Selective Mutism: Information for Parents and Caregivers
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“She won't speak to anyone…”
Jane is 6 years old and can dance and sing in front of her family…. she might even be the next Idol! But in music class she is paralyzed by fear and can’t say a word.
Jay is a 7 year old boy who plays soccer with his brothers and talks excitedly about his favorite World Cup team. Yet, at recess time, he stands alone watching the other kids play soccer and doesn’t speak when others ask him if he wants to play. The other kids think he’s a snob, and so they ignore him.
Mary is a 5 year old girl who talks at home with all her brothers, sisters and parents… but she has never spoken to anyone outside her home.
What is Selective Mutism?
Everyone gets shy from time to time. In fact, having just enough shyness can be helpful because it can protect us from doing things that may be embarrassing or awkward. But when shyness keeps a child or teen from speaking, then it may be a condition called Selective Mutism.
Selective Mutism is a severe anxiety disorder where a child is:
- Not able to speak (or ‘mute’) in certain situations (for example, at school or public places)
- Able to speak where she feels relaxed (like at home)
Children with Selective Mutism are not being mute ‘on purpose’. They are not trying to ‘control’ a situation by being mute. Not speaking is the way they protect themselves from severe anxiety.
Because anxiety is at the root of Selective Mutisim, punishing, pressuring or making a child feel guilty won’t help at all. Doing these things can even be harmful. Trying to force a child to speak can make a child even more anxious and can backfire, making the mutism even worse.
On the other hand, anything you can do to reduce a child’s anxiety can make it easier for them to speak in situations that make them afraid. Helping children take small steps to facing their fears is one of the best ways to help a child overcome mutism.
How do I know if my child has Selective Mutism?
Most children with Selective Mutism look and act like any other child, when they are in a comfortable situation. But when they are in other situations, like school or other social settings, they feel very anxious.
Before or during social interactions, a child with Selective Mutism may:
- Withdraw or ‘shut down’ when in the situation that makes them so anxious
- Refuse to follow adult’s directions, and seem disobedient or defiant (for example, refusing to go somewhere that makes them feel anxious)
- Avoid the stressful situation or activity
- Complain of stomach aches or headaches
- Stare into space, avoid eye contact or not smile
- Have trouble saying simple things like ‘hello’, ‘goodbye’ or ‘thank you’
Children with Selective Mutism may also have:
- Social Anxiety Disorder (9 out of 10 children with Selective Mutism have this)
- Difficulty being away from parents (Separation Anxiety)
- Some form of speech or language problems
- Daytime wetting or bed wetting (enuresis)
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How does Selective Mutism develop?
2 main factors are involved in Selective Mutism:
Family History: Most children with Selective Mutism have a family history of anxiety traits.
- Our brains have a hard-wired ‘fear system’. This ‘turns on’ when we feel we are in danger. It allows us to be ready to ‘fight’ or flee danger.
- In children with Selective Mutism, this ‘fear system’ gets ‘turned on’ easily by social situations. These children over estimate the danger in these situations, and become very anxious.
Environment and experience: Children with Selective Mutism 'learn' behaviours that will help reduce their anxiety.
- When children feel a social situation is ‘dangerous’, they stay quiet, hide behind their parents or try to avoid the situation in other ways. When others respond by speaking for them or moving on, they feel less anxious. So these children learn that not speaking or avoiding social interaction helps them feel less anxious, and this behaviour becomes a pattern.
How can I help my child?
- Get help early. This is critical. The longer that the Selective Mutism lasts, the harder it is to treat, because the behaviours children use to avoid speaking become reinforced. This makes changing their behaviours more difficult.
- Build on the bond between parents and children. Children with Selective Mutism feel the most secure when they are around their parents and less secure around others. It’s important to strengthen and build on this attachment. This will help children become more confident.
- Spend time with your child. Try to set aside some special time each day where each of your children gets a turn to have you all to himself. This is not always easy, especially if you’re a single parent or have more than one child. But even 15 minutes of special time for each child every weekday can make a difference. Make this special time longer on weekends or whenever possible.
- Choose activities that promote conversation. Board games, throwing a ball around, baking, crafts or Lego will give you lots of chances for your child to talk about feelings and emotions. Video games are not the best choice for this time, as they don’t give the same chances for eye contact and talking.
