Selective mutism – fact-sheetSelective mutism is described as a rare psychological disorder inchildren. Children (and adults) with the disorder are fully capable ofspeech and understanding language, but fail to speak in certain socialsituations when it is expected of them. They function normally in otherareas of behavior and learning, though appear severely withdrawn and someare unable to participate in group activities due to their extremeanxiety. It is like an extreme form of shyness, but the intensity andduration distinguish it. As an example, a child may be completely silentat school, for years at a time, but speak quite freely or even excessivelyat home.No single cause has been established, but there is some evidence thatthere is a hereditary component. Typical sufferers have some of thefollowing traits when anxious, some of which are often perceived asrudeness:They find it difficult to maintain eye contact.Often don&#39;t smile and have blank expressions.They move stiffly and awkwardly.They find situations where talk is normally expected particularly hard tohandle. (answering school registers, saying hello, goodbye, thank-you,etc.)They tend to worry about things more than othersThey can be very sensitive to noise and crowdsFind it difficult to express themselvesPreliminary research from work at the Selective Mutism Anxiety Researchand Treatment Center (SMart Center) indicates that there is a proportionof children with Selective Mutism who come from bilingual/multilingualfamilies, have spent time in a foreign country, and/or have been exposedto another language during their formative language development (ages 2 –4years old.)   These children are usually innately temperamentallyinhibited but the additional stress of &#39;speaking another language&#39; andbeing insecure with their skills is enough to cause an increased anxietylevel and mutism.A small percentage of children with Selective Mutism do not seem to be theleast bit shy.  Many of these children perform and do whatever they can toget others attention and are described as &#39;professional mimes!&#39; Reasonsfor mutism in these children are not proven, but preliminary research fromthe SMart Center indicates that these children may have other reasons formutism. For example, years of living mute and therefore have ingrainedmute behavior despite their lack of social anxiety symptoms or otherdevelopmental/speech problems.   These children are literally &#39;stuck&#39; inthe nonverbal stage of communication.Studies have shown NO evidence that the cause of Selective Mutism isrelated to abuse, neglect or trauma.It is important to understand that some children with Selective Mutism maystart out with mutism in school and other social settings. Due to negativereinforcement of their mutism, misunderstandings from those around themand perhaps heightened stress within their environment, they may developmutism in all settings. These children have &#39;progressive mutism&#39; and aremute in/out of the home with all people, including parents and siblings.It is important to realize that the majority of children with SelectiveMutism are as normal and are as socially appropriate as any other childwhen in a comfortable environment.  Parents will often comment howboisterous, social, funny, inquisitive, extremely verbal, and even bossyand stubborn these children are at home!   What differentiates mostchildren with Selective Mutism is their severe behavioral inhibition andinability to speak and communicate comfortably in most social settings.It is important for parents and teachers to understand that the physicaland behavioral symptoms are due to anxiety and treatment needs to focus onhelping the child learn the coping skills to combat anxious feelings .MUTISM is just one of the many characteristics that children withSelective Mutism portray.It is common for many children with Selective Mutism  to have a blankfacial expression and never seem to smile.  Many have stiff or awkwardbody language when in a social setting and seem very uncomfortable orunhappy.    Some will turn their heads, chew or twirl their hair, avoideye contact, or withdraw into a corner or away from the group seeminglymore interested in playing alone.Children with Selective Mutism often have tremendous difficulty initiatingand may hesitate to respond even nonverbally.  This can be quitefrustrating to the child as time goes by.   The child&#39;s nonverbalcommunication may go on for many years, becoming more ingrained andreinforced unless the child is properly diagnosed and treated.  Ingrainedbehavior often manifests itself by a child &#39;looking&#39; and &#39;acting&#39; normallybut communicating nonverbally.   This particular child cannot just &#39;start&#39;speaking.  Treatment needs to center on methods to help the child&#39;unlearn&#39; the present mute behavior.TreatmentThe main goals of treatment should be to lower anxiety , increaseself-esteem and increase social confidence and communication.   Emphasisshould never be on &#39;getting a child to talk.&#39;  ALL expectations forverbalization should be removed.   