone or not playing at all, hesitation in responding (even nonverbally), distractibility, difficulty following a serial of directions or staying on task, difficulty completing tasks. Experience at the Smart Heart dictates that sensory processing difficulties may or may not cause learning or academic difficulties. Many children, especially, highly intelligent children can compensate academically and really practise quite well. MANY focus on their bookish skills, oftentimes leaving behind 'the social interaction' within schoolhouse. This tends to exist more obvious as the child ages. What is crucial to understand is that many of these symptoms may Non be in a comfortable and anticipated setting, such as at home. In some children, in that location are processing problems, such every bit auditory processing disorder, that cause learning problems also as heightened stress.
  11. Behavioral: Children with Selective Mutism are often inflexible and stubborn, moody, bossy, assertive and domineering at home. They may besides exhibit dramatic mood swings, crying spells, withdrawal, avoidance, denial, and procrastination. These children accept a need for inner control, lodge and structure, and may resist change or have difficulty with transitions. Some children may act silly or human action out negatively in school, parties, in front of family and friends. WHY? These children have developed maladaptive coping mechanisms to combat their anxiety.
  12. Co-Morbid Anxieties: Separation anxiety, Obsessive Compulsive Disorder (OCD), hoarding, Trichotillomania (hair pulling, skin picking), Generalized Feet Disorder, Specific phobias, Panic Disorder.
  13. Communication Difficulties: Some children may take difficulty responding nonverbally to others, i.e., cannot point/nod in response to a teachers question, or indicate cheers by mouthing words. For many, waving hello/bye is extremely difficult. However, this is situational. This same child can not merely respond nonverbally when comfortable, merely tin chatter nonstop! Some children may take difficulty initiating nonverbally when anxious, i.e., accept difficulty or are unable to initiate play with peers or go upward to a instructor to indicate need or want.
  14. Social Appointment Difficulties: When one truly examines the characteristics of a kid with Selective Mutism, it is obvious that many are unable to socially engage properly. When confronted by a stranger or less familiar individual, a child may withdraw, avoid heart contact, and 'shut downwardly,' not just leaving a child speechless but preventing him/her from engaging with some other individual. Greeting others, initiating needs and wants, etc., are often incommunicable for many children. Many shadow their parents in social environments often fugitive whatever social interaction at all. The common instance given is; 'A child in grocery story tin can sing, express joy and talk loudly, but as soon as someone confronts him/her, the child freezes, avoids and withdraws from social interaction.' As the kid ages, freezing and shutting down rarely exist, simply the child remains either noncommunicative or will reply nonverbally after an indeterminate amount of warm up fourth dimension.

MUTISM is simply one of the many characteristics that children with Selective Mutism portray.

When are about children diagnosed as having Selective Mutism?
Most children are diagnosed between 3 and 8 years former. In retrospect, it is often noted that these children were temperamentally inhibited and severely anxious in social settings equally infants and toddlers, but adults thought they were just very shy. Most children have a history of separation anxiety and beingness tedious to warm upwards. Frequently it is non until children enter school and at that place is an expectation to perform, interact and speak, that Selective Mutism becomes more obvious. What often happens is teachers tell parents the kid is not talking or interacting with the other children. In other situations, parents will observe, early, that their child is not speaking to nearly individuals outside the home.
If mutism persists for more than a month, a parent should bring this to the attention of their child'southward physician.

Why do so few teachers, therapists and physicians understand Selective Mutism?
Studies of Selective Mutism are scarce. Near research results are based on subjective findings based on a limited number of children. In addition, textbook descriptions are often nonexistent, or data is limited, and in many situations, the information is inaccurate and misleading. As a consequence, few people truly understand Selective Mutism. Professionals and teachers will often tell a parent, the child is merely shy, or they volition outgrow their silence. Others interpret the mutism equally a ways of beingness oppositional and defiant, manipulative or decision-making. Some professionals erroneously view Selective Mutism every bit a variant of autism or an indication of severe learning disabilities. For most children who are truly affected by Selective Mutism, this is completely wrong and inappropriate!

Enquiry at the SMart Center indicates that children who seem oppositional in nature often have parents, teachers, and/or treating professionals who take pressured them to speak for months, perhaps years. Mutism not merely persists in these children, but is negatively reinforced. These children may develop oppositional behaviors out of a combination of frustration, their ain inability to make sense of their mutism, and others pressuring them to speak.