- Create a safe space for expressing feelings. Name feelings and let your child see how you handle feelings in a positive way. Let your child know that whatever she is feeling is OK. You don’t have to share all of your child’s feelings, but acknowledge them (“I can see how that might have made you feel angry”). Don’t tell your child that what they are feeling is wrong. Give your child a chance to vent while you listen and support.
- Create a ‘goodbye ritual’. When you say ‘goodbye’, remember to mention of when you’ll see each other again. You could remind your child of something you’re looking forward to doing with them (Pancakes for breakfast? Taco night? Working on that puzzle later?). This will be very reassuring for your child. You can add a hug or a kiss, or maybe even a secret family handshake J.
What doesn’t help
- Forcing your child to speak, this will only make the anxiety worse.
- Ignoring the problem. Parents may hear that their child is just shy and will outgrow the Selective Mutism. But there are serious consequences for a child who can’t communicate or speak to others:
- It can be hard to make friends. Not having friends or being isolated can put children at risk for teasing or bullying.
- It can impact a child's learning. Your child won’t be able to ask questions or ask for help. Teachers can find it hard to assess your child’s learning needs. Your child will not be able to take part in group work or learn important presentation skills. Over time, problems at school can affect your child’s self esteem, make anxiety or depression worse or make your child feel isolated. Children in these situations sometimes refuse to go to school.
- Blaming your child for being manipulative. Remember, anxiety is at the root of this-your child is not trying to control things by not speaking. Your anger and frustration will only make things worse. All children do well if they can. When they can’t, it’s because they don’t have the skills they need. Fortunately, there are effective treatments for Selective Mutism.
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How is Selective Mutism treated?
Seek professional treatment with an experienced child psychologist if your child is mute for a month or more. Treatment will focus on:
- Reducing your child’s anxiety
- Helping teachers and other adults understand Selective Mutism and develop reasonable expectations for communication.
- Developing a communication hierarchy and helping your child to gradually face fears at a reasonable pace.
Treatment approaches depend on the child, but may include:
1 Behavioural Strategies
These are step-by-step plans to help a child gradually take part in more communication. These plans often include ‘reward’ systems for when the child makes progress. They involve:
- Gradually exposing your child to more and more social situations in non-threatening ways, without ‘pushing’ or overwhelming your child.
- Encouraging structured social activities with other children (for example, a team sport or club)
- Working from the ‘inside’ outwards, by encouraging talking with close family and relatives. You then might try having one friend play with your child at home, gradually increasing the number of friends and different locations (playground or school).
- Starting with structured activities (like watching movies, board games, sports) where your child will feel less pressure to speak
Progressing to more unstructured activities (free play, dramatic play)
Helping your child in public settings:
- Give your child chances to communicate in a public setting.
- Encourage your child to take part in ordering food at a restaurant. For example, your child could start by pointing to menu items. You can have your child respond with ‘yes’ or ‘no’ in front of the server to questions you ask, or could say what they want with a prompt from you.
- Take advantage of any chance for communication: paying at the grocery store, checking out a library book or saying ‘thank you’ to the bus driver.
- Don’t make it a big deal when your child does speak. Calmly acknowledge what your child said, and carry on. When you have a quiet moment later, you could say something like, “You spoke very politely to the waiter in the restaurant-I think he appreciated that”.
Helping your child in school settings:
- Take your child into school, when few people are around, so your child can practice communicating.
- Encourage your child to invite children home to play. Hopefully, as your child feels more comfortable with friends outside of school, she will eventually be able to speak with these friends at school.
- When you feel your child is ready, bring your child with a friend or two to play at school when no one else is around. This may mean the playground on a weekend, or the gym or a classroom after school. To play inside the school, you will probably need to speak with your child’s principal first.
- Once your child is comfortable with this, have the teacher come around when your child is playing. Later on, other students can be introduced.
2 Cognitive-behavioral (CBT) strategies:
These strategies help children handle their anxiety. Many selectively mute children have ‘worry thoughts’ about others hearing their voice, or asking them questions about why they do not talk. Teaching children ‘coping thoughts’ helps them to overcome these worries. Examples of coping thoughts include, ‘My voice sounds fine’, ‘Its okay to worry about my voice from time to time’, ‘They’re not laughing at me’. These strategies work very well with the behavioural strategies outlined above.
