Has a teacher reported that your child does not speak readily at school? Does your talkative, bubbly child suddenly clam up with you walk into a larger family gathering or into her dance class?
If your child is a completely different person at home than she is in other social settings, she may have selective mutism. Selective mutism is often misunderstood and can be misdiagnosed, but early detection and treatment is crucial to better outcomes down the road.
What if your child isn’t just shy?
Selective mutism was always believed to be rare, however more children may meet the criteria of a diagnosis than previously thought.
Child psychologist Kristen Eastman, PsyD, says that in the past, children who were thought to be “just shy” or “defiant” for not talking may actually meet the criteria for selective mutism. Many seemed to think that a child would “grow out of” the behavior, which is not always the case.
What may appear as “just shyness” actually has its roots in anxiety, specifically an underlying fear of the expectation to talk, she says.
“Shy kids may not volunteer to read aloud to the class, but when they need to do things, they can,” Dr. Eastman says. “The main difference is that shy children function, whereas children with selective mutism cannot.”
What does selective mutism look like?
A child with selective mutism may not communicate in select social settings (often school), but he or she can comfortably talk in at least one other place (typically home).
Both girls and boys can be affected, though the condition tends to impact girls more than boys. The average age of onset is under age 5, but it is often more evident when a child enters a structured social setting (such as preschool or daycare).
Children with selective mutism are overcome with anxiety at the prospect of giving a book report, saying hello to a classmate or talking with their coach at soccer practice. So they’re rendered frozen and unable to initiate and/or respond. Because of this, their experience at school and in other social settings may be hindered, teachers may be unable to assess them and they may struggle socially.
Selective mutism can look different depending on the child:
- Some children can only talk to their immediate family and no one else outside of the home, even extended family.
- Others may talk to relatives they see more regularly and not to those they do not know as well.
- Some may talk to other children but not to adults outside of their home. Others may talk to their teacher when it’s one on one, but freeze up in the larger group setting when others are within earshot.
It’s important to understand that there’s much variability in how it appears — from day to day, from person to person and from setting to setting. These are all examples of selective mutism.
Watch for these signs of selective mutism:
- Frozen or unresponsive manner.
- Rigid, “stiff as a board” body posture.
- Expressionless, flat or “deer in headlights” face.
- Slow to respond in a social situation.
- Clinginess with parents when entering into social settings.
Early diagnosis is important
It’s important for parents to trust their instincts. If you feel like your child is acting very differently in select social settings outside of your home, and/or with select people, it is important to talk to your doctor.
“The earlier you can make a diagnosis and start intervening, the better the prognosis long-term,” Dr. Eastman says.
5 tips for parents
Dr. Eastman says that when she works with children with selective mutism, her goal is “to help the child to start associating social settings with less anxiety and increased comfort as soon as possible.”
She suggests the following initial strategies:
- Take away verbal demands in social situations when possible. If you lower verbal demands and expectations, your child will gradually learn to associate social situations with comfort and positive feelings rather than anxiety. This means don’t start talking to or asking questions of the child as soon as they walk into the birthday party. This also means don’t talk about the child not talking all the time!
- Focus on building comfort. Understand that your child will not enter into social situations as readily as other children. Allowing more time to ease into a situation, whether arriving early or allowing for practice time before entering into the larger group, is a must. Respect the longer warm up time and think of ways to get your child more comfortable. Use humor whenever possible, help him get started in the activity and provide positive encouragement.
- Focus on nonverbal communication. Rather than posing questions requiring a verbal answer, instead ask your child a question that allows a nod, thumbs-up or thumbs-down. Talk with teachers, coaches and others to encourage them to ask questions that your child can respond to in this same way.
- Work in steps. Put your child in situations where they are comfortable and talking freely, and then gradually introduce a new person, expand to a new setting or add a new demand. Don’t push your child to do it all at once.
- Start slow and continue to set realistic goals.As long as you start slow and initially focus on your child’s comfort, it is okay to gently push them so they can progress. Setting goals “just slightly beyond reach” is beneficial and when done at the appropriate time, it will yield change.
Don’t avoid placing demands on the child or avoid social situations because of your child’s selective mutism. It is important to realize that a child with selective mutism won’t improve while sitting at home with her immediate family, as she is already comfortable and talking here.
Though dealing with the problem may seem stressful at first, your child’s anxiety will reduce with time and you will see progress, Dr. Eastman says.
Talk with your physician who can help you create a plan of action. Selective mutism typically does not go away on its own, and in fact can lead to worsened anxiety and social difficulty if not addressed. Treatment requires a cohesive plan between home and school to produce lasting change.