As a result of the scarcity and ofttimes inaccuracy of data in the published literature, children with Selective Mutism may exist misdiagnosed and mismanaged. In many circumstances, parents will wait and promise their kid outgrows their mutism (and may fifty-fifty by advised to do then past well-meaning, but uninformed professionals). However, without proper recognition and handling, most of these children do NOT outgrow Selective Mutism and terminate up going through years without speaking, interacting unremarkably, or developing appropriate social skills. In fact, many individuals who suffer from Selective Mutism and social anxiety who do not go proper treatment to develop necessary coping skills may develop the negative ramifications of untreated feet (see below).

Why is it so important to have my kid diagnosed when he/she is and so young?
Our findings signal that the earlier a child is treated for Selective Mutism, the quicker the response to treatment, and the better the overall prognosis. If a child remains mute for many years, his/her behavior tin go a conditioned response where the child literally gets used to not-verbalizing. In other words, Selective Mutism tin can become a difficult habit to break!

Because Selective Mutism is an anxiety disorder, if left untreated, it can have negative consequences throughout the child's life and, unfortunately, pave the mode for an array of bookish, social and emotional repercussions such as:

  • Worsening anxiety
  • Depression and manifestations of other anxiety disorders
  • Social isolation and withdrawal
  • Poor self-esteem and self-confidence
  • Schoolhouse refusal, poor bookish functioning, and the possibility of quitting school
  • Underachievement academically and in the piece of work identify
  • Cocky-medication with drugs and/or alcohol
  • Suicidal thoughts and possible suicide

Anxiety disorders are the most common mental illnesses among children and adolescents. Our main objective is to diagnose children early, so they tin receive proper handling at an early age, develop proper coping skills, and overcome their feet. According to the US Surgeon General, our country is in a state of emergency as far every bit children'southward mental health is concerned. 10% of children suffer from mental disorders, but less than 5% of these children are actually receiving treatment.

If parents suspect their child has Selective Mutism, what should they do?
Parents should initially remove all pressure and expectations for the child to speak, carrying to their child that they understand he/she is scared and it is hard to get the words out and that they will help their child through this difficult time. Praise the child's efforts and accomplishments, support and acknowledge the difficulties and frustrations.

Parents should speak with their family physician or pediatrician and/or seek out a psychiatrist or a therapist who has experience with Selective Mutism. However, delight note that having feel with Selective Mutism does not guarantee that the treatment approach and understanding is correct. In fact, a clinician with less experience, yet who has an splendid agreement of Selective Mutism may be an ideal selection for your kid.

What are the key questions to inquire a potential therapist or physician?
Do your homework! Y'all will have a much better idea what to look for if you understand Selective Mutism. Educate yourself as much as possible before seeing whatsoever professional. Parents should read as much information as they can nigh Selective Mutism. The Selective Mutism Association website has endless pages of information and it is updated on a regular basis.

Key questions to enquire include:

  • What are your areas of expertise?
  • Have you ever treated a child with Selective Mutism? If and so, how many and what are your success rates?
  • What are your views on Selective Mutism? In other words, what are some of the reasons a child manifests mutism?
  • What is your treatment arroyo to Selective Mutism?
  • What will be my office every bit a parent? What is the teacher'due south role?
  • What is your opinion on medication in treating Selective Mutism and when do you consider medication?
  • Can yous supply me with references of families yous take worked with?
  • How will yous piece of work with my child to help him/her progress communicatively?*

*Children do not progress communicatively without learning coping skills. But lowering anxiety is Non enough to enable the child to begin engaging socially, learn to progress to verbal communication and feel comfortable in an environment. Skills must be taught.

Caution: When speaking to potential treating professionals, delight be cautious of those who come across Selective Mutism as a decision-making/manipulative behavior. Treatment approaches based on field of study and forcing a child to speak are inappropriate and will only heighten anxiety and negatively reinforce mute behavior.

How is a child evaluated for Selective Mutism?
Social Communication Feet Treatment® or S-CAT® is an evidenced-based program created by Dr. Elisa Shipon-Blum and implemented at the Selective Mutism Feet Research and Handling Middle (SMart Eye). Presently, the SMart Center is the ONLY Middle in the world that implements South-CAT®.

Dr. Elisa Shipon-Blum'due south S-True cat® Programme is based on the concept that Selective Mutism (SM) is a social communication anxiety disorder that is more than simply not speaking.  Families in the S-True cat® Program are provided with structured, individualized, step-by-step treatment.

Dr. Shipon-Blum has created the SM-Stages of Social Communication Condolement Scale© that describes the various stages of social communication possible for a child suffering from Selective Mutism. Children suffering from Selective Mutism (SM) change their level of social communication based on the setting as well as the expectations from others within a setting. As a result, social comfort and communication will modify from setting to setting and person to person.  The Social Communication Span®illustrates this concept in a visual class.

