Selective Mutism

One day, with my child, I opened the Pokemon app with my smartphone and wandered around to catch monsters. While my son was searching for monsters on the app near a Starbox, I happened to meet an old friend of mine there. After I greeted him warmly, I introduced my son to the friend. Then the friend asked my son his name... . Isn't the boy suddenly just staring at him without saying anything? A bit awkward... . To break this silence, I spoke. I told the friend my son's name instead of my son.

Selective mutism is:

Selective mutism is a childhood anxiety disorder diagnosed when a child usually speaks comfortably but does not speak consistently under certain special circumstances. This disorder is a disorder in which children usually speak comfortably with their families at home, but become paralyzed and unable to speak in front of certain places or people due to anxiety. This disorder is commonly found in children aged 3 to 4 years and is distinct from the behavior of children with language problems, personality shyness, or developmental problems, which are seen during an adjustment period in a new environment.

Children with selective mutism speak in some situations but do not speak completely or rarely when others are around. They also appear frozen, paralyzed, or in some cases angry when strangers ask questions or they feel uncomfortable in certain situations or people. Or, even though they know how to speak, they use gestures such as pointing, nodding, or a funny expression to express themselves.

Most children with selective mutism can speak and live normally, and develop normally, except for not speaking to specific situations and people. It is found in less than 1% of the population and at a similar rate in both boys and girls, of whom about 90% have social phobia or social anxiety disorder. Symptoms usually appear early, but are often identifiable as the daycare, kindergarten, or school begins.

 

DSM-5 Diagnostic Criteria

1. Consistent failure to speak in specific social situations in which there is an expectation for speaking (e.g., at school) despite speaking in other situations.

2. The disturbance interferes with educational or occupational achievement or with social communication.

3. The duration of the disturbance is at least 1 month (not limited to the first month of school).

4. The failure to speak is not attributable to a lack of knowledge of, or comfort with the spoken language required in the social situation.

5. The disturbance is not better explained by a communication disorder (e.g., childhood-onset fluency disorder) and does not occur exclusively during the course of autism spectrum disorder, schizophrenia, or another psychotic disorder.

Diagnostic and Statistical Manual of Mental Disorders (DSM-5)

 

Causes of selective mutism:

• The cause of selective mutism is not accurately known. There are genetic, temperamental, and environmental factors, including a variety of family history that increase the probability of onset. There are many factors that can affect the cause of this disorder, such as mother's anxiety, incorrect parenting attitudes such as overprotectiveness in the home environment, scar and trauma in relationships with friends.
• In general, it is known that genetic factors have a significant effect on the occurrence of selective mutism. In other words, if there is a family member with anxiety disorders, the genetic cause for this anxiety can affect the child. In this case, it may show signs of extreme shyness and severe anxiety, along with separation anxiety, frequent crying, sleep disorder, and hardness from in early childhood.
• Studies have shown that children with introspective temperaments are vulnerable to anxiety and are more likely to be exposed to selective mutism. In particular, it is said that the activity of the amygdala, which receives danger signals through the sympathetic nervous system and responds appropriately to them, is reduced in social situations that cause anxiety.
• Children who are exposed to this disorder have difficulty in processing certain information because they have difficulty in responding normally to the senses. Children with selective mutism have difficulty in processing stimuli such as sound, light, touch, taste and smell. In other words, children are very sensitive to these stimuli, which in turn causes them to misinterpret environmental and social situations, causing them to experience anxiety and frustration. And to avoid these situations, they selectively do negative things, such as not speaking.
• About 20 to 30 percent of children with selective speech have learning disabilities, including language impairment or hearing impairment, and have an introverted temperament that makes them shy and anxious. A combination of these difficulties causes selective mutism in anxious and uncomfortable situations.
• Introverted and linguistically insecure children who have lived abroad for a long time and have been exposed to other languages may avoid speaking and may even suffer from this disorder.
• Studies show that there is no evidence that the causes of selective mutism are related to abuse, neglect or trauma.

 

Treatment of selective mutism:

If your child is suspected of having selective mutism, it is recommended that you and your child visit the hospital together. At the hospital, your child should be tested for hearing problems, language development problems, or other medical problems. It is then recommended that your child should be diagnosed at the department of psychiatry and counselling center after checking up the situation in which you speak naturally and the situation in which he or she is mute.

The main focus of treatment is to reduce anxiety, increase self-esteem, and increase social confidence and communication skills. The important thing here is that the focus should not be on the child to speak. In other words, all expectations of verbalization should be removed and gradually led to positive reinforcement to develop verbal communication.

The most commonly used to treat selective speech is cognitive behavioral therapy. Positive reinforcement should help children who are struggling with selective mutism gradually and systematically develop self-confidence through speaking assignments or exposure training to find their voice. In addition to play therapy, sand play therapy, art therapy, and brain training, anti-anxiety or antidepressants may be used to reduce anxiety in severe cases.

 

The story of me and my son mentioned at the beginning of this article is a situation that almost all parents experience. In fact, there will be no parents and no children who have not experienced this situation. Because my son is unfamiliar with the situation, or is very shy, or anxious to meet someone he doesn't know, or he is so busy catching monsters, etc. he may have been unable to answer the question for many reasons and stood like a mute. However, if the child's response does not change positively in a similar situation that continues...We should take a closer look at the inside of our children. Whether anxiety is in their minds… And sometimes you need to take a good look at yourself as a father or mother who responds to your children. You need to reflect on whether your parenting attitude leads children to social unrest.