With lowered anxiety, confidence, andthe use of appropriate tactics/techniques, communication will increase asthe child progresses from nonverbal to verbal communication.Children do not progress communicatively without learning coping skills.Simply lowering anxiety is NOT enough to enable the child to beginengaging socially, learning to progress to verbal communication andfeeling comfortable in an environment. SKILLS must be taught.Treatment approaches should be individualized, but the majority ofchildren are treated using a combination of:(1)     Behavioral Therapy:   Positive Reinforcement and Desensitizationtechniques are the primary behavior treatments for Selective Mutism, aswell as removing all pressure to speak.   Emphasis should be onunderstanding the child and acknowledging their anxiety.  Introducing thechild to social environments in subtle and non-threatening ways is anexcellent way to help the child feel more comfortable, i.e., Parents cantake the child into school when few people are around to get the child to&#39;practice speaking.&#39;  Eventually, bring a friend or two to school andallow the children to play when other children are not present.   Smallgroups with only a small number of children help, as well as allowingparents to spend time with the child within the class.  After the child isspeaking quite normally, the teacher, and then the students are graduallyintroduced into the group setting.   Positive reinforcement forverbalization should be introduced when, and only when, anxiety is loweredand the child feels comfortable and is obviously ready for some subtleencouragement.(2)     Play Therapy, Psychotherapy, and other psychological approaches:  These can be effective if all pressure for verbalization is removed andemphasis is on helping the child relax and open up.  Confronting mutism ina non-threatening way is important.   These children are SCARED, and thefocus should be to help them identify their level of &#39;being scared&#39; in aparticular situation.  Helping them to realize that you understand and arethere to help them relieves tremendous pressure.(3)     Cognitive Behavioral Therapy:   CBT trained therapists helpchildren modify their behavior by helping them redirect their fears andworries into positive thoughts.  CBT needs to incorporate awareness andacknowledgement of anxiety and mutism.   Most children with SelectiveMutism &#39;worry&#39; about others hearing their voice, asking them questionsabout &#39;why they do not talk&#39; and trying to force them to speak.   Thefocus should be on emphasizing the child&#39;s positive attributes, buildingconfidence in social settings, and lowering overall anxiety and worries.(4)     Medication:   - no…(5)     Self-esteem boosters:   Parents should emphasize their child&#39;spositive attributes.  For example, if your child is artistic, then by allmeans show off the artwork!   Have a special wall to display your child&#39;smasterpieces; perhaps you can even have a special exhibition!  Have them&#39;explain&#39; their artwork to family members and close friends.   Thispromotes more verbalization practice, as well as helps with confidence!(6)     Frequent socialization:   Encourage as much socialization aspossible without &#39;pushing&#39; your child.  Arrange frequent play dates withclassmates or even small group interactions with individuals the childknows well.   The goals is for your child to feel comfortable enough withthe classmates so that verbalization will occur.  Most children withSelective Mutism will talk to friends in their own home.   As the childgets increasingly comfortable speaking to one child, invite another childover, and then have two or three children at a time!  Transfer speakinginto the school via set tactics/techniques.  For some children, SocialSkill therapy is necessary and often helpful in accomplishing increasedcommunication.(7)     School involvement:   Parents need to educate teachers and schoolpersonnel about Selective Mutism!  You must be an advocate for your child.  The school needs to understand that children with Selective Mutism arenot being defiant or stubborn by not speaking, that they truly CANNOTspeak.  Explain to the teacher that a child needs to feel that it is&#39;alright&#39; for them not to speak.   Nonverbal communication is acceptablein the beginning.  As the child progresses with treatment, the teachershould be involved in the treatment plan with verbalization beingencouraged in subtle, non-threatening ways.  An Individualized EducationalPlan or 504 Plan may be necessary to help accommodate your child&#39;sinability to communicate verbally and to help the child progresscommunicatively as well as build social comfort.(8)     Family involvement and parental acceptance:   Family members mustbe involved in the entire treatment process!  Very often changes inparenting styles and expectations are necessary to accommodate the needsof the child.   Remember, never pressure or force your child to speak…thiswill only cause more anxiety.  Convey to your child that you are there forthem.   Spend one on one time, especially at night, when all pressure isoff and engage your child in discussions about their feelings.  Allowingyour child to &#39;open up&#39; helps relieve stress.   A parent&#39;s acceptance andunderstanding is crucial for the child!