Selective Mutism in Children: Types, Symptoms, Causes & Treatment

Children's mental health should be a priority, as they are mostly incapable of expressing their problems. Selective mutism can be one such issue. It is a severe anxiety disorder that prevents children from speaking in certain social situations. It is essential to diagnose this condition to avoid future complications.

Do you wish to find out about selective mutism? Then, keep reading this article for a comprehensive guide.

Selective mutism is a condition that occurs when children fail to express themselves in a particular setting with people that they are not comfortable with. They start feeling anxious in such a situation, which can harm their mental health.

Children often feel free to talk and open up to their parents, friends and close relatives. However, when they meet strangers or distant relatives, they feel awkward and embarrassed to talk to them. If this condition is neglected, it might impair their overall communication and socialisation skills. It can also hamper their mental health issues with extreme anxiety and panic from a young age.

It is important to know about the symptoms of selective mutism to diagnose and treat it at an early stage. Here are some of the symptoms which prove the possibilities of this condition.

• Anxiety and panic in social situations
• Tendency to avoid conversations and eye contact
• Social awkwardness
• Rude or disinterested answers
• Shy and withdrawn attitude
• Fidgeting or avoiding movement
• Use of nonverbal communication
• Stubborn or aggressive behaviour
• A shift in tone and personality based on social situations

If your child shows these symptoms, do not hesitate to visit a psychologist for quick counselling sessions and try to diagnose the problem. It can escalate faster if left unattended.

It might be tricky to understand the exact causes of selective mutism, as it is a condition that has developed since childhood. Some of the causes are as follows:

• According to clinical experts, fear or phobia might be the primary cause of such a condition.
• Children who grow up in an environment where they do not feel safe develop fear, anxiety and panic. This might result in this condition. However, this might be different for some children suffering from this issue.
• Another cause can be a lack of exposure. Children not taken out in public too often might be scared in rare social situations. Moreover, they will hardly know how to communicate with strangers, as they only know their family members.
• Children with hearing impairment and speech and language disorders are also likely to avoid socialising. This is because they are usually embarrassed by their condition and avoid strangers.
• In addition, there is a condition called sensory integration dysfunction, where children face trouble processing sensory information. This also causes them to withdraw from social interactions.

Children suffering from selective mutism disorder are likely to face the following risks.

• Communication Difficulties: One of the biggest risks of SM is connected with communication. Children who suffer from this condition will likely face difficulty communicating with people.
• Temperamental Inhibition: This condition causes children to be highly restrained and withdrawn from society. They might not participate in any social activities.
• Social Anxiety Symptoms: Most children who develop this disorder are likely to develop the symptoms of social anxiety after growing up. They get uncomfortable being the centre of attention and are embarrassed to do anything in public.
• Physical Health Problems: SM can cause physical problems like nausea, headaches, joint and chest pains, shortness of breath, palpitation, increased heart rates, stomach ache, etc.
• Behavioural Problems: Children suffering from SM are likely to have mood shifts. They can be moody, stubborn and assertive. Moreover, they might be rude and aggressive in social situations when they feel uncomfortable.
• Developmental Delay: Suffering from SM can cause developmental delays among children. While some start catching up after a certain age, others might report cases of autism for such delays.

The diagnosis of selective mutism depends on the ability of the parents and family members to notice their children and take proper steps at the right time. 

If parents observe children avoiding communication and social gatherings, they need to start observing them for at least a month. Then, if the problem persists, they must visit a speech and language therapy clinic.

The therapist will discuss the condition of the children with the parents before directly talking with them. They are likely to ask questions about the following:

• History of medical conditions of the child.
• History of anxiety in the family line.
• Any incidents that might cause stress.
• Traumatic events and situations.
• Any disruption in daily routine.

After analysing these issues, the therapist will decide on the child's health condition. For example, if the therapist feels the child suffers from SM, the treatment procedure will begin accordingly.

The treatment of selective mutism depends on multiple factors. These are as follows:

• The time span for a person suffering from social awkwardness.
• Any additional communication or learning difficulties.
• Family and parental relationships and coordination.
• Social status and bonding at school.

Here are the common types of treatment used for healing children from SM.

1. Cognitive Behavioural Therapy (CBT)

This therapy allows individuals to focus on their thoughts regarding themselves and the world. It uses graded exposure to challenge the common fear and paranoia in the patients. While younger children can also benefit from this therapy, it is more appropriate for slightly older children undergoing adolescence. Here, the therapist will ask questions about children's feelings when they undergo anxiety and offer coping strategies.

2. Behavioural Therapy

As the name suggests, this therapy aims to understand the patients' behavioural issues and solve them. Instead of examining a child’s past or thoughts, the theorists analyse their current behaviour. They replace bad habits with good ones and reinforce desired behaviour. They must understand the problems causing problematic behaviour and manage the same.

3. Graded Exposure

In this type of therapy, therapists deal with situations that cause the least anxiety and slowly move deeper. For instance, if children feel anxious about talking to strangers over the telephone, therapists ask them to do the same. This way, they learn that these activities are not necessarily stressful and get a hold of their feelings.

4. Stimulus Fading

In this type of therapy, children start talking with their parents or anyone close to them. The therapist joins the conversation. As the child gets comfortable, the parents leave, and the therapist takes over. This way, they learn to open up and interact with strangers.

5. Medicine

Finally, medicines can be a great way to treat SM. This is more appropriate for teenagers than young children. Therapists might suggest antidepressants if they feel the children are having a hard time. However, the dosage is usually mild. Moreover, they mainly prefer a change in the environment to bring changes rather than focusing on medicines.

It is up to the parents to monitor their children's behaviour over time. Before consulting a doctor, they must observe if they are showing symptoms of SM. They need to cut some slacks for children with speech and hearing impairments.

They must contact professionals if they feel the children are disinterested and withdrawn from social gatherings for a long time. Then, psychologists and counsellors will be the right option for starting the treatment.

There are no specific means of preventing secretive mutism in children. However, the best parents can do is to ensure a safe and healthy environment for them. Children who do not face any anxiety, fear or paranoia are less likely to develop SM. Moreover, they need to check if the children face intimidation or fear in schools and classrooms and try to eliminate such possibilities. This might help them prevent SM in children.

Therefore, selective mutism in children is a burning issue. As this article pointed out, it is important to diagnose and treat this condition to avoid any complications in future. Parents have a pivotal role in dealing with such conditions among children. They need to monitor the children's behaviour to identify its symptoms before seeking treatment.