What is Selective Mutism?

Selective Mutism (previously known as elective mutism) is a disorder that usually occurs during childhood. It is characterised by a child having difficulty speaking (or is silent) in at least one social setting, despite being able to speak normally in other situations. Often it will be shown by children who can speak confidently at home but are silent at school. The child can be described as having a real FEAR around speaking or social interactions in certain situations and it can be incredibly distressing for the child and family. Selective mutism typically occurs before a child is 5 years old and is usually first noticed when the child starts school but it can often be missed resulting in later or misdiagnoses.

 

Diagnostic Criteria

 

Selective Mutism (SM) is described in  The Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM–5; American Psychiatric Association, 2013). They state that the following criteria warrant a diagnosis of SM:

  • Consistent failure to speak in at least one specific situation with the ability to speak in at least one specific situation.

  • Not speaking interferes with education or social communication.

  • Duration more than 1 month.

  • Mutism not due to lack of knowledge or comfort with the language or due to another communication disorder.

 

The DSM-5 now classifys SM as an anxiety disorder. As well as the above criteria it is recognised that children with SM may also show: anxiety disorder e.g. social phobia (reported in over 90% of cases), excessive shyness, fear of social embarrassment, social isolation and withdrawal. It is essential that these addtional difficulties are considered if a treatment programme is to be successful.

 

There is NO evidence to suggest that SM is resultant from trauma, abuse or neglect - despite many common misconceptions of this. SM should not be confused with traumatic mutism which most often occurs suddenly in all environments in response to significant trauma e.g. loss of family member.

 

Prevalence

 

SM was once considered rare but affects more than 6 in 1000 children. Despite these figures there are still very few professionals who are trained in supporting with SM. As a result there is a great deal of misunderstanding around this condition which often results in adults thinking that the child is being defiant or oppositional. This then affects the management of these behaviours, which when treated incorrectly can do more harm than good.

 

Children with SM are likely to show different patterns of behaviour and anxiety - not all behaviours are the same. As a result SM is widely under diagnosed and this inconsistency can also make it more difficult for others to understand the children's behaviour e.g. some children are confident in everything but speaking, making age appropriate progress in all other areas whereas others at the opposite end of the spectrum may be completely social withdrawn and unable to even communicate or respond non verbally.

 

Presentation

 

The difference in presentation of speaking anxiety in SM has been described as a spectrum or hierarchy of difficulty. The Social Communication Anxiety Scale and Stages of Confident Speaking are two tools used to plot where a child is at to support understanding of difficulties and support planning (See assessment in the resources section for further information).

 

The speaking patterns of children with SM are also widely variable. Speaking rules tend to be goverend by place, person and/or activity - as such one child may only be silent with adults at school whereas another child may be unable to speak to family members. Identification of the child's speaking rules is an important part of the assessment process to help identify appropriate first targets for intervention.

 

The postive of SM is that although this disorder can persist into adulthood if left untreated, in most cases, with appropriate treatment SM can be CURED. In more complex cases intervention will signifantly reduce the level of anxiety for the individual. Early intervention involving training, information provision and therapy sessions is best as part of an comprehensive programme that supports the child, family and school. There is help out there for children and adults at any stage of SM and it is hoped that this website will be able to provide information on the most appropiate supports available.

 

What is not Selective Mutism?

 

SM may not be the cause of speaking difficulty if:

  • The child has NEVER spoken in ANY environments.

  • The child has only recently been exposed to the language used in the specific environment - a period of up to 6 months may be required for the child to become confident in that setting but this should be carefully monitored. This is referred to as the "silent period" in second language aquisition.

  • The mutism occurred suddenly in all environments in response to trauma.

  • The mutism can be explained via other communication difficulties such as stammering.

 

If you are unsure of whether or not your child is experiencing SM always contact a health care professional e.g. Speech Therapist/Psychologist with experience in this area to gain further information and obtain a full assessment.

 

More Information

 

Key Factors to Consider First

 

Shyness

 

Commonly Co-occuring Conditions

 

Examples of SM

 

 

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