Selective Mutism (SM) (formerly known as Elective Mutism), has been described as a disorder that effects children, causing them to not be able to speak in certain situations, due to severe anxiety.  It effects their communication skills in many ways.  To properly diagnose this disorder, the child must be studied for at least 30 days.  If left untreated, this disorder could possibly exist for many years.  It's a slow growing disorder, that often starts to show its presence in toddlers that suffer from separation anxiety.  The average patient is most often diagnosed when the child begins going to school and occasionally the diagnosis doesn't happen until the child's later years, due to the lack of awareness and education by pediatricians.

The effects of an episode of SM usually will last for at least 30 days, and if the situation that causes this disorder to appear is in the child's school, it can cause severe interference in their education

There have been many personality and psychological disorders associated with SM.  These vary from extreme shyness, withdrawal from society, to agoraphobia.  SM has differing degrees of severity and include both verbal and nonverbal communication.  The degree of severity changes from situation to situation.  The average child who suffers from SM does not suffer from any speech problems.  However, they may suffer from problems with articulation, receptive language disorder, or phonological disorder, these problems of communication are not the primary reason for the child's SM.

The average child with SM is seen by a collaboration of doctors, speech pathologists, psychiatrists, psychologists as well as working with their school teachers and family members.  The parents of the child are interviewed by a speech pathologist.  This is due to the fact that the child with SM most always will not talk in this situation.  Information discussed in this interview will cover such topics as:

  • the history of the symptoms and when they first started
  • the degree of severity of SM
  • if there are any other psychological disorders diagnosed in the child
  • does the child have an average development in their speech and language skills
  • is the child capable of finding the proper words they need in expressing their ideas
  • is there a family history of any psychological disorders
  • a review of the complete medical records of the child
  • a complete review of the child's school history including; results from the standardized tests, any notes in the child's record, and any report cards

The child will then be evaluated by the speech pathologist on their speech and language skills.  This is usually conducted where the child will be most comfortable, in the child's home with their family.  The speech pathologist during the evaluation, usually does the following:

  • evaluate the child's language comprehension skills, this could be a simple picture puzzle that the child is supposed to put together
  • may test a child's hearing and inner ear functions
  • may ask the child to repeat certain words to evaluate their muscle coordination as weak muscles or the lack of speech coordination may be a sign of a neurological disorder
  • will record the child's speech for comparison of other recordings that will be made in later sessions

After these interviews have been conducted, the team of doctors will meet and share the information they obtained and create what they feel will be the proper behavioral treatment for the child.  The basis for this treatment is the belief that the child suffering from SM will have an episode of Mutism if the anxiety level increases in certain social situations.

The child will receive communication reinforcement by progressively learning to use their verbal skills instead of their nonverbal skills.  This is often obtained by the use of stimulus fading.  Stimulus fading is when the child will have a simple set of goals to achieve, a gradual increase in verbal communication, and a decrease in the nonverbal communication.  The child may be asked to whisper at the beginning of their treatment, gradually getting louder until they reach their true speech level.  If the child responds well to their therapist and therapy, they may be asked to watch themselves on video where they were taped, with the therapist, and performing the desired behavior that the therapy is trying to strengthen.  They are asked to repeat this performance in hopes that it will raise their confidence level and help them in situations when the SM makes itself present.  This also helps to reduce their level of anxiety. 

If there are any underlying language or speech problems that are causing the SM episodes to be worse, the therapist will first make sure that the episode of SM is not due to the fact that the child is in fear that they may say something wrong.  Therapy may consist of activities such as, role-playing or situation reversal to help lower the child's anxiety level and increase self-confidence.

The therapist may often visit as well as work with the child's teachers to instruct them on how to lower the anxiety level for the child in the classroom setting.  Through the use of smaller groups instead of one large classroom, it has been observed that the child with SM finds it less intimidating and may not have an SM episode while in the smaller group.

Each child with SM responds differently to each treatment.  What may not work for one child may work for another.  It may take a combination of treatments depending on the individual needs.

SM is a relatively rare disorder that effects less than one percent of children that have been seen by a health professional.


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