Selective mutism in children

abuse  Selective mutism in children
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Occasional anxiety is a normal part of any child’s journey of discovery, occurring in tandem with new experiences, especially during their formative years. However, some children may endure extreme anxiety to the extent that it prevents them from being able to speak in certain places or with certain people. This is the case for a child with selective mutism. اضافة اعلان

Selective mutism (SM) is an extreme anxiety disorder that causes the inability to speak in social situations that a person finds very stressful, including school or around relatives they do not see often.

Children with SM experience long-lasting and debilitating anxiety that interferes with their daily functioning and affects their development. However, a child with selective mutism is not necessarily shy, timid, or choosing to be silent. Rather, their inability to speak is caused by their anxiety. In fact, they can talk freely in situations where they feel comfortable, such as with close family members.

SM is a rare condition that can start in children as young as two and, if left untreated, it may persist into adulthood.

Symptoms usually become discernable when a child begins school.
Children with SM experience long-lasting and debilitating anxiety that interferes with their daily functioning and affects their development.
When faced with a stressful situation, such as the expectation to speak in front of many or certain people, freezing is triggered as a response due to feelings of panic rising, thus making talking impossible. This leads them to avoid any situation they anticipate will provoke a distressing reaction.

SM is usually comorbid; children with social anxiety or social phobia experience great difficulty responding to or initiating conversations. However, not every child manifests anxiety in the same way. While some may be completely motionless and mute in certain social settings, others might be able to whisper to a select person.

Children who are less severely affected can even feel relaxed around a small number of people in their school. Still, they might also be unable to communicate effectively when placed in a larger group setting.

According to the American Psychiatric Association, approximately one percent of children seen in behavioral health settings have SM. However, it is difficult to have an accurate population estimate due to the condition’s relative rarity, different diagnostic criteria, and variations in diagnostic procedure.

A dated study from 1997, published in the Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP), claimed that SM tends to be more common in girls, with a 1.5–2.5:1 female to male ratio. However, more recent studies published in JAACAP reported an equal ratio between girls and boys.

A 2004 study in JAACAP found that children who are immigrants or in a language minority are more likely to develop SM than their non-immigrant counterparts.

A 2020 study published in BMC Psychiatry found that if both parents have a psychiatric disorder, their child is three times more likely to develop SM. It also discovered that the likelihood of developing SM is higher in children with fathers over the age of 35 or who have single mothers. 

There is no known single cause for SM. Many factors combined can lead to its manifestation.

Some studies have shown that most children with SM have a genetic predisposition, meaning it can be inherited from one or more family members. Researchers believe that children with an anxiety disorder, specifically a type of social anxiety disorder, are more likely to develop SM.

Some children with SM also have sensory processing disorder (SPD). SPD makes it difficult for children to process certain sensory information as they are overly sensitive to touch, lights, tastes, sounds, and smells.

SPD can lead a child to misinterpret social cues, which, in turn, leads to anxiety and frustration. The result is them shutting down or withdrawing from social situations. Other associated problems with SM are speech and language issues, such as stuttering.

While no evidence suggests a child with SM is more likely to have experienced abuse, neglect, or trauma; untreated psychological issues or unaddressed triggers may lead to the development of anxiety around communication.

A common misconception regarding children with SM is that they are controlling or manipulative. There is also the assumption that SM and autism come in tandem, but there is no evidence so far that suggests any type of relationship between the two.

Signs and symptoms
The main warning sign of SM is the ability of a child to talk and engage freely at home but experience sudden stillness at school or around strangers, even in the parents’ or caregivers’ presence. The child may also resort to nonverbal communication such as gestures, facial expressions, and nodding.

A child with SM may also avoid making eye contact and appear stiff, tense, uncoordinated, and tremble or blush.

However, symptoms differ with each child. While some appear shy, nervous, socially awkward, and clingy, others seem disinterested, rude, or sulky. They might complain of having a stomachache and racing heart, while others may even become aggressive, uncooperative, throw temper tantrums, and become defensive when questioned by their parents.

The more severe the case of SM, the less likely the child is to communicate, whether it be spoken, written, or nonverbal.

In a school setting, children with SM find it difficult to communicate with peers and teachers, join activities, and create friendships. They may freeze upon noticing themselves becoming the focus of attention, such as having their photo taken, playing sports in front of an audience, or passing something to a peer or teacher. They also find it difficult to ask for help. In class, they usually seem tired, distracted, and have trouble thinking clearly.

Diagnosis and treatment
The good news with SM is that it can successfully be overcome when diagnosed at an early age and treated appropriately. Once multiple signs are detected, it is important to contact the child’s primary healthcare provider, who will ask about their medical history, family history with anxiety disorders, along with the symptoms they demonstrated. Academic reports and comments from teachers may be requested as well.

Usually, the child will be given a full medical exam for their ears, tongue, lips, and jaw paired with a neurological exam to rule out any other possible medical conditions. The child will then be referred to a speech-language pathologist, psychologist, or psychiatrist who will help with further assessment.

Treatment varies depending on each child’s needs. Some require speech therapy. Others may require family and behavioral therapy for any emotional issues. Prescription medicine from a licensed psychiatrist to reduce anxiety may be another option.

Another treatment is stimulus fading, which is when the child is put in a relaxed situation with a person they can comfortably speak to and gradually bringing a new person into the room.
A 2020 study published in BMC Psychiatry found that if both parents have a psychiatric disorder, their child is three times more likely to develop SM.
Self-modelling is another option, which is