Some children may simply be shy and not like to talk to others. They might talk when they are in a comfortable situation or with people they know. Yet some children will not talk at all. Parents may be worried that these are selective mutism symptoms. How are parents to know and distinguish selective mutism from other disorders? Help is available.
We see children's personalities emerge as they get older and become more social. Some kids (like adults) are more extroverted and talkative, while others are quiet and reserved.
Yet some children may be too shy to talk in certain situations.
Selective mutism is a disorder in which a child feels comfortable speaking with some people in particular situations but not with others. For example, a child may talk frequently at home or with friends, but they appear to lose their capacity to communicate once they get to school. This is one of the common selective mutism symptoms.
When parents observe this behavior, it is possible that the child is showing selective mutism symptoms. This is not caused by shyness. To answer some questions about selective mutism symptoms, what to do and how speech therapy can help, speech-language pathologists have written this guide.
Selective Mutism Symptoms
Selective mutism is classified as an anxiety disorder rather than a communication problem. Many children with selective mutism, as well as other anxiety disorders, are genetically susceptible to it.
Children are often diagnosed with selective mutism around the ages of 3-5 when they enter daycare or start school and the behavior becomes a problem.
Signs of Selective Mutism
Children with selective mutism may show the following signs and symptoms:
- The child does not speak when they should (e.g., in school). In this specific situation, the child will not speak; they will talk in other places (e.g., at home)
- School, work or socializing is impacted by not talking
- The non-talking behavior lasts for longer than 1 month (children are often shy when school first starts for the year, so this is not often counted)
- The child knows the language needed for the situation (so this is not a case where the child is learning a second language)
- The child has no known or diagnosed speech or language disorder
What Causes Selective Mutism?
- Selective mutism is caused by a variety of factors such as:
- An anxiety disorder
- Poor family relationships
- Psychological issues that were not addressed
- Self-esteem issues
- Problems with sound processing
- A speech or language problem, such as stuttering
- Family history of anxiety disorders or selective mutism
- A traumatic experience
Selective mutism might also co-occur with other delays and language problems, and about 10% of children with the disorder seem to have a language, learning, or speech articulation problem needing additional speech therapy. Selective mutism is defined in the DSM-V as a psychiatric disorder. Yet psychologists and speech therapists can work together to help the child start to talk.
How Can Parents Tell the Difference Between Selective Mutism Symptoms and Other Disorders
Parents often confuse selective mutism with other types of language disorders.Here are some differences between expressive language delay or social communication disorders and selective mutism.
- Language Delay/Disorder: The child does not have the language skills (vocabulary, grammar) and may even be a late talker that is not reaching their milestones. They will not selectively use language in one situation or another.
- Social Communication Disorder: The child has difficulty knowing when to use the language they already know. They have issues with interacting with others and reading social cues (e.g., when to start/stop a conversation). A child with a social communication disorder might speak in all situations but not appropriately.
If a child has selective mutism, they are not intentionally choosing to be silent. This is a diagnosable disorder, not a choice, so selective mutism symptoms should not be ignored.
How is a Speech Therapist Involved in Diagnosis?
Parents that are worried about how and when their child speaks should speak to a doctor first. A psychologist or psychiatrist should also be consulted to determine whether there is an anxiety disorder. The child's speech and language skills can be evaluated by a speech language pathologist (SLP).
Speech and language evaluations might include:
- Speaking with parents about a child’s developmental, medical and family history
- Recommendations for a hearing screening
- Observing how your child uses their lips, jaw, and tongue for speech
- Testing receptive and expressive language skills
- Listening to the child use language (parents might need to provide a video recording from home for this observation as the child might not want to communicate with the speech pathologist)
How Can Speech Therapy Help with Selective Mutism?
A doctor might prescribe medication for anxiety, which has proven to be effective in some cases. Speech therapy would address having your child feel comfortable speaking in a variety of contexts. When a child refuses to speak, they may need to concentrate on changing their communication behavior. If a child has any other speech or language issues that are not associated with selective mutism, those would be addressed separately.
As discussed by the American Speech-Language Hearing Association, to help change a child’s behaviors, the speech therapist might:
- Use Stimulus Fading: Help the child start talking to one person first and then slowly add other people and other situations. New communication partners and situations would be added very slowly so that the child feels comfortable.
- Shaping: The speech therapist would reward the child for attempting to communicate in any way. This can be with sounds, gestures, moving their mouth, and even making noise with an object. The ultimate goal would be speech.
- Self-Modeling Strategie: The child can watch themselves talking in a comfortable situation, like at home, on video. This can increase their comfort level by expanding who and where they talk.
- Recommendations for Family/Teachers: Parents and caregivers might inadvertently put pressure on the child to speak when they are not ready which can make the situation worse by increasing anxiety. The speech therapist can provide concrete recommendations to people in the child’s life to decrease pressure and therefore increase the chances the child will start talking.
What Can Parents Do if they Think Their Child Has Selective Mutism?
Since selective mutism falls under a diagnosable anxiety disorder, parents should first get the advice of a psychiatrist or psychologist. A speech therapist would help with holistic family and behavioral therapy. Following are some techniques that parents can start to use at home.
- Decrease eye contact when the child does not speak; this can decrease pressure to talk which is at the heart of the issue and may overwhelm the child
- If parents ask the child a question and they don’t answer, continue talking and even model a response; continue to initiate conversation
- If the child alway speaks to one conversation partner over a particular task in a specific situation, try changing only 1 thing. For example, if the child always talks about puzzles in their bedroom with their grandparent, try moving the same activity to another private room; if the child does not want to talk, do not increase the pressure on them
- Give your child praise if they communicate in any way that is outside of typical for them. If they wave to someone outside and never have before, give verbal praise and a high five. Like all of us, they are doing their best
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This information is educational and does not replace an individualized evaluation by a qualified professional.