MythBusters: Selective Mutism Edition
Selective Mutism (SM) is an anxiety disorder where a child is unable to speak in certain social situations, despite being able to talk in others. There is a noticeable and significant shift in a child’s speech across different settings. This anxiety around speaking often interferes with both social interactions and academics since children with Selective Mutism may struggle with behaviors such as asking for help, participating in class discussions, telling others what they like/think, identifying mistakes, engaging in writing assignments, and reading in front of others. Unfortunately, SM is not as well-known as we would hope and therefore, can be misunderstood. A few of the common myths need some explanation to better understand children with SM.
Myth: My child WON’T speak.
Fact: My child is unable to speak in this situation.
Children with SM often get labeled as “oppositional,” as if they are making a choice not to speak when in fact, their anxiety is so high, that they feel like they cannot get the words out. By switching the language to “unable to” or “cannot,” we shift the onerous onto the anxiety, rather than the choice of the child. Keep in mind that a situation can prove challenging for a child with SM based on the people, the setting, or the activity they are engaged in – or even a combination!
Myth: My child is just shy.
Fact: My child has anxiety, being shy is something different.
Like all other children, there are children with SM who are more extroverted and those who are more introverted. Many children with SM are not described as shy when their anxiety is low and can be quite the opposite. Remember, the anxiety is impeding your child from being themselves or doing what they would typically be able to. This anxiety does not change your child’s personality. Whether you have an outgoing or shy child when the anxiety is low, our goal is to help your child be themselves across situations. Try to avoid labeling your SM child as “shy,” as they tend to take on that persona after hearing it repeatedly, when in fact it may not match up with who they are. Providing context for your treating clinician lets us know what we are working towards. We love to see home videos to know your child’s true baseline!
Myth: Selective Mutism is Social Anxiety.
Fact: Selective Mutism and Social Anxiety are two different diagnoses.
Selective Mutism is an anxiety disorder specifically around speaking in social situations. Social Anxiety is an anxiety disorder characterized by excessive self-consciousness around social situations. These disorders have a high rate of comorbidity, but they do differ and many children will be faced with significant anxiety in one area and not the other. Older children and adolescents with social anxiety will identify anxieties around what others think of them. Younger children may not be able to identify those anxieties specifically, but will be impaired in their behaviors and physical engagement. This can be in addition to or separate from a diagnosis of SM. So, if a child struggles to eat in front of others, go up to the board to point to the weather, freezes during dance class, or cannot participate in gym, their behaviors may be a result of social anxiety, whether or not they can speak in these settings. If a child participates in class nonverbally and connects with peers without speaking, a child may be struggling with SM, but not social anxiety. In children, social anxiety must occur with peers, while SM can be specific to any person, place, activity or a combination of more than one.
Myth: My child will have an easier time speaking with people they know best.
Fact: My child will likely have a harder time speaking with people they know best, if they have a history of difficulty speaking with them.
It seems like children would feel most comfortable facing their anxiety with the people they know best and are most comfortable with. However, children with SM typically develop “contamination” around the people they know best, places they go to regularly, and activities they do most often. This means that they have a learned history of not talking, which then makes them feel as though it is a harder goal to reach. When a child with SM is unsuccessful in speaking with a certain person repeatedly, both the child and that person form misconceptions that the child cannot speak in that situation or that the child does not talk to that person. By beginning with helping your child to speak with people that are “uncontaminated” or new, children with SM get to first work on building bravery in general verbal situations, before shifting to situations that already have a history of difficulty. A child with SM can absolutely be successful with contaminated people, places, or activities, it is just harder.
If you have any concerns about your child struggling with the symptoms of Selective Mutism, reach out to our office for a consultation call. We would be happy to guide you in whether treatment would be appropriate and what it may look like.
