Quite a lot of us can get nervous and a little bit jittery when we encounter a new social situation that we haven’t been in before. We might be shy to interact at first, and reluctant to talk to strangers, but often after a short period of time, we become used to it and freely talk to those around us. But what happens when those nerves and jitters don’t go away? What happens when someone gets so anxious that they can’t talk at all?
Selective mutism (SM) is an anxiety disorder “…characterised by a [person’s] inability to speak and communicate effectively in select social settings.” The person or child is often able to speak in a comfortable or familiar environment (such as at home) but has trouble in other social situations, for example at school or out in public. Even when a familiar person (eg: a parent or carer) is present in these places, the person with SM may still be unable to speak, or may even whisper into their ear. Other anxiety-related behaviours, such as muscle tension and shaking, can accompany SM, but not always. The way in which it manifests is different for every person.
What causes it?
It can be difficult to pinpoint a specific cause of SM. If a child experiences severe and constant bullying at school, it can make them so anxious to the point where they choose not to speak for fear of being made fun of by others. Other times, it may be brought on by a significant loss or trauma in a person’s life, such as the death of a close family member. If there is a family history of anxiety-related disorders, it can mean that someone may be more prone to anxiety themselves, though this is not always the case. Sometimes children have very disordered family and domestic situations (such going back and forth between the custody of separated parents), it may lead to an increase in anxiety levels. Often, there may not be one singular cause of SM, with a combination of a number of factors leading to the mutism. As a result of this, it is vital to conduct an in-depth interview with a parent, carer or relative to obtain an overall view and understanding of the person’s situation and how the SM impacts their daily life, as well as any potential causes of anxiety.
What can we do to help?
A team approach to therapy is quite often the best way to help someone deal with their SM. A psychologist is often included, to help the person/child identify what the causes of anxiety are, and to provide methods to help deal with these as appropriate. In some cases, anxiety medication may be needed.
In terms of therapy approaches, a graduated exposure approach is one commonly used way to assist those with SM. With this, the person or child is very slowly introduced to a new social situation in which they may need to speak, or to a new conversational partner. An example of an approach to therapy for a child with SM who cannot speak to their teacher in the classroom could be:
- Talking to a familiar person (eg: mum or dad) in the classroom without the teacher present
- Continuing the conversation, with the child’s teacher sitting just outside the room with the door closed (the child knows they’re sitting outside)
- Doing the same thing, but with the door being slightly ajar
- The teacher sitting on a chair near the door (but not saying anything or looking at the child)
- Gradually moving closer and closer and closer to where the parent and child are sitting, but still not saying anything
- The teacher saying only one or two words, but not directly to the child
- Increasing sentence length, and moving towards talking directly to the child
- Group conversation with the parent, child and teacher (with no anxiety behaviours/signs)
The exact approach to therapy for SM will vary between people and the environments in which they are unable to speak. It could be working towards ordering coffee and cake in a café, or it could even be talking to the checkout operator at the supermarket. The best way forward with therapy needs to be assessed on a case-by-case basis, with appropriate plans made for each client.
If you are concerned about a child, teenager or adult who you think might be showing signs or selective mutism (SM), please refer them to either a speech pathologist or psychologist (or both), who will formulate a plan for the best way forward.
There is no need to live in silence!