About Selective Mutism

Selective mutism is an anxiety disorder characterized by the persistent lack of speech in at least one social situation (e.g., school, extra curricular activities, grandma’s house, doctor’s office, etc.), despite the ability to speak perfectly well in other situations (e.g., home). Children with selective mutism are often described as being quite chatty and verbal at home or with comfortable speaking partners.  Onset of selective mutism typically occurs before a child is 5 years-old and is usually first noticed when the child enters school.  Children with selective mutism often have first degree relatives (siblings, parents) with selective mutism and/or social anxiety.  

I first learned of selective mutism in 1999 while working in the public school system.  At that time, I found it both heartbreaking and maddening that a child could make it to his senior year in high school without proper treatment for this debilitating condition.  As a result, I have made children with selective mutism a focus of my psychology practice and my training experience.  

I have since learned a great deal about this disorder and about the unmet need for best practice treatment in this area.  In addition to completing advanced training through the Selective Mutism Group’s Selective Mutism Proficiency Program, I have spent years researching and treating children with this disorder, learning from each child as I go.  Although I have successfully treated many children with selective mutism, each child presents a unique challenge, and I find that in order to provide the best care, I must continually work to improve my skills and abilities through training and practice.  

Myths About Selective Mutism

• Selective mutism is rare
  • Actually…
    • between 1 to 2 percent of children have this disorder. 
• Children outgrow it, so we should just wait it out
  • Actually….
    • The longer the behavior persists, the harder it can be to overcome.
    • These children are in pain.  Children who have selective mutism often describe it as quite painful and frustrating, and those who have overcome it have talked about “lost years” in which they were “trapped in silence.” 
    • Although some children outgrow this disorder, some do not, and in the interim, they suffer socially, academically, and emotionally.
    • Years of opportunities for social growth and learning are often lost.

• They are controlling, strong-willed, or stubborn.  They could talk if they wanted to (because they talk to so and so…)
  • Actually…
    • Children often describe it as feeling as though their words are stuck in their throat or that their words just disappear when they encounter a speech demand.
    • For these children, certain individuals and settings become “contaminated,” making it very difficult for a child to communicate in that setting or with that person, despite the child’s strong desire to do do. 
    • These children are anxious and therefore may be rigid in many areas of their lives; however, this does not mean that they are maliciously attempting to control their environment by not speaking.
• It is caused by a traumatic experience, abuse, neglectful parenting, permissive parents, or helicopter parents.
  • Actually…
    • Selective mutism presents very differently from post-traumatic mutism, with post-traumatic mutism generally occurring across all settings with sudden onset and sudden remittance, appearing after a trauma and after typical speech development and socialization have already been established.
    • Selective mutism has a significant genetic component, with siblings and parents often sharing symptoms of the disorder.
    • It is our natural instinct to rescue when we see someone in distress, and when we see a child struggling with talking, we all do this; thus, almost everyone the child encounters inadvertently reinforces the child’s silent behavior by rescuing them in some fashion.
    • Pro-active parents play a vital role in the treatment of this disorder; however, those who have taken a “wait-and-see” approach typically have done so on the advice of a well-meaning clinician or educator who is simply not knowledgeable in selective mutism best practice.

Ineffective Interventions

• Forcing/demanding speech when the child is not ready
• Embarrassing the child
• Traditional play therapy (typically only reinforces the silence)
• A “wait and see” approach
• Punishment
• Demanding verbal manners: please, thanks you, hello, good-bye (hardest thing!)
• Individual therapy without school/community support (it cannot work in a vacuum)

What does work?

• cognitive Behavioral Therapy (with a “little c and a BIG B”):
  • Working with the child on incremental behavioral goals, while providing structure and support, including anxiety reduction techniques, thinking strategies, and parenting/teaching strategies to help the child open up and move into his or her verbal/social world

AND

• Community/school-based interventions (focused on successful completion of INCREMENTAL GOALS in the target setting and with the speech partners with whom the child is having trouble speaking)
• Medication may be helpful when the behaviors are long-standing, not responsive to treatment, or complicated by other disorders

Please contact me if you have questions or wish to seek treatment for your child.

 

Jacqueline Hood, Ph.D.
Licensed Psychologist 

Serving Plano, North Dallas, Richardson, Frisco, McKinney, and Murphy.

2801 Regal Rd., Plano, Texas

By Appointment Only

972-827-7921