Emphasis should never be on getting a child to talk. The .gov means its official. Organizations: GARD is not currently aware of . These children are able to speak and communicate in settings where they are comfortable, secure, and relaxed. The main goals of treatment should be to lower anxiety, increase self-esteem and increase social confidence and communication. This is caused by the freeze response. More studies are necessary to fully assess speech/language abnormalities and Selective Mutism as well as processing disorders and Selective Mutism. An adaptive response to sympathetic nervous system arousal that affects behavior including speech. If the other children talked to her, she would turn away. As social relationships are built, and a child develops one or a few friendships, he/she may interact and even whisper or speak to a few children in school or other settings but seem to be disinterested or ignore other classroom peers. Psychodynamic therapy. ago. What is the teachers role? As peers begin dating and socializing more, children with Selective Mutism may remain more aloof, isolated, and alone. Studies have shown no evidence that the cause of Selective Mutism is related to abuse, neglect or trauma. Still, among the pharmacotherapeutic options available, SSRIs are most commonly recommended for selective mutism. Selective Mutism - American Speech-Language-Hearing Association (ASHA) Careers, Unable to load your collection due to an error. Intense attachments to parents lead to extreme interdependency and distrust of the outside world. In fact, many individuals who suffer from Selective Mutism and social anxiety who do not get proper treatment to develop necessary coping skills may develop the negative ramifications of untreated anxiety (see below). Educate yourself as much as possible before seeing any professional. Children with Selective Mutism may or may not speak to the diagnosing professional. The condition lasts at least one month. You will have a much better idea what to look for if you understand Selective Mutism. Some children may stand motionless with fear as they are confronted with specific social settings. What differentiates most children with Selective Mutism is their severe behavioral inhibition and inability to speak and communicate comfortably in most social settings. Viana AG, Beidel DC, Rabian B. Children with selective mutism don't choose to be silent. Peabody picture vocabulary test-III. Elective mutism - About the Disease - Genetic and Rare Diseases Medication-based interventions. Hereditary or genetic component with a significant overlap between selective mutism and social anxiety disorder . Studies show that individuals with inhibited temperaments are more prone to anxiety than those without shy temperaments. Some children with Selective Mutism feel as though they are on stage every minute of the day! Praise the childs efforts and accomplishments, support and acknowledge the difficulties and frustrations. In the home with parents and siblings, the child tends to engage in normal conversation. Black and Uhde based this theory on data showing high incidences of selective mutism in families with social phobia. Families in theS-CAT Programare provided with structured, individualized, step-by-step treatment. Early on, a parent interview reviewing the child's comprehensive medical history, including in-depth review of prenatal and perinatal course, helps screen for neurological, speech, and language difficulties and assess trends in meeting developmental milestones. In other words, what are some of the reasons a child manifests mutism? Details such as whether the child actually does attempt to communicate nonverbally are important to assess. government site. The office setting is used to help prepare the child for the school and real world environments by developing strategies to help the child unlearn his or her conditioned behavior. Most children are diagnosed between 3 and 8 years old. sharing sensitive information, make sure youre on a federal Because it is a rare disorder, selective mutism remains challenging to study and many theories persist regarding its etiology and association with other conditions such as social phobia and social anxiety. On one hand, parental bias occurs when parents reinforce mute behavior by smiling, laughing, or speaking for the child rather than recognize the oppositional component of the behavior. The majority of children with Selective Mutism have a genetic predisposition to anxiety. Second, psychiatric symptoms should be explored through a structured diagnostic interview using tools such as the Diagnostic Interview for Children and Adolescentsparent version. For example, a 2000 study by Kristensen11 highlights the way children with selective mutism may show developmental delay as often as they show anxiety disorders (68.5% for comorbid developmental delay compared to 74.1% for comorbid anxiety). Selective mutism is a psychological condition that usually affects children characterized by continuous refusal to speak in social situations by a child who is able and willing to speak to selected persons. The spacing effect describes the process of spacing material out rather than presenting one large novel stimulus. Treatment is then developed via the whole child approach under the direction of the treatment professional, the child, parents, and school personnel working together. What are the most common characteristics of children with Selective Mutism? Strategies and interventions are developed based on where the child is on the Social Communication Bridge in a