Fear of Talking (Selective Mutism)

What is selective mutism?

Selective mutism is disorder where your child does not speak in public even though he can speak and understand spoken language. It used to be called elective mutism.

The disorder occurs in about 1 in every 1,000 children. It is more common in girls than boys.

What is the cause?

The cause of selective mutism is not known. It tends to run in families. A child is more likely to have this disorder if other family members have had problems with selective mutism, social anxiety, or other anxiety disorders. It is not caused by abuse or trauma.

Children with this disorder do not choose to be silent. They are afraid. Most children with selective mutism also have social phobia or social anxiety. Social phobia is an anxiety disorder in which children fear situations where they might say or do something embarrassing. Just thinking about group activities or speaking in front of the class makes the child very anxious.

What are the symptoms?

You may notice your child is very shy when she enters school and seems unable to talk to other children.

Many parents are confused by this behavior because their child is often very outgoing at home. Some children will talk easily on the phone to people, but cannot talk to them face-to-face.

Your child may have selective mutism if:

• Your child does not speak in social situations where talking is expected (such as school, play groups), but can talk at home to family members.
• The problem starts to cause problems at school and with social development.
• The problem lasts longer than a month.
• Your child has no other problems with language, such as understanding language or stuttering.
• Your child often seems shy, afraid, or anxious.

How is it diagnosed?

Your healthcare provider or therapist will ask about your child's symptoms and any drug or alcohol use. Your child may have some lab tests to rule out medical problems.

You may want to contact a mental health therapist who specializes in working with children and teens. The therapist will ask questions, observe the child, and may give some special tests. Parents and teachers will also be asked about the child's behavior. It is important to get a very thorough medical, social, and psychological history from the child and family. The mental health specialist will assess:

• how severe the child's symptoms are
• how much they interfere with the child's daily activities
• if the anxiety seems appropriate for the child's age.

How is it treated?

Children do not just grow out of this disorder. Treatment at an early age is important. It helps if the child and parents learn about the disorder.

The main goal with treatment is to lower anxiety and to increase self-esteem and confidence in social settings. Cognitive behavior therapy (CBT) helps children learn what causes them to feel anxious and how to control it. CBT might also include social skills training, role-playing, and learning relaxation skills. A speech language pathologist (SLP) may be helpful. Medicine may be used along with behavioral therapy to help with anxiety. Medicine should be prescribed by a child psychiatrist familiar with this disorder.

How can I help my child?

• Let your child watch you talking in a relaxed way in a lot of different situations such as in the neighborhood with friends, at school events, and while ordering at restaurants.
• Always reinforce any attempt your child makes to speak in a public place by gently patting his or her shoulder or providing verbal praise in a soft voice.
• Don't force your child to talk or ridicule your child for not speaking. This does not work and often makes the child more anxious.
• Don't talk about your child's problem to relatives or friends when the child is present. This may make the child more anxious.
• Let children talk to you about the scary feelings. Your support and understanding can help children deal with their fears.
• Help your child to speak where she is comfortable. Usually that means in small groups of people that your child knows. If your child is more comfortable at home, it may be helpful to invite friends over often to give your child more chances to talk with others.
• Many children who are shy start to speak in new places after they have become familiar with the teacher, new children, or the place. If this does not happen and the shyness starts to affect your child's progress in school and socially, it is time to seek help.

For more information, see the Selective Mutism Foundation Web site at http://www.selectivemutismfoundation.org