Shyness or selective mutism?
10th Jul 2019
Shyness or selective mutism?
Many people feel shy, awkward or apprehensive when meeting new people and, for some, this sense of shyness limits their ability to participate actively in social situations. However, shyness usually dissipates as we become more familiar with people and places. Although such shyness may take days or even weeks to dissipate, particularly for children entering new environments such as nursery or school, as time passes shyness usually resolves and the child is able to participate actively in play, lessons and chatting with friends and teachers.
Some children, however, continue to find certain social situations much more challenging. They may be confident chatterboxes at home or in conversation with certain people, but be silent or speak only minimally in other environments or with other people. An example would be a child who chats away happily at home or in the playground but does not speak with adults at nursery or at school, or does not speak to friends in situations where others might overhear. It is possible that a child with this pattern or similar could have selective mutism. If so, they are likely to benefit from help and support.
What is selective mutism?
Selective mutism often begins in early childhood. Behaviours vary from child to child, but the essential feature of selective mutism is that the child does not speak or speaks very little in certain situations, whilst in other situations, they are chatty and talk freely (Johnson & Wintgens, 2017). In this way, the selective in the term “selective mutism” indicates that the behaviour is present only in certain, usually quite specific, situations, whilst mutism indicates that the child is silent or speaks in a very limited manner in these specific situations. To be regarded as selective mutism the failure to speak must have persisted for over a month (or more than two months in a new environment such as nursery or school), and be impacting on the child’s education or social communication.
An important point to highlight is that children experiencing selective mutism are not refusing to speak. Instead, selective mutism is rooted in anxiety and fear (ICD-11, 2019), and can be thought of as a phobia. In this way, the inability to speak results from a fear or extreme panic response, and the child experiences high levels of anxiety associated with speaking in specific situations. Either the thought of speaking in these situations fills them with such dread that they are physically unable to speak; or they protect themselves from this intensely distressing experience by avoiding speech (Johnson & Wintgens, 2017). The fear of speaking may not be logical or rational, but is nevertheless present and exerting a huge influence on the child’s behaviour and ability to interact with others.
What can be done to help a child with selective mutism?
Selective mutism and its consequences can become more entrenched over time, so appropriate support is likely to be most effective and simpler the earlier it is put in place. As with other phobias, selective mutism is unlikely to improve if the child is pushed or forced to face their fears. A more successful approach is to gradually tackle the fears with appropriate support, understanding and knowledge. Key features of appropriate support include:
- Being open with the child, acknowledging the current difficulties around speaking in certain situations and the likelihood that this will become easier over time,
- Eliminating demands for the child to speak in feared speaking situations whilst, at the same time, ensuring that there are opportunities for the child to speak when they feel able to do so,
- Educating family members, nursery staff, school staff and other adults in the child’s life on (1) the nature of selective mutism, (2) how to reduce demands on speech whilst leaving the door open for the child to speak when they are able to do so, and (3) how to respond when the child does speak.
These elements provide an essential foundation for progress and are the most important building blocks in helping reduce the child’s fears around talking. Once this foundation is firmly established, a structured programme of careful, step-by-step exposure to the child’s feared situations can help bring about further change.
There are some excellent resources available with further information about selective mutism. These include the website of the Selective Mutism Information and Research Association (SMiRA), which has a wealth of accessible information, including http://www.selectivemutism.org.uk/info-where-to-get-help-with-selective-mutism/. SMiRA also has an active Facebook Group: https://www.facebook.com/groups/SMIRASelectiveMutism/. Speech therapists and psychologists who have knowledge of and experience working with selective mutism can provide support and guidance for people with selective mutism, their families and schools.
With time, patience and support, the fears of many young children with selective mutism will recede, enabling them to thrive at home, at school and with friends.
This is a Guest Post by Kirsten Howells.
Kirsten is a Speech & Language Therapist in private practice at Brighter Spaces Wilmslow.