Generality
Selective mutism is a particular condition belonging to the group of anxiety disorders .
Selective mutism usually begins in the pediatric age and is characterized by the inability to speak in almost all social contexts, although there are no delays neither in learning nor in language development.
The diagnosis is not always simple, since it is necessary to distinguish selective mutism from other disorders that may relate to the ability to learn and communicate, from other forms of mutism (for example, a temporary mutism caused by entry into a new school, or in a new country or state, etc.) and other types of anxiety disorders.
Patients with selective mutism need adequate psychological support to overcome the problem.
What is that
What is Selective Mutism?
Selective mutism is an anxiety disorder for which patients who suffer from it (usually children) are unable to express themselves and communicate in certain situations and areas (such as, for example, in school, during sport, during play and recreational activities).
Despite the inability to communicate in social contexts, children with selective mutism generally have normal development and language skills . In fact, with their parents and in their family contexts, dumb-selective children are able to speak and express themselves correctly; in some cases they can even be very talkative.
Incidence
Although precise statistical data are not available, selective mutism is considered to be a rather rare disorder which, according to some estimates, would occur in seven children in a thousand.
Selective mutism seems to affect females more frequently than males and tends to be more widespread in children belonging to bilingual families, to isolated or ethnic minority families and to children with anxious and / or family members who have difficulty in establishing social relations.
Causes
What are the Causes of Selective Mutism?
Although the causes underlying the appearance of selective mutism have not yet been fully clarified, some studies have shown that this disorder is connected to a strong state of anxiety, although it is not clear why this condition develops in the child .
Despite the common belief that children with selective mutism would have been victims of trauma, abandonment or violence, many doctors categorically exclude this possibility.
Furthermore, a research conducted in 2011 has hypothesized a possible genetic cause, but this theory has yet to be demonstrated and in any case the only study conducted on it would not be sufficient to give a clear proof.
Therefore, the real cause responsible for selective mutism remains unknown today.
Manifestations and Symptoms
Symptoms and manifestations of Selective Mutism
Selective mutism begins in the pediatric age, when the child begins his own training course. Usually, the appearance of the disorder occurs around the age of four, when the child begins to attend kindergarten; however, there are also cases in which the disorder appears a few years later, with entry into elementary schools.
However, selective mutism manifests itself as an inability to speak - therefore, to communicate (both with adults and with children, peers and others) - when we find ourselves in social contexts of any kind. On the contrary, in the home environment, with parents and possibly with very close relatives, the child with this disorder is able to express himself correctly without any problem. In fact, in most cases (but not all) children with selective mutism do not present neurological problems or learning or language disorders, but possess the same abilities as their peers.
However, there are some exceptions: some dumb-selective children, in fact, even if they cannot speak, can communicate in different social contexts also through gestures, nods of the head, whispers, or through monosyllabic sounds or by imitating animal sounds. In some cases, such as at school, dumb-selective children could communicate through written notes (of course, this only applies to small patients who have already learned to read and write).
However, the inability to speak derives from the distress and anxiety caused by being in certain social contexts. This condition of malaise can be guessed from the behavior of the child with selective mutism which, generally, is difficult to maintain eye contact, has an inexpressive face, has low self-esteem and presents physical rigidity .
Wrong interpretation of the manifestations of selective mutism
In some cases, parents, as well as teachers or even pediatricians tend to underestimate the problem, do not worry and believe that the disorder is due to simple shyness, because the child is able to communicate in the family. In doing so, however, there is the risk of considerably delaying the diagnosis, the disorder is consolidated and becomes increasingly evident. In such situations where the anxiety disorder is underestimated, the child's silences could even be interpreted as the will to provoke the interlocutor or the will to escape the rules or their duties (such as the study). This situation can lead to forcing by teachers and parents who can do nothing but worsen the condition of anxiety in which the child finds himself and which can cause a further reduction in his self-esteem.
It is clear, therefore, that an incorrect interpretation of the manifestations of selective mutism can exponentially increase the patient's discomfort experienced, as well as delay the diagnosis and make the subsequent treatment difficult.
Diagnosis
When and How is Selective Mutism Diagnosed?
Selective mutism is diagnosed in the pediatric age, generally in the period in which the child starts attending kindergarten, or when he starts attending elementary school.
