Selective Mutism (also known as SM) is a term used when children who are able to talk comfortably to some people, usually family members and close friends, are silent or unable to talk to other people.
Selective Mutism is considered a type of anxiety disorder and is not a ‘choice’ made by the child.
The age of onset for Selective Mutism is between 3 and 5 years of age, which is typically when children begin playgroup, nursery, or school and the problem becomes apparent. Children can be considered as having Selective Mutism if they have not spoken in specific situations to certain people for over a month, however this does not include the first month of school/nursery as it can take time for them to settle in to a new environment.
Low vs High-Profile Selective Mutism
Not all children with Selective Mutism are completely silent; some children have what is known as ‘low-profile SM’, which means they will speak when prompted but will struggle to start conversations. Children with high-profile Selective Mutism are easier to recognise because they do not speak at all to certain people.
Facts about Selective Mutism:
- Selective Mutism is more common than previously thought. It affects 1 in 140 children, which is one or more children in most primary and secondary schools.
- Selective Mutism is not caused by trauma or abuse: children who have SM are no more likely to have been abused than any other child.
- SM affects children of a sensitive disposition, and are likely to have other family members who are shy or anxious, and have difficulties with social relationships.
- Children who are bilingual or come from migrant backgrounds are more likely to have SM.
- Girls are slightly more affected by SM than boys.
- Selective Mutism can persist into adulthood, and possibly worsen, if left untreated.
- Children who have SM are also likely to have other difficulties, including developmental delay, social anxiety, and speech and language impairments.
- Each child with SM will have a different pattern of when they do and don’t speak, but each pattern will be predictable, for example:
- They might talk to immediate family at home, but not speak to any extended family.
- They might not speak to their family when outside the home, or where they might be overheard by others.
- They might not talk at all in their classroom or in the dinner hall.
- They might speak to specific friends on the playground.
How can a Speech and Language Therapist help?
Speech and Language Therapists are often one of the key professionals involved in assessing and treating a child with Selective Mutism, however the treatment process will always involve working as a team with family members and school/nursery staff.
Initially, an assessment of the child and their environments would be carried out before any intervention takes place. Intervention for children with Selective Mutism includes:
- A behavioural programme which aims to reduce the child’s anxiety and phobia around speaking.
- This is a ‘small steps’ programme which helps the child progress a pace comfortable for them, with achievable targets often chosen by the child themselves.
- Treatment always includes the parents and school staff, with frequent review meetings and joint target setting as ongoing support is essential.
Early identification is essential for ensuring that steps are taken before the child’s anxieties become firmly established.
How can parents help?
- By openly acknowledging the child’s difficulties in an accepting and relaxed atmosphere. Speaking with the child about their SM is important and making sure they know that it will get easier with time.
- The child should not be labelled as ‘silent’ or ‘non-speaking’ in front of other people or punished for remaining silent, as this will only increase anxiety.
- Encouraging general participation in social activities, with no pressure to communicate verbally.
- Non-verbal communication attempts by the child, such as gesture and writing service, should be warmly accepted.
- Encourage conversation at home about school activities, family events, thoughts and feelings, in order to develop verbal skills and confidence in self-expression. Humour, jokes and laughter can teach the child that speaking is fun!
- Adults and others should avoid answering or speaking for the child.
- Parents should explain to other adults or family members about Selective Mutism so they don’t feel offended or accidentally increase the child’s anxiety.
- Home visits by nursery/school staff may help reduce the child’s anxiety about speaking to them in the nursery/school setting.
Important things to remember about Selective Mutism:
- Children with SM do not choose to be silent, they have a fear of speaking in certain situations.
- Children with SM are not shy, and are often described as very chatty with those they feel comfortable speaking to.
- Without the right help and support, children with SM can worsen overtime and their difficulties can persist into adulthood.
Check out these useful links for more information on Selective Mutism:
- Channel 4 documentary – Help Me to Speak
- BBC Documentary – My Child Won’t Speak
- TED Talk – Understanding Selective Mutism by Candice Powell-Caldwell (mother of a child with SM)
- SMIRA – UK registered charity for Selective Mutism: http://www.selectivemutism.org.uk/
- NHS Choices page on Selective Mutism: http://www.nhs.uk/conditions/selective-mutism/Pages/Introduction.aspx
- Selective Mutism Foundation: https://www.selectivemutismfoundation.org/
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