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When a Child Won’t Speak … Shyness or Selective Mutism?

If a young child talks freely and enthusiastically at home but has difficulty verbalizing with non-family members in public or social settings, she may be classified as a child who is shy, reluctant to speak or one who has special needs. However, there’s another possibility. The non-speaking child may have selective mutism, a little-known anxiety disorder that arises in the preschool years around three to five-years-old.

Though with good intentions, parents and educators are unable to properly evaluate children who don’t speak. They often implement a non-pressure approach allowing children to communicate at their own pace and comfort level. This wait-and-see approach only exacerbates the problem and results in misunderstandings and misclassifications which ultimately affect the child. To prevent non-speaking children from suffering unnecessarily, it is best for parents and educators to work in tandem to educate themselves on the differences in a child’s speech habits.

What is the Difference Between Shyness and Selective Mutism?

According to Fairfax-based licensed clinical psychologist Dr. Courtney Ferenz, “selective mutism (SM) is an anxiety disorder, characterized by a lack of verbal communication in specific settings.” Dr. Ferenz states that parents describe children with SM as having a dual personality by being “talkative at home but very quiet or virtually silent in other settings.”

By contrast, “shyness is a personality trait, which is … fixed and affect[s] one’s general temperament,” according to Alexandria-based licensed clinical psychologist Dr. Kristin Swanson. While shy children typically overcome their inability to speak with others by warming up a bit, the warm-up period does not work with children who have SM. “In fact, the longer a child spends in an environment without speaking, the harder it can be to begin using their voice,” Dr. Swanson says.

Misunderstandings

While often classified as special needs, it’s important for parents to understand that SM can actually affect all children and not just those with special needs. Dr. Swanson acknowledges that children with SM may be “misdiagnosed as having other challenges or disorders [particularly if] a child is unable to speak at school or may appear frozen or disengaged … [and in] social interactions, can be confused with an autism spectrum disorder.” She stresses that “it is important to have an accurate diagnosis and understanding of the presenting symptoms to provide the best support to allow that child to be successful.”

Dr. Ferenz cites several additional misunderstandings of a child who has SM including “being oppositional or defiant … [an assumption] that they are not intelligent … [and a belief that] these children have a pervasive developmental disorder and always behave in this manner.”

Symptoms and Potential Treatment

Though there is no statistical evidence to indicate whether SM affects children based on ethnicity, it is believed SM occurs most frequently during preschool and early elementary age years. Dr. Ferenz hypothesized that girls are twice as likely to be diagnosed with SM than boys due to the possibility that society expects girls to be more social. Dr. Swanson states that SM is “estimated to affect 1 in 1,000 children referred for treatment.”

Dr. Ferenz notes that children who have SM “have difficulty initiating conversations and responding to questions verbally, have poor eye contact, are slow to respond and might appear stiff or ‘frozen’ in social situations.” Dr. Swanson expands SM symptoms to include non-verbal communications as well. “Kids with SM may … be hesitant to communicate with gestures, writing or pointing. It is not only a fear of being seen or heard speaking but of communicating in general.”

Advice for Parents and Educators

Dr. Swanson feels strongly that parents should be curious about how their child responds in different environments and ask questions. Consequently, parents are the best line of defense to help identify any possible SM symptoms by comparing their child’s ability, preference and tendency to speak at home in comfortable surroundings versus speaking with others in public, unknown situations.

It is a great idea for parents to talk to their child’s teachers or any adults with whom the child spends time, including babysitters, coaches and extracurricular adult leaders. By talking to other adults and understanding how a child communicates outside the home, this will provide clues as to whether the inability to speak is caused by SM or is associated with a different issue.

Depending on those conversations with adults who spend time with their children, parents are encouraged to seek formal evaluations and help from local licensed medical professionals experienced with SM and national sources including the Child Mind Institute, the SMart Center and Thriving Minds Behavioral Health.

Dr. Ferenz and the practice where she works, The Child and Family Counseling Group, P.L.C. in Fairfax offers a set of 12 excellent tips for teachers and educators in working with children who may have SM. The list includes practical things teachers can do to help children with SM feel more at ease in the classroom in subtle, yet concrete ways that minimize the risk of exposing the other children in the classroom with sensitive information about the child, while helping that child manage her anxiety of speaking in public.

The formative years of a child may seem scary for the child who may have anxiety when speaking in public and manages that anxiety by not speaking to others in public situations. If you suspect that your child may have selective mutism, please keep communication open with all adults who come in contact with your child and teacher. If your child is formally diagnosed, she may receive behavioral treatments from professionals to help with verbal communications. As a last resort, pharmacological treatments may be available. In all cases, there is always hope!

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