Unfortunately, however, it is not always easy to make a diagnosis of selective mutism, since it is necessary to exclude all the other causes that could lead the child to not speak and not express himself in certain contexts. Furthermore, selective mutism does not manifest itself in the same way in all patients, but can occur with different nuances . In fact, as mentioned, some children suffering from this disorder are not completely incapable of expressing themselves in social contexts, but can communicate through writing, or through sounds or nods of the head.
In any case, should a child present any of the "unusual" behaviors mentioned above, the situation should not be underestimated in any way and it would be good to seek advice from a specialist doctor, in order to be able to carry out a diagnosis of selective mutism early . In this regard, we point out that the timely diagnosis of selective mutism is fundamental for the success of the therapeutic strategy that must be undertaken in these cases. Indeed, if detected early, selective mutism can be successfully treated and relatively quickly.
Diagnostic Criteria for Selective Mutism
The DSM-5 provides a list of diagnostic criteria that medical specialists can use to make a correct diagnosis of selective mutism; naturally, taking into consideration all the variations of the case and all the nuances that this anxious disorder can take in different patients. However, according to the diagnostic criteria reported by the DSM, patients with selective mutism should have the following characteristics:
- Constant inability to speak in specific social contexts in which the individual is expected to speak (such as, for example, in kindergarten or school), despite being able to speak in other situations.
- The condition interferes with academic or work results, or interferes with social communication.
- The duration of the condition must be at least one month (not limited to the first month of school during which the child may not speak due to the discomfort created from the beginning of the school period).
- The inability to speak should not be caused by not knowing or not feeling comfortable with the kind of language required by the social situation.
- The condition is not better explained by communication disorders and does not manifest itself exclusively during the course of autism spectrum disorders, schizophrenia or other psychotic disorders.
Deepening: the DSM
The DSM (from the English Diagnostic and Statistical Manual of Mental Disorders ), or the diagnostic and statistical manual of mental disorders, is a text written by the American Psychiatric Association (APA) which groups together and describes various mental disorders, reporting symptoms and manifestations. The DSM is currently (2018) in its fifth edition (hence the abbreviation DSM-5).
Care
Is There a Care Against Selective Mutism?
As previously mentioned, if selective mutism is diagnosed early, there is a greater probability of therapeutic success in a relatively short time.
The treatment of selective mutism always requires the intervention of the specialist doctor, since children who present this anxiety disorder need adequate and correct psychological support . Currently, the cure that seems to have had the most success in the treatment of selective mutism involves the use of cognitive-behavioral therapy that has the following objectives:
- Reduce the frequency and intensity of anxious states that attack children in social contexts;
- Try to obtain a condition of sufficient tranquility in social situations that cause problems for the child;
- Increase self-esteem and self-confidence in the child;
- Stimulate the child to express thoughts, emotions and needs (not necessarily through words);
- Provide the child with strategies to help him establish and maintain interpersonal relationships.
Useful Tips
How to behave with children with selective mutism
When you become aware of the fact that your child or family member suffers from selective mutism it may not be easy to manage the situation. Sometimes, it is not possible to understand this disorder and its mechanisms, consequently, we approach the child in the wrong way. Therefore, here are some tips that could be useful.
- Do not force the child to talk, do not blackmail him (eg "If you talk I buy you the toy you wanted") and don't make him feel guilty if he can't communicate.
- Try to reassure him when you find yourself in those situations considered a source of anxiety for the child and try to put him at ease.
- Communicate with the child in a normal way, in a calm and calm tone;
- Inviting friends at home can be useful for fostering relationships with peers, in fact, the home is usually a familiar and reassuring environment for a child suffering from selective mutism.
- Maintain a constant dialogue with the teachers and with all the figures that follow the child during the execution of social activities (eg sports, recreational activities, etc.). in this way, it is possible to know the attitudes and behaviors held by the child during the activities performed outside the home.
Naturally, it remains of fundamental importance to contact a specialist doctor experienced in this type of disorders. This healthcare figure, in fact, will be able to advise parents and teachers on how to manage and help small, selective dumb patients.
Eventually - in addition to consulting with a specialist - it is possible to turn to specific non-profit associations (also present in Italy) that work to provide support for the families of children with selective mutism.
