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Selective Mutism Anxiety Disorder

By Susha Cheriyedath, MSc

Selective mutism is an anxiety disorder primarily affecting children. It is characterized by the inability of the child to speak in select situations, while being talkative otherwise. It was earlier called elective mutism.

Children with this disorder may find it difficult to speak in front of strangers, or at school or soccer practice, where there is a demand to speak or answer questions.

However, these children speak normally and comfortably in other situations, when they are at home or with friends. Selective mutism affects nearly 1 % of the population and it is seen more often in girls than boys.

Most of the children affected by this disorder also suffer from social anxiety and it can be very painful to the child. These children have a fear of social interactions and speaking when they are expected to speak or communicate something, especially while responding to questions. They also find it difficult to communicate non-verbally, thus affecting overall social engagement. They feel overwhelmed by simple, day to day situations when they are confronted by people.

Signs of Selective Mutism

Selective mutism does not manifest in the same manner in all children. Some children with the condition can go completely mute and not talk to anybody in a social setting, while others may speak to some people. These children sometimes use gestures such as nodding, pointing, or other facial expressions to meet their basic needs, despite talking normally in other situations.

Some children may freeze out of fear in some situations and feel socially isolated. Children who are less severely affected may socialize with select people in a relaxed way, but find it tough to communicate with teachers at school. These symptoms last well beyond the first month in school. Most children with the condition are very timid and shy, but they don’t find it difficult to learn other skills and they seem normal in other aspects of their lives. Sometimes they fail to speak when they are uncomfortable with a certain language that needs to be spoken in a certain situation.

Care should be taken during diagnosis to ensure that the signs and symptoms are not linked to any other communication disorder, such as stuttering and do not occur exclusively during the course of other disorders, such as psychotic disorder or autism spectrum disorder.

Selective Mutism in Adolescence

Selective mutism is harder to manage as kids get older. They become used to avoiding situations that demand them to speak. The longer these children miss out on key social learning opportunities, the more they are affected. Older children have difficulties in friendships and peer relationships and are prone to more anxiety disorders and even depression. Teens may resort to self-medication with drugs or alcohol to tackle anxiety and this can complicate the condition.

Selective Mutism and Traumatic Mutism

While most children with selective mutism are mute in some settings and can speak in others, those with traumatic mutism tend to become mute in all situations. This kind of mutism is usually triggered by a traumatic experience, such as witnessing the death of a loved one and should not be confused with selective mutism. Children with selective mutism have social anxiety and inhibitions and they go mute mostly in an attempt to deal with the anxiety caused by specific social encounters.

Although selective mutism may begin at school and certain social settings, it can develop into mutism in all situations due to the stress they experience or the negative reinforcement that happens when an adult tries to help them out and talks for them in such situations. This is referred to as progressive mutism and results in children being mute in all settings with all people, even at home. Selective mutism affects children’s lives significantly by interfering with their academic performance and relationships. Children with the disorder often miss out on normal childhood fun and experiences.

References

Reviewed by Jonas Wilson, Ing. Med.

Further Reading

Last Updated: Aug 19, 2016

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