For example, a child may be "chatting upwardly a tempest" with their friend or family member in one setting, withal come across that same person in another setting (such as at school or perchance at a family unit function) and the child may have difficulty socially engaging, communicating nonverbally and perhaps the child cannot communicate at all!

For some children, they appear very comfortable and mutism is the well-nigh noted symptom. This usually means they are able to engage nonverbally with others via astute nonverbal skills (professional person mimes!) in near, if not all settings. These children are stuck in the nonverbal stage of communication (Stage one) and suffer from a subtype of SM called Speech Phobia.

Although mutism is the virtually noted symptom of SM, the inability to speak simply touches on the surface of our children.  A complete understanding of the child is necessary to develop an appropriate treatment program for dwelling house and in the real earth, as well as in schoolhouse by developing accommodations and interventions, e.g. IEP or 504 Program.

According to Dr. Shipon-Blum's work, afterwards a complete evaluation consisting of parent and teacher cess forms such every bit the Selective Mutism Comprehensive Diagnostic Questionnaire (SM-CDQ)© and the SM Schoolhouse Evaluation Form©, and parent and child interviews, treatment needs to address three fundamental questions:

  1. Why  did this child develop (including influencing, precipitating and maintaining factors)?
  2. Why  does Selective Mutism persist despite past handling and/or parent/teacher awareness?
  3. What  tin can be washed at abode, in school, and in the existent world to help the kid build the coping skills needed to overcome his/her social advice challenges?

To help a child suffering in silence, an understanding of which stage the kid is in during particular social encounters must be adult. The Social Communication Anxiety Inventory (SCAI©) tin exist used to determine the stage of social communication on the  Social Communication Span®. Handling is and then developed via the whole kid arroyo under the direction of the treatment professional, the kid, parents, and school personnel working together.

Dr. Shipon-Blum emphasizes that although anxiety lowering is cardinal, it is often non enough, peculiarly every bit children age. Over time, many children with Selective Mutism no longer feel broken-hearted, but their mutism and lack of proper social appointment continue to exist in select settings.

Children with SM need strategies and interventions to progress from nonverbal to spoken communication. This is the Transitional Phase of Advice, an aspect missing from most treatment plans. In other words, how exercise you lot help a child progress from nonverbal to verbal communication?

Strategies and interventions are developed based on where the child is on the Social Communication Bridge in a particular setting and are meant to be a desensitizing method as well as a vehicle to unlearn conditioned behavior. Time in the therapy office is simply not enough. The role setting is used to help set the child for the school and real earth environments by developing strategies to assistance the child unlearn his or her conditioned behavior. So, in the real world and within the school setting, the strategies and interventions are implemented.

The S-CAT® Plan incorporates feet lowering techniques, methods to build self-esteem, and strategies and interventions to help with social comfort and advice progression. This may include bridging from close downwardly to nonverbal advice then transitioning into spoken advice via the Verbal Intermediary®, Ritual Sound Approach®, and possibly the use of augmentative devices.

Children with SM need to understand, feel in control, and accept choice in their treatment (historic period dependent). These are critical components of Social Communication Feet Treatment® strategies, which provide the child with choices and aid to transfer the child'southward need for control into the strategies and interventions.

S-CAT® games and goals (based on historic period and where the child is on the Social Communication Bridge®) are used to help develop social comfort and ultimately progress into speech via the apply of ritualistic and controlled methods. Strategy charts are used to assist develop social comfort and progress into speech. Silent goals (environmental changes) and active goals (child directed goals based on selection and control) are some of the other tools used within the S-Cat® Programme.

Every kid is different and therefore an individualized treatment plan needs to be developed to comprise home (parent education, ecology changes), the child's unique needs, and school modifications (teacher education, accommodations and interventions). By lowering feet, increasing self-esteem, and increasing communication and social conviction within a variety of real world settings, the child suffering in silence will develop necessary coping skills to enable for proper social, emotional, and bookish functioning.

A trained professional person familiar with Selective Mutism will have a parental interview. Emphasis will be on social interaction and developmental history, other manifestations of anxiety, behavioral characteristics (shy temperament), home life description (family stress, divorce, death, etc.) and medical history. From the results of the initial interview, the professional person will oft see the child. Children with Selective Mutism may or may not speak to the diagnosing professional. Whether or non a child speaks to the evaluating physician does non really matter. An astute professional should be able to appraise interpersonal communication skills and build rapport quite easily and, if given at least one session and possibly viewing videotapes from abode, can rule in or out Selective Mutism as a diagnosis.