particular setting and are meant to be a desensitizing method as well as a vehicle to unlearn conditioned behavior. [12] Prevalence is low, but not as rare as once thought. Selective mutism is most common in children under age 5. Skills must be taught. Caution: When speaking to potential treating professionals, please be cautious of those who see Selective Mutism as a controlling/manipulative behavior. Sertraline treatment of 5 children diagnosed with selective mutism: a single-case research trial. Selective mutism is a rare and multidimensional childhood disorder that typically affects children entering school age. This disparity again suggests that the incongruence may be due to both parental bias and/or clinical misinterpretation of observed behavior. Researchat the Selective Mutism Anxiety Research and Treatment Center (SMart Center) indicates that there is a proportion of children with Selective Mutism who come from bilingual/multilingual families, have spent time in a foreign country, and/or have been exposed to another language during their formative language development (ages 2-4 years old). Our findings indicate that the earlier a child is treated for Selective Mutism, the quicker the response to treatment, and the better the overall prognosis. This usually means they are able to engage nonverbally with others via astute nonverbal skills (professional mimes!) Selective Mutism is a complex childhood anxiety disorder characterized by a childs inability to speak and communicate effectively in select social settings, such as school. Selective Mutism is therefore a symptom. FOIA (DSM-V-TR) (APA, 2018). The disturbance interferes with educational or occupational achievement or with social communication. (Adopted from actual testimonials from the Selective Mutism Foundation). Self modeling is one approach that involves viewing edited videotapes modeling appropriate behaviors. Parent-child enmeshment and overdependence is shown to be related to the development of selective mutism.27 An abnormal parent-child relationship establishes the incorrect notion that the child needs the parent to survive. Dr. Wong is from the Department of Pediatrics, Madigan Army Medical Center, Tacoma, Washington. Comorbidities and treatment. Selective mutism - NHS Selective mutism is a condition in which a person can speak in some situations but not in others. Authors note: The above criteria are quite vague/nonspecific and should not be used alone to rule in or rule out the diagnosis of Selective Mutism. The Heterogeneity of Selective Mutism: A Primer for a More Refined What is your opinion on medication in treating Selective Mutism and when do you consider medication? Phenelzine treatment of elective mutism: a case report. the contents by NLM or the National Institutes of Health. For some children, they appear very comfortable and mutism is the most noted symptom. Does anyone have selective mutism because of gender dysphoria? What behavior characteristics does a child with Selective Mutism portray in social settings? What Is Selective Mutism - Selective Mutism Anxiety & Related Disorders Research does not show a single cause of selective mutism. Indeed, a wide range of psychological theories and empirical data attempt to explain the etiology of selective mutism (Table 1). Lastly, the argument for why selective mutism does not belong under the social phobia classification relates to prognosis. Researchers are finding that both genetic and environmental factors contribute to the risk of developing an anxiety disorder. However, it is important to emphasize these theories are based on a small set of studies available to date. The onset of selective mutism usually occurs before the age of five. For instance, new classmates are gradually introduced into settings where the individual will likely speak. Robin_thegonk 1 min. While this association has not been validated in further studies, the 7.4-percent rate is significantly higher than the rate of Asperger's disorder in the general population (0.3%). This is likely because the average age of onset for SM is between ages 2-5, and most children recover from SM within a few years. S-CAT games and goals (based on age and where the child is on the Social Communication Bridge) are used to help develop social comfort and ultimately progress into speech via the use of ritualistic and controlled methods. In the context of selective mutism, the assumption is that the child has an oral and/or anal fixation and may be maintaining a family secret, displacing anger toward a parent, or regressing to a nonverbal stage in his or her development.2 The child's selective mutism is viewed as a coping mechanism for dealing with anger and anxiety, and represents behavior intended to punish the parents.3 With little empirical data to support this model, this explanation is currently losing validity. Before Why does a child develop Selective Mutism? It is common for many children with Selective Mutism to have a blank facial expression and never seem to smile. Specific techniques including reinforcement, stimulus fading, token procedures, shaping or prompting, contingency management, self-modeling, and response initiation provide more empirical data-substantiating efficacy.3 Treatment ideally begins with addressing the verbal and nonverbal negative reinforcement that sustains selective mutism behavior. Blum NJ, Kell RS, Starr HL, et al. Most children with selective mutism outgrow the disorder spontaneously, while individuals with social phobia do not outgrow the disorder.22. A nonverbal test, such as the Peabody Picture