What Are the Symptoms of Selective Mutism?

Many children are shy for a while when they first start kindergarten, but most eventually become comfortable in school, make friends, and talk to the teacher. Those with selective mutism remain silent and may not speak for a month or longer. Some children with selective mutism make gestures, nod, or write notes to communicate. Others use one-syllable words or whispers. Many children with selective mutism are very shy and fearful and may have nervous habits, such as biting their nails. They may cling to their parents and sulk around strangers but might throw temper tantrums and be stubborn and demanding at home. When pushed to speak, they may become stubborn in their refusal. It is sometimes hard for adults to understand that fear, not stubbornness, is at the root of selective mutism and that children with this condition experience speaking as risky, scary, or dangerous. Understood in this way, people can understand that a child's stubborn refusal to speak as a strong, but misguided, attempt at self-protection.

How Is Selective Mutism Diagnosed?

Some children with selective mutism will speak to a mental health professional, but others will not. Even if children are silent, though, a skilled professional therapist still can learn a lot by watching how they behave. The therapist can also talk to parents and teachers to find out more about the problem and possible factors that contribute to it. In addition, a number of tests may be used to exclude other possible causes for failing to speak. These include special medical tests to rule out brain damage, intelligence and academic tests to rule out learning problems, speech and language tests to rule out communication disorders, and hearing tests to rule out hearing loss.

How Is Selective Mutism Treated?

Most children who have selective mutism want to feel comfortable talking. Although they resist efforts to help them talk at first, therapy can be effective in treating this problem. The most common treatment for selective mutism is behavioral (bee-HAY-vyor-al) therapy, which helps people gradually change specific, unwanted types of behavior. For example, after the therapist helps the child to feel comfortable, the child might be rewarded for speaking softly and clearly into a tape recorder. Once they have succeeded at this several times, they can move on to being rewarded for speaking to one child at school. Children who are selectively mute may speak to specific children. They then might be invited to participate in a group with the children to whom the selectively mute child speaks.

Often family therapy is added, which helps identify and change behavior patterns within the family that may play a role in maintaining mutism. When a child has selective mutism, it is common for the family members to speak for the child. While they begin to do this out of love and concern and the desire to be helpful, these patterns must be discontinued to help motivate reluctant children to begin to speak for themselves. Play therapy and drawing are often used to help these children to express their feelings and worries. In addition, some children with selective mutism are prescribed medications used for treating anxiety. These medications help lessen the anxiety that plays an important role in the selectively mute child's behavior, allowing the child to take the risks involved in talking.

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