Because twenty-30% of children with Selective Mutism have an abnormality with speech and linguistic communication, a thorough speech and language evaluation is often ordered. If motor/sensory issues exist an occupational therapy evaluation is also recommended. A complete physical test (including hearing), standardized testing, psycho-educational testing as well every bit a thorough developmental screening are frequently recommended if the diagnosis is not clear.

What are the diagnostic criteria for Selective Mutism?
DSM-IV-TR (2000) defines Selective Mutism as follows:

  1. Consequent failure to speak in specific social situations (in which there is an expectation for speaking, east.g., at school) despite speaking in other situations.
  2. The disturbance interferes with educational or occupational achievement or with social communication.
  3. The duration of the disturbance is at least one month (not limited to the first calendar month of school).
  4. The failure to speak is non due to a lack of noesis of, or condolement with, the spoken language required in the social situation.
  5. The disturbance is not better deemed for by a Communication Disorder (e.g., stuttering) and does not occur exclusively during a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder.

Associated features of Selective Mutism may include excessive shyness, fear of social embarrassment, social isolation and withdrawal, clinging, compulsive traits, negativism, temper tantrums, or controlling or oppositional behavior, particularly at abode. There may exist severe damage in social and schoolhouse functioning. Teasing or goading by peers is common. Although children with this disorder generally have normal language skills, there may occasionally exist an associated Communication Disorder (east.g., Phonological Disorder, Expressive Language Disorder, or Mixed Receptive- Expressive Language Disorder) or a general medical condition that causes abnormalities of articulation. Mental Retardation, hospitalization or extreme psychosocial stressors may be associated with the disorder. In addition, in clinical settings children with Selective Mutism are almost always given an additional diagnosis of Feet Disorder, specially Social Phobia is common. (DSM-IV-TR) (APA, 2000)

Authors notation: The above criteria are quite vague/nonspecific and should not be used solitary to rule in or rule out the diagnosis of Selective Mutism. As mentioned before, children with Selective Mutism manifest many behavioral characteristics other than mutism. In add-on, since children with Selective Mutism frequently have difficulty responding and/or initiating nonverbally, Selective Mutism can be viewed every bit a communication disorder. In addition, children with autism, PDD-NOS, Aspergers and other developmental disorders can manifest mutism that is selective in location.

How is Selective Mutism treated?
The principal goals of treatment should be to lower anxiety, increase self-esteem and increase social confidence and advice. Emphasis should never exist on getting a child to talk. All expectations for verbalization should be removed. With lowered anxiety, conviction, and the employ of appropriate tactics/techniques, advice will increment equally the kid progresses from nonverbal to exact communication. Treatment approaches should exist individualized, but the majority of children are treated using a combination of:

  1. Social Communication Anxiety Therapy® (S-CAT®): This is the philosophy of treatment implemented at the Selective Mutism, Feet, and Related Disorders Handling Center (SMart Eye). This treatment includes development of an individualized treatment programme that focuses on the whole kid and incorporates a Team arroyo involving the child, parent, school personnel, and treating professional. Recommended therapeutic tactics and techniques are implemented to build social comfort and progression of communication comfort (nonverbal and verbal) in diverse social settings (in and out of school). Considering anxiety levels change from situation to situation, and often from one person to the next, methods oft alter from one social situation to another. Therefore, by lowering anxiety, increasing self-esteem, as well as increasing communication and social confidence inside a variety of Real World settings, the child suffering in silence will develop necessary coping skills to enable for proper social, emotional, developmental, and academic functioning.
  2. Behavioral Therapy: Positive Reinforcement and Desensitization techniques are the main behavior treatments for Selective Mutism, as well as removing all pressure to speak. Emphasis should be on understanding the child and acknowledging their anxiety. Introducing the child to social environments in subtle and non-threatening ways is an excellent way to aid the kid feel more than comfortable, i.e., Parents can take the child into schoolhouse when few people are around to get the child to practice speaking. Somewhen, bring a friend or ii to schoolhouse and allow the children to play when other children are not nowadays. Pocket-size groups with only a pocket-sized number of children are helpful, as well as allowing parents to spend time with the child within the course. After the child is speaking quite normally, the teacher, and so the students are gradually introduced into the group setting. Positive reinforcement for verbalization should be introduced when, and but when, anxiety is lowered and the child feels comfortable and is patently ready for some subtle encouragement.
  3. Play Therapy, Psychotherapy, and other psychological approaches: These can be effective if all force per unit area for verbalization is removed and emphasis is on helping the kid relax and open. Confronting mutism in a non-threatening style is important. These children are SCARED, and the focus should be to help them identify their level of being scared' in a detail state of affairs. Helping them to realize that you empathise and are at that place to assistance them relieves tremendous force per unit area.
  4. Cognitive Behavioral Therapy: CBT trained therapists help children change their behavior by helping them redirect their fears and worries into positive thoughts. CBT needs to incorporate sensation and acknowledgement of anxiety and mutism. Almost children with Selective Mutism worry about others hearing their voice, asking them questions virtually why they exercise not talk and trying to force them to speak. The focus should be on emphasizing the childs positive attributes, building confidence in social settings, and lowering overall anxiety and worries.
  5. Medication: Studies signal that the nearly constructive arroyo to treatment is a combination of behavioral techniques and medication. Oftentimes behavioral techniques are used for an indeterminate corporeality of fourth dimension prior to the add-on of medication. If children are not making plenty progress with behavioral therapy alone, medication may be recommended to reduce the feet level. Serotonin reuptake inhibitors (SSRIs) such every bit Prozac, Paxil, Celexa, Luvox, and Zoloft are very effective in the treatment of anxiety disorders. Similar to the SSRIs, there are other drugs that affect 1 or more neurotransmitters such as serotonin, norepinephrine, GABA, and dopamine, etc. which are also proving to be affective. Examples are Effexor XR and Buspar. Both classes of drugs work well in children who have a true biochemical imbalance. This seems to exist the case in the majority of children with Selective Mutism. Very often, we have seen positive furnishings in as fiddling equally a week! Medication is used equally a spring kickoff with the promise that, as we lower feet via medication, we can implement behavioral techniques more easily and successfully! Goals for the elapsing of treatment with medication are ordinarily 9-12 months.
  6. Self-esteem boosters: Parents should emphasize their childs positive attributes. For example, if your child is artistic, then by all means bear witness off the artwork! Take a special wall to brandish your childs masterpieces; perhaps you can even accept a special exhibition! Have them explicate their artwork to family unit members and shut friends. This promotes more verbalization practice, likewise as helps with conviction!
  7. Frequent socialization: Encourage as much socialization as possible without pushing your child. Conform frequent play dates with classmates or even minor grouping interactions with individuals the child knows well. The goals is for your kid to experience comfy enough with the classmates so that verbalization volition occur. Near children with Selective Mutism will talk to friends in their own domicile. As the child gets increasingly comfortable speaking to i kid, invite another kid over, and then accept two or 3 children at a fourth dimension! Transfer speaking into the school via set tactics/techniques. For some children, Social Skills therapy is necessary and often helpful in accomplishing increased communication.
  8. School interest: Parents demand to educate teachers and school personnel about Selective Mutism! You must exist an advocate for your child. The school needs to understand that children with Selective Mutism are non being defiant or stubborn by non speaking, that they truly CANNOT speak. Explain to the instructor that a child needs to experience that it is alright for them not to speak. Nonverbal advice is acceptable in the beginning. Equally the child progresses with treatment, the teacher should be involved in the handling plan with verbalization being encouraged in subtle, non-threatening means. An Individualized Educational Plan (IEP) or 504 Plan may exist necessary to assistance suit your childs inability to communicate verbally and to assistance the child progress communicatively as well as build social condolement.
  9. Family unit interest and parental credence: Family members must be involved in the entire handling process! Very often changes in parenting styles and expectations are necessary to adjust the needs of the child. Think, never force per unit area or force your child to speak this will merely cause more anxiety. Convey to your kid that you are in that location for them. Spend 1 on one time, especially at night, when all pressure is off and engage your kid in discussions about their feelings. Allowing your child to open up helps relieve stress. A parents credence and agreement is crucial for the child!

It is important to realize that with proper diagnosis and treatment, the prognosis for overcoming Selective Mutism is fantabulous!

Author: Dr. Elisa Shipon-Blum is President and Manager of the Selective Mutism, Anxiety, & Related Disorders Treatment Center (SMart Center). She created CommuniCamp™, an intensive group treatment plan for Selective Mutism, and is also Founder and Director Emeritus of the Selective Mutism Association and a Clinical Banana Professor of Psychology and Family Medicine PCOM. Dr. Shipon-Blum's initial interest in Selective Mutism was personal. Her experience trying to find help for her girl made the need for research, development of advisable/effective treatment strategies, and dissemination of information virtually this social-communication disorder abundantly clear. Many of these findings are based on research from treatment at the SMart Center of hundreds of children with Selective Mutism.

Contributors: Christine Stanley, Lori Dabney, Laurie Gorski