Selective Mutism

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Selective Mutism

Introduction

Selective mutism is a behaviour associated with social anxiety. The individual has the ability to speak but is unable to due to extreme anxiety. The condition can be described as a type of phobia with sufferers experiencing the same feelings of panic and anxiety as other people with severe phobias. The phobia is generally about speaking in front of strangers, people in authority, peers and extended family. Selective mutes will usually speak at home with close family members but will not when unfamiliar people are there or when they are away from home. Attempts to force selective mutes to speak only increase the anxiety associated with speaking and reinforce the phobia. Selective mutism is generally a temporary developmental condition and over time most will develop functional communication skills. Support with managing the social anxiety aspects of the condition will determine how confident they emerge in their communication as adults.


Diagnosis

Selective mutism is most often diagnosed by a speech and language therapist who will have accessed the child's language ability and their speech production. Sometimes it may be diagnosed by other professionals such as an educational pyschologist. Information will be gathered from the parents about the child's talking in a variety of settings. Children with selective mutism are usually less anxious at home with their immediate family and will often speak in that setting. It may therefore only be after their child starts pre-school that parents become aware of a difficulty. Selective mutism is categorised as an anxiety disorder and can be diagnosed when symptoms have been present for at least one month and the child has been attending their school or pre-school setting for over a month.



Frequency

Selective mutism occurs in about 1% of the population. It is more prevalent in girls than boys.


Causes

No specific cause has been identified. Like many developmental conditions there are a multitude of factors that carry an increased risk for selective mutism. These include:

It is believed that selective mutism occurs because an area of the brain called the amygdala, which assesses potential danger, has a lower than average threshold for excitability and therefore is triggered by social events such as parties, social gatherings, unfamiliar people, unfamiliar situations and school.



Difficulties Associated With Selective Mutism

Selective mutism is a spectrum condition with some mutes not speaking in almost all contexts and others speaking in all but a few situations. Clearly, the nature of support required will depend on the extent of the child's needs.

Common characteristics:


Support

It is really important that staff in the school or pre-school setting create a structured plan to meet the needs of the selective mute child. This should be focussed primarily on reducing anxiety and ensuring that staff neither reward or punish the child's lack of talking. Providing some alternatives to speaking can be helpful but the focus needs to be on creating safe situations in which the child will feel secure enough to speak. Any plan needs to be individual to the child's age and needs. Further advice and strategies on the Selective Mutism Management page.


Resources

Five Minute Guide to Selective Mutism

PDF icon

This guide designed for parents and staff can be printed on A4 paper and folded to make a handy A5 leaflet.

You may also be interested in the following pages:

Selective Mutism Strategies

Social Anxiety Disorder


Sources

Johnson, M. & Glassberg, A. (1997) Breaking Down The Barriers. Canterbury and Thanet Speech and Language Therapy Department
McMinn, J. (2004) Supporting Children with Speech and Language Impairment and Associated Difficulties. Birmingham: The Questions Publishing Company
NHS Choices (2015) Selective Mutism Available at www.nhs.uk/conditions/selective-mutism/Pages/Introduction.aspx (Accessed 01.04.15)
Shipon-Blum, E. (2015) What is selective mutism? Available at www.selectivemutismcenter.org/whatisselectivemutism (Accessed 06.05.15)
Smith, B. et al (2014) Tackling Selective Mutism. London: Jessica Kingsley Publishers