Vocabulary Test, Third Edition (PPVT-III), may be used to test receptive language in children with selective mutism.4,9. Bethesda, MD 20894, Web Policies Diagnostic and Statistical Manual of Mental Disorders. Emphasis will be on social interaction and developmental history, other manifestations of anxiety, behavioral characteristics (shy temperament), home life description (family stress, divorce, death, etc.) The anxiety experienced may cause a child to shut down, avoid and withdraw from a situation, or it may cause him/her to act out, have tantrums and manifest negative behaviors. Reasons for mutism in these children are not proven, but preliminary research from the SMart Center indicates that these children may have other reasons for mutism. A huge gap in the SM literature is that studies are conducted almost exclusively in children. Have you ever treated a child with Selective Mutism? Black B, Uhde TW. Given the multidimensional manifestations of selective mutism, treatment options are similarly diverse. Selective mutism is a complex childhood anxiety disorder characterized by a child's inability to speak and communicate effectively in select social settings, such as school. According to Dr. Shipon-Blums work, after a complete evaluation consisting of parent and teacher assessment forms such as the Selective Mutism Comprehensive Diagnostic Questionnaire (SM-CDQ) and the SM School Evaluation Form, and parent and child interviews, treatment needs to address three key questions: To help a child suffering in silence, an understanding of which stage the child is in during particular social encounters must be developed. This is achieved by the therapist rapidly developing rapport with the child using nonverbal play and empathetic statements. Hence, the majority of the data on selective mutism derives from case reports and small-scale populations that may not provide an accurate representation of selective mutism in the population. This technique videotapes children talking fluently in familiar contexts and then edits the video to show the child talking fluently among strangers or at school. . They may be sensitive to sounds, lights, touch, taste and smells. Is selective mutism an anxiety disorder? Cause: GARD does not currently have information about the cause of this disease. Many children with this condition have a family history of anxiety disorders, and they often begin displaying multiple signs of anxiety (such as separation anxiety, mood swings, rigid behaviours, sleep problems, and social withdrawal) at a very early age. Ingrained behavior often manifests itself by a child looking and acting normally but communicating nonverbally. Why do so few teachers, therapists and physicians understand Selective Mutism? The risk . Because our S-CAT therapy is proven and extensively researched.. Because SM and social communication issues are all we do, all day, every day. An individual's pattern of mutism can vary greatly. Under this model, the persistent refusal to speak is a symptom of anxiety.16 Hence, Black and Uhde suggest that selective mutism may belong on the spectrum of childhood speech, inhibition, and social anxiety disorders. In other words, Selective Mutism can become a difficult habit to break! Psychodynamic theory emphasizes the concept of unresolved conflict. SM is just shyness. Most have inhibited temperaments and manifest social anxiety. Selective mutism (SM) is a childhood disorder characterized by a consistent failure to speak in specific social situations (eg, school) despite speaking normally in other settings (eg, at home). Selective mutism is an anxiety disorder. Selective mutism: A review and integration of the last 15 years. It can continue into adolescence and adulthood if not managed. What is your treatment approach to Selective Mutism? Selective mutism and anxiety: A review of the current conceptualization of the disorder. Dow SP, Sonies BC, Scheib D, et al. In elementary school, it was not until third grade that Chloe spoke to her teacher for the first time after a devoted teacher did behavioral therapy exercises with her in the summer and prior to and after school. and medical history. Treatment approaches should be individualized, but the majority of children are treated using a combination of: It is important to realize that with proper diagnosis and treatment, the prognosis for overcoming Selective Mutism is excellent! An example would be a child who witnesses the death of a grandparent or other traumatic event, is unable to process the event, and becomes mute in all settings. Research at the SMart Center indicates that children who seem oppositional in nature often have parents, teachers, and/or treating professionals who have pressured them to speak for months, perhaps years. Selective Mutism and Autism: Is My Child Mute or Autistic? Selective mutism is a persistent disorder with a variable outcome (Hua and Major, 2016 ). Author: Dr. Elisa Shipon-Blum is President and Director of the Selective Mutism, Anxiety, & Related Disorders Treatment Center (SMart Center). Selective mutism is a complex childhood anxiety disorder in which the child will speak at certain times when in a comfortable secure and relaxed environment, but not necessarily in other situations (lasting for more than one month). Practical guidelines for the assessment and treatment of selective mutism. The disinhibitory adverse effects of SSRIs theoretically enhance the effectiveness in treating selective mutism, which is considered an inhibitory behavior.9,17 In a trial by Black and Uhde18 among six children with selective