Selective Mutism

Selective Mutism 

• Selective Mutism is a complex childhood disorder characterized by children’s inability to communicate or speak in social settings such as nursery or school.

• Most children with selective mutism are diagnosed between 3 to 8 years old but it is common not be noticed until they enter nursery or school that their condition becomes obvious. 

• These children have a fear of speaking and of social interaction, the anxiety is so strong that they often describe it as the physical feeling of choking caused by muscular tension and it is the expectation of  having to speak, interact or respond ‘on demand’ rather than when they choose that they become overwhelmed by this anxiety.

• Not all children present in the same way – some may be completely mute and unable to speak or communicate to anyone in a social setting, other may be able to speak to a select few or perhaps whisper, some stand motionless with fear as they are confronted with specific social settings.  Less severely affected children  may look relaxed and carefree and are able to socialize with one or a few children but are unable to speak and communicate effectively to practitioners or in front of most of their peer group.

• The main warning sign is the marked contrast in the child's ability to engage with different people, characterised by a sudden stillness and frozen facial expression when they're expected to talk to someone who's outside their comfort zone.

They may avoid eye contact and appear:

•  nervous, uneasy or socially awkward

•  rude, disinterested or sulky

• clingy

•  shy and withdrawn

• stiff, tense or poorly co-ordinated

• stubborn or aggressive,  parents/carers may report their child having temper tantrums when they get home from school, or getting angry when questioned about their time in the setting/day.

Children with selective mutism need specialist support to help them overcome their anxieties and to learn to manage social situations. 

Timing getting support for a child with selective mutism (SM) is important. The child needs to have had a month in a nursery/school without speaking before a request for assistance from speech and language therapy is made. It is also important not to confuse bilingual children with SM children as they often go through a quiet period.  Do not, however, leave it too late to make a request for assistance as early intervention is important.

In supporting a child with selective mutism working collaboratively between the setting, SLT and family is crucial. Often the support is delivered by working on supporting the environment and people in using the appropriate strategies rather than working directly with the child.

Specialist advice is that the emphasis should never be on getting the child with selective mutism to talk.  All expectations for verbalisation should be removed as this will lower anxiety and place the child in control of when and if they choose to interact.

What can you do?

• Adults working with these young children need to reduce their levels of anxiety by creating a positive environment for the child and this means: 

• Building  up a good relationship with the child and family

• Helping  them feel safe and secure in the setting

• Trying not let the child become anxious

• Reassuring them that they will be able to speak when ready

• Concentrate on them having fun

• Praising all efforts they make to join in and interact with others (but be careful not to ‘over praise’ which may have the less desired result of drawing more attention to the child).

• Avoid you (or others) drawing attention to the child if/when they speak. Show no surprise when the child speaks, but respond warmly as you would to any other child

• Seeking  support and guidance from Speech and Language therapy – support line or a referral with parent/carer consent