Is My Child Quiet or Could it Be a Disorder? (page 2)
One of the most reliable findings in the study of people is that they have varying dispositions. We differ in our energy levels, interests, and in the amount of social interaction that we like. Children too are different from one another. Studies find that even young infants react to situations in a variety of ways. Some have high levels of curiosity and attend to sights and sounds with great relish. Others are calm and quiet and are pleased when others approach them, but do not make many sounds to attract attention. Still others have a high level of activity and can be overly reactive to sights and sounds. The variations in disposition that people, including infants and children, show include a range of interest in and responses to social interaction with others. The level of a person’s social interest and comfort can be fairly stable over time and may be a source of concern for parents.
Some infants and children have an inhibited disposition that includes a hesitancy to respond to novel situations, including new social situations. As infants, inhibited children often pull back from toys, people, and situations that they have not encountered before. They may observe from a distance and show real distress if approached too quickly. The physical reactions of these children show increased heart rates and changes in their brain activity that suggest that they perceive new situations as potentially dangerous. Yet, given time to observe the situations, these infants usually warm up and get involved in typical ways. Studies have found that about 8% of young children have an inhibited reaction to novelty. Long-term studies of these children find that many of them continue to be inhibited as they grow older and they are prone to experience anxiety in new settings and in social interactions.
When children are anxious about social interaction, they withdraw from contact or engage in contact with other children or adults only after a very long warm-up period. They may refrain from joining other children at parties, on the playground, or in school settings. At times, they will not speak with adults outside of their family and cling to parents when approached. Selective mutism is a specific form of social anxiety in which children speak very openly at home with family members, but they are not able to comfortably talk in other settings with other people. Parents may notice this in restaurants or stores or when children are introduced to a new adult or child or, in some cases, a family relative that is not highly familiar to the child. At times, parents learn about the problem from school staff when the child enters preschool or Kindergarten. Sometimes, parents are surprised and doubtful about the reports because their child is just like other children when parents are around and show no hesitation to talk or play. This form of social anxiety is seen in about 1% of children and is usually noticed in preschool or Kindergarten. The typical course for a child with selective mutism is not clear. However, it does not seem to be temporary for many children. Teens and adults who have had the condition report that it takes years to overcome. Our experience has been that most cases do not resolve for a long time.
The impact of selective mutism and social anxiety
There are a variety of presentations of the problem. 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 can parents do?
First, think carefully about your concerns. If your child slowly warms up in new situations and talks quietly and plays with others after getting to know them, do not be too alarmed. Many children establish good friendships and are socially satisfied even though they are not the most talkative in the group. However, recognize social anxiety for what it is. If your child is very withdrawn, but is very different with familiar people consider whether or not the social withdrawal is hindering adjustment. Also, consider whether or not your child can speak when he/she wants to and whether your child can take care of her needs by speaking to adults or other children. A child that longingly looks to play or plays with others, but does not speak is probably bound up with anxiety. Do not assume that these children will grow out of the problem. Also, consider teacher reports very carefully. Your home chatterbox may be quite quiet away from home, and teachers are the first to notice.
Second, encourage your child to get involved in social interactions. Do not protect your child by keeping him isolated from others. Let him see that social interaction can be fun and rewarding.
Third, do not throw your child into social situations without some support. When your child is getting ready for social situations, let her sit on the side while she observes the others and gets to know what they are doing. Then, gradually nudge her to participate while reassuring her that you will be available if there are major problems. Expect your child to try out some contacts and do not let her leave until an attempt has been made.
Fourth, be careful in describing your child. Do not state to others that your child is “shy” when they approach him and he does not respond. This only gives your child an idea that the situation is permanent and part of his character. You can indicate that he will talk as he gets comfortable.
Fifth, consistently encourage your child to respond to others with some form of communication. Accept gestures and nodding of the head. If a response is not essential, do not speak for your child. It is harmful for children to learn that their parents will take care of their communication needs. So, if your child is asked what flavor ice cream she wants, do not give the answer. Do not be harsh, but you can take your child off to the side and expect her to talk to you and give you the answer. You can build on this form of responding in the future, so that your child talks to you in the presence of others. Your child will be disappointed, but without being punitive, you can let him see that overcoming anxiety about talking will be beneficial.
Finally, if selective talking is limiting your child, seek help. There are several forms of treatment that show promise in helping children gain control over anxiety and enhance their social adjustment. Forms of behavior therapy are assisting children and medication treatments are effective many times. A combination approach using behavior therapy and medication may be the most useful.
• The Selective Mutism Foundation, Inc.- www.selectivemutismfoundation.org
• The Selective Mutism Group - www.selectivemutism.org
• Freeing Your Child From Anxiety. By Tamar Chansky.
• The Anxiety Cure for Children: A Guide for Parents. By Elizabeth DuPont, Robert DuPont, and Caroline DuPont.
Written and developed by Richard Gallagher, Ph.D. and the staff of the NYU Child Study Center.
About the NYU child study center
The NYU Child Study Center is dedicated to the research, prevention and treatment of child and adolescent mental health problems. The Center offers evaluation and treatment for children and teenagers with anxiety, depression, learning or attention difficulties, neuropsychiatric problems, and trauma and stress related symptoms.
We offer a limited number of clinical studies at no cost for specific disorders and age groups. To see if your child would be appropriate for one of these studies, please call (212) 263-8916.
The NYU Child Study Center also offers workshops and lectures for parents, educators and mental health professionals on a variety of mental health and parenting topics. The Family Education Series consists of 13 informative workshops focused on child behavioral and attentional difficulties. To learn more or to request a speaker, please call (212) 263-8861. For further information, guidelines and practical suggestions on child mental health and parenting issues, please visit the NYU Child Study Center’s website, AboutOurKids.org.
Reprinted with the permission of the NYU Child Study Center. © NYU Child Study Center.
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