mutism, children actively administered fluoxetine over a period of 12 weeks showed improved ratings on mutism and anxiety although other symptoms remained unchanged.18 In a separate case report written by Black and Udhe,16 a 12-year-old girl who had never spoken at school was treated successfully with fluoxetine. Circle Pines, MN: American Guidance Services; 1997. ASHA / Public / Speech / Disorders / Selective Mutism Some children are uncomfortable speaking in unfamiliar situations or with people they don't know. If parents suspect their child has Selective Mutism, what should they do? DSI may cause a child to misinterpret environmental and social cues. Children with traumatic mutism usually develop mutism suddenly in all situations. This particular child cannot just start speaking. But in many cases, a child may not have any trouble at all . Abnormal Psych Exam 2 Flashcards | Quizlet For those children with anxious predispositions, teasing from other children ignites a pattern of avoidance and resultant mutism. Jacobsen T. Case study: Is selective mutism a manifestation of dissociative identity disorder? Dissociative identity theory. IEP or 504 Plan. The https:// ensures that you are connecting to the These advances ultimately raise awareness of selective mutism as a childhood disorder that can profoundly disrupt the lives of individuals and families. Selective mutism in adulthood. This perspective is based on the observation that many children experience neurotic relationships with their parents (most commonly the mother). This assessment assists to rule out other conditions, such as schizophrenia or mental retardation, that impede speech but exclude the diagnosis of selective mutism.3 While complex, the psychiatric evaluation may also involve evaluating shyness in the psychosocial and family history. Giddan JJ, Milling L. Comorbidity of psychiatric and communication disorders in children. Is Your Child Just Shy Or Is It Selective Mutism? On the other hand, clinicians tended to identify higher rates of speech and language disorders, less developed social skills, and increased social anxiety in selectively mute children despite unproven deficits.27. However, please note that having experience with Selective Mutism does not guarantee that the treatment approach and understanding is correct. Many theories attempt to explain the etiology of selective mutism. Her experience trying to find help for her daughter made the need for research, development of appropriate/effective treatment strategies, and dissemination of information about this social-communication disorder abundantly clear. Black B, Uhde TW. For example, Wright et al20 reported a positive response to treatment with fluoxetine in a combined treatment plan that also included family and behavioral therapy . Selective Mutism - American Speech-Language-Hearing Association The Center for Emotional Health of Greater Philadelphia and co-founder of ThinkPsych, notes that both environmental and genetic . Consistent failure to speak in specific social situations (in which there is an expectation for speaking, e.g., at school) despite speaking in other situations. Possessing multiple identities inhibits individual from talking to other people of our fear of revealing traumatic conflicts and experiences. Selective mutism is a rare childhood anxiety disorder in which a child experiences a trigger response and is unable to speak in certain situations or to certain people. Chloe's battle with this disorder is not completely over, but she has made tremendous progress. The relationship of self-efficacy and depression to stuttering. Undoubtedly, future research is needed to elucidate the biological and psychological components of selective mutism. Etiological perspectives are based in psychodynamic theory, behavioral theory, associations with social phobia and social anxiety, the family systems perspective, dissociative identity disorder, and the response to trauma. Dr. Shipon-Blum emphasizes that although anxiety lowering is key, it is often not enough, especially as children age. Posttraumatic stress disorder (PTSD) with dissociative features has also been associated as a potential precursor of selective mutism.29,31 Although it is an uncommon explanation for selective mutism, several cases of children who experienced severe abuse and trauma fit the classification of selective mutism. Selective mutism - PubMed In: Ballendger JC, editor. What is the difference between Selective Mutism and traumatic mutism? Children who are selectively mute may not speak in certain social situations; this may be at school, nursery or other community settings. Further, deeper investigation into possible trauma and neurological injuries should also be considered in evaluating potential language and social impediments. Selective mutism is an anxiety disorder characterized by an inability to speak or communicate in certain social settings, such as at school, work, or in the community. Is Selective Mutism A Rare Genetic Anxiety Disorder. Selective mutism is associated with a number of comorbid disorders that complicate the child's clinical presentation. Selective mutism occurs between ages three and six but social phobia typically manifests between ages 11 and 13. Segments of questions and answer sessions were modified to play the child talking in contexts and situations where the child was previously mute. . They usually start talking when they feel more comfortable. This perspective is significant because it frames selective mutism as a symptom of anxiety rather than consciously manipulative behavior.24.