About Selective Mutism - Profiles of Silence

Introduction

Those that have worked with selectively mute children have encountered wide variations in their social actions. Some children enjoy contact with others and will play easily, but remain silent. Some have a close friend who often speaks for them by interpreting gestures. Others find all aspects of social situations uncomfortable and do not participate at all. Whatever form the condition takes, it can persist. There are children in the 2nd, 3rd, and 4th grades who have never spoken in school. There are students in high school who have not uttered any or no more than a few words in a school setting. As you can imagine, the condition can have dramatically negative effects on social functioning.

What is Selective Mutism?

Selective mutism refers to selective silence in a child who speaks freely in very familiar situations. Children who demonstrate this condition appear comfortable and talkative with close family members. However, whenever people other than the closest family members are present, the child is quiet and shy. Some children avoid eye contact and do not communicate in any form with others. They refrain from the use of gestures or changes in facial expression.

Selective Mutism is defined by:

1) a persistent failure to speak in special social situations despite speaking in other situations
2) lack of speech which interferes with educational or occupational success
3) silence is of at least one month's duration after the beginning of the school year
4) failure to speak not due to lack of knowledge of language used in the situation
5) the disturbance is not solely accounted for by a Communication Disorder, Psychotic Disorder, or a Pervasive Developmental Disorder.

How prevalent is selective mutism?

Selective mutism occurs in a small number of children, probably less than 1% of children in the elementary school settings. It is not known how often children demonstrate the problem during the pre-school years. Prevalence may be higher in the pre-school years because many more children are attending preschool programs than in the past. Children who have developmental language or articulation problems and children whose first language is not English are more likely to be selectively mute. In both circumstances, children may be quiet because of concerns about accents and limited fluency.

How does selective mutism develop?

Research shows that most children with selective mutism were anxious in social situations from an early age. Contrary to many popular ideas, most selectively mute children have not experienced trauma. Rather their history often includes a toddler period of appropriate language development at home, but clingy, dependent behavior in the presence of unfamiliar or infrequently encountered people. Some children have shown mild forms of separation anxiety, although overt refusal to attend school is not usual. For children for whom English is a second language, case studies usually indicate that the children were not comfortable speaking with people in their first language either.

At this time, researchers believe that most selective mutism is a form of social phobia: that is, an anxiety disorder that reflects inhibited social actionts for fear of embarrassment or concerns that others will judge them negatively. Some children have reported that their throats clog up when looking at others as if their vocal chords will not permit them to speak. It is probable that children with the condition have inhibited dispositions as part of their personality characteristics. Extensive studies by Dr. Jerome Kagan and his colleagues have found that about 5% of children react to novel situations with high levels of uncomfortable arousal and a tendency to withdraw. This pattern is observed as early as infancy and can persist into the school-age years. Anxiety disorders often develop in such inhibited children because they have not learned to quiet their reactions or they have not learned to cope with their fears. It is believed that children who demonstrate selective mutism are a subset of inhibited children who have not learned to quiet their nervous reactions in social situations. Well-intentioned family members who are aware of a child's anxiety probably supported their limited use of speech by talking for them. Initially, this is not a problem, but, as the condition persists, support has probably become overly protective. By the time the condition is diagnosed, children have learned to communicate nonverbally for several years so that their patterns are usually well developed. Often, when the children are pushed, even mildly to speak for themselves, they may have overt outbursts and oppositional behavior. In summary, most professionals believe that selective mutism results from a negative interaction of a child's disposition with family reactions that inadvertently support withdrawal and lack of communication.