Does your child talk at home or with friends but refuse to talk at school? A child with selective mutism (MS) will talk at some times and in some places, but not in others. This might start when your child goes to school. Sometimes, it starts when a child is younger. According to the Child Mind Institute, Children with selective mutism (SM) are talkative at home but unable to speak in more public settings, including school.
What is Selective Mutism?
When children are unable to speak around certain people or in certain settings, they may have an anxiety disorder called selective mutism (SM). It is common for kids with SM to be very chatty at home with family but silent at school. Parents typically start noticing signs of SM when a child is three or four years old. The disorder might not be diagnosed until the child is school-aged when the problems with speaking become more apparent. A child with SM might go a whole year or more in a classroom without speaking once to her teachers, counselors, or peers. Typically, kids with SM are mild-mannered and polite in classroom settings, so their silence can be misinterpreted as shyness and never addressed as a possible barrier to their learning. Additionally, pediatricians may tell parents that the “shyness” will pass and discourage families from seeking treatment. Selective mutism can cause significant impairment in a child’s life. It can interfere with kids’ performance at school, both academically and socially. It can prevent kids from asking for help if they need it, like telling the teacher they need to use the bathroom. Furthermore, it can prevent kids from engaging in many fun activities that require verbal communication, including play dates. The good news is that with the right help, kids with SM can get better.
Signs of Selective Mutism
If your child has selective mutism, you may notice that:
- They will not speak at times when they should, like in school. This will happen all of the time in that situation. Your child will talk at other times and in other places.
- Not speaking gets in the way of school, work, or friendships.
- This behavior lasts for at least 1 month. This does not include the first month of school because children may be shy and not talk right away.
- Your child can speak the language needed at that time. A child who does not know the language being used may not talk. This is not selective mutism.
- Your child does not have a speech or language problem that might cause them to stop talking.
Dispelling the Myths
Selective mutism is relatively rare, so people, even pediatricians or other specialists, might not immediately recognize it, or might mistake it for autism or a communication disorder. People may also mistakenly think that a child isn’t talking because he/she is being willful or oppositional. In reality, children with SM are extremely anxious and can’t talk, even when they want to. In other words, a child with SM is unable to speak, not refusing to speak. There’s also a misconception that kids who can’t speak in some settings have been traumatized. In fact, kids who become mute after a traumatic experience are typically mute in all situations, not specific social environments, as is the case with SM. Finally, it’s not unusual for relatives to think a child with SM is “just being shy,” and will “grow out of it.” But these kids are much more than shy — they’re frozen with anxiety. The longer a child doesn’t speak in certain settings, the more she/he will miss out on, and the harder it will be to treat the problem.
Treatment for Selective Mutism
The good news is that selective mutism (SM) is very treatable with the right care. Kids with SM respond best to behavioral therapy that is focused on helping them learn to speak in new settings, during new activities, and with new people. If you are concerned that your child might have SM, you should get a comprehensive evaluation that establishes a diagnosis. The evaluation should specifically examine the circumstances in which your child is verbal and non-verbal, and if she/he might have any co-occurring conditions (like other anxiety disorders). An evaluation will also rule out other diagnoses, such as a communication or language disorder, which could also be causing restricted speech. Children with SM should never be pushed to speak. The pace of treatment should be gradual, and children shouldn’t be asked to do something that is too difficult for them. Instead, treatment should follow specialized behavior therapy techniques that prompt speech and then reinforce successful speaking experiences with lots of labeled praise and small incentives. This careful progression helps children gain confidence and prepares them for experiences that get progressively more challenging.
Tips for Helping Kids Talk
- Wait 5 seconds: We often don’t give kids enough time to respond. Waiting 5 seconds without repeating the question or letting anyone answer for a child is a good rule of thumb. It also helps kids learn to tolerate their anxiety.
- Use labeled praise: Instead of just saying “Great job!” be specific… “Great job telling us you want to juice!” This way kids know exactly what they are being praised for, and they feel motivated to keep going.
- Rephrase your question: Instead of asking questions that can be answered with “yes” or “no” – or, more often, nodding or shaking his/her head – ask a question that is more likely to prompt a verbal response. Try giving the child choices (“Would you like a puppy sticker or a star sticker?”) or asking more open-ended questions (“What should we play next?”)
- Practice echoing: Repeat or paraphrase what the child is saying. This is reinforcing and lets her/him know that he/she’s been heard and understood. For kids who speak very quietly, repeating what they say also helps them participate in bigger groups.
- Be a sportscaster: Do a play-by-play recap of what the child is doing: “You’re drawing a flower” or “I see you’re pointing to the picture in the book.” This helps convey interest in what the child is doing and is a good technique to fall back on when he/she is being nonverbal.
This article is provided by Dr. Ralph Kueche (Child Psychologist). Dr. Kuechle is a Child and Adolescent Clinical Psychologist who specializes in treating children and their families who may be struggling with mood and behavioral issues. Learn more about Dr. Kuechle.