Medications may be helpful for children whose Selective Mutism does not respond to various behavioral approaches. Medication can help reduce anxiety to allow the treatment plan to have a greater effect. Antidepressants known asSSRIs (selective serotonin reuptake inhibitors) have the most evidence for helping children and youth with anxiety conditions. Medications can be prescribed by a family physician, pediatrician or psychiatrist.
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Working with the School
Meeting with teacher, without the child around. Parents need to take the lead to approach school staff about their child’s Selective Mutism.
School staff who may be able to help:
- School psychologists
- Guidance counselors
- Behaviour therapists
- Principals or Vice-principals
- Speech-language pathologists
- Social workers
Hopefully the school will be familiar with Selective Mutism. If not, you can provide the school with a copy of this handout. You can also share key messages about Selective Mutism. Make sure to let teachers and school staff know that your child:
- Is not being defiant or stubborn by not speaking
- Communicates better when she feels less anxious. Blame, teasing, humiliation and coercion do not help her to speak
- May need to use non-verbal communication at first
You can also:
- Ask the teacher if it is possible to have a greeting ritual ("Good morning, hope you had a good evening last night!"), as well as a goodbye ritual at the end of the school day ("Have a great day, I'm looking forward to seeing you tomorrow!").
- Educate other students (and school staff). Give the teacher permission to tell other students and staff about your child's difficulties, at a time when your child is not in the classroom. The teacher might say something such as “You know how some people are very shy? Well, _____ is so shy, that it’s called “Selective Mutism”. It’s a kind of anxiety that makes it really hard for _____ to speak at school. The good news is that there are things that all of us can do to help.”
Meeting with parents, teacher and the child
It is important to introduce your child to the people she feels anxious speaking around (for example, a teacher or child care provider). It is also important to let your child know that he can trust and feel safe with that person.
If your child is anxious speaking in front of the teacher, have a meeting with the teacher without your child. This will give you a chance to get to know the teacher. You can then arrange a time to meet the teacher with your child. Let your child know that you have already met the teacher, and that your child can feel comfortable with him. For example, you can say something like, "I'd like you to meet Mrs. So and So. You know what? She's really into dogs, just like you. In fact, she has a dog of her own. I think she's really nice, and I think you're going to get along with her."
Working with Peers, Friends, Neighbours, Relatives
It is important to talk alone with friends, neighbours and relatives. They usually mean well, but may still pressure your child to speak. They may think your child just needs a little push, and may even think that you’re ‘coddling’ your child.
As a parent, you might say something like:
“Everybody has things they are afraid of, like big dogs or the dark. For _______, talking to people can sometimes be scary. The good news is that there are things that all of us can do to help ________ feel more comfortable talking.
Things that would help _____:
- Treating him like a good friend
- Being nice to him and
- Including him in activities, by asking if she wants to play or join in
Things that don’t help:
- Forcing children to talk, because it just makes them even more anxious.
- Telling others “He doesn’t talk”
- Making a big deal if he does speak. This might make him more nervous and self conscious. Just calmly
acknowledge what he has said, and go on as usual.
Parenting Styles and Selectively Mute Children
Most children do best when parents have an ‘authoritative’ parenting style. With selectively mute children, this is even more important. This means parents are warm, gentle and supportive, but also have reasonable rules and expectations for behaviour. Harsh, punishing and rigid parenting approaches will not help a child at all. Finding the middle ground between being too permissive (parent educator Barbara Coloroso calls this being a ‘jellyfish’), and being too authoritarian (Coloroso calls this being a ‘brick wall’) isn’t easy. An ‘authoritative’ or ‘back-bone’ parent tries to find this balance.
Too permissive (Jelly fish parenting)
- Not enough rules
- Not concerned enough
- Not taking problem behaviours seriously
- Not protecting enough
- Giving too much independence
Too authoritarian (Brick wall parenting)
- Too many rules
- Too concerned
- Taking behaviour problems too seriously
- Being over protective
- Not giving enough independence
Children and youth do best when parents try to find an “authoritative” balance.
1. Giving your children and youth guidance and rules so they can figure out how to be responsible.
2. Giving your children and youth more freedom as they show more responsibility.
3. Spending time with your children and youth, talking, doing activities or just hanging out to build a warm, healthy relationship.
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Reducing anxiety and changing behaviours one step at a time
1. First, you need to work with your child, a psychologist and your child’s school to come up with a plan. To do this, you’ll need to:
- Figure out what your child’s long-term goals are. “What do you want to be when you grow up?” ”What do you want to do in the future?”
- Find some way to help your child understand how being able to talk to others will help him to reach his future goals. For example, “Being a police officer sounds like a great idea. So do you know what needs to happen so you can become a police officer? You’ll need to finish high school, then go to police school. And we’ll need to help you have the confidence so you can talk.”
2. Set specific goals, starting with things that are easiest to do and work up to things that are the most difficult. Explain that you don’t expect her to be able to do the hardest things right away. But by taking small steps every day, she can ‘get there’. For example, you might say something like,
“What would happen if I gave you 100 lbs to lift right now? It’d probably be too much! So say that we wanted you to one day be able to lift 100 lbs. How would we do it? We’d start you step-by-step – we’d give you 1 lb to lift. And if you could lift that, what would we do? That’s right, we’d give you 2 lbs. And if you could lift that? That’s right, we’d give you 3 lbs. And let’s say that 3 lbs was too much? Well, we could go back down to 2 lbs, or we could go part-way, down to 2 ½ lbs… Then, if you could lift the 2 ½ lbs, we could go back up to 3 lbs….”
Developing goals based on what’s easiest and hardest
- Starting a conversation with and adult, teacher or peer Give longer, more complex answers to open ended questions (like a response to “What did you do today?”
- Give yes or no responses to questions
- Using a ‘regular’ voice
- Non-verbal communication (like gestures or writing)
Remind your child that she can always go down a step for a little while if she is having trouble with a hard step.
Easiest, starting steps
- Non-verbal communication (gestures, writing, email, facebook)
- Whispering to close family
- Speaking to others through parent
- Whispering to teacher or classmates
- Speaking in normal tone with yes or no responses
- Conversations with anyone in full sentences
Managing anxiety and trying things that make you afraid takes courage. Take note of when your child takes a step forward and speaks in situations he finds difficult. But take care-enthusiastic praise can make your children’s anxiety worse, because it brings more attention to the problem. A warm smile, a wink, a touch or a calm, quiet word is all that is needed.
You might also acknowledge your child’s effort and success with a family treat like a special dinner or dessert, a family ‘toast’, or a family outing. Be sure to include your other children as well, for example “Let’s have a little celebration. Kevin was able to ask his teacher a question today, and Sarah’s been doing a great job tidying up after school. Why don’t we all walk over to the store to get some ice cream after dinner tonight?”
Remember-punishing a child for not speaking will not help. Punishment will only make the anxiety worse, making it even harder for your child to speak. If your child isn’t able to take an expected step forward, move down a step for a bit. Let your child get more comfortable at that step, and then try to move ahead again.
A Personal Step by Step Plan!
Talk with your child to create a step by step plan to reach your child’s goals. Start at the lowest step with the easiest goals, and put the hardest goals at the top.
Where to find help in Ottawa and Eastern Ontario
In a crisis? Child, Youth and Family Crisis Line for Eastern Ontario, 613-260-2360 or toll-free, 1-877-7775
Looking for mental health help? www.eMentalHealth.ca is a bilingual directory of mental health services and resources for Ottawa, Eastern Ontario and Canada.
The Children’s Hospital of Eastern Ontario Your doctor can make a referral by calling our mental health intake line at: 613-737-7600, ext. 2496.
Youth Services Bureau, for ages 12-20, 613-562-3004
To find a psychologist in Ottawa: Call the Ottawa Academy of Psychology referral service (613) 235-2529. Listing of many, but not all, Ottawa psychologists, http://www.ottawa-psychologists.org/
To Find a psychologist anywhere in Ontario: Call the College of Psychologists of Ontario, 1-800-489-8388 www.cpo.on.ca.
To find a speech language pathologist in Ontario: College of Audiologists and Speech Language Pathologists of Ontario (www.caslpo.com)
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Books for Parents and teachers
- Helping Children with Selective Mutism and Their Parents; A Guide for School-Based Professionals, Christopher Kearney, May 2010
- Helping Your Child With Selective Mutism: Steps to Overcome a Fear of Speaking, Angela McHolm, Charles Cunningham, Melanie Vanier, Aug 2005
- Selective Mutism Resource Manual, Maggie Johnson, June 2001
Books for Children
- Cat's Got Your Tongue?: A Story for Children Afraid to Speak, by Charles Schaefer, Judith Friedman, 1992, ages 4-8
- Understanding Katie, by Elisa Shipon-Blum, 2003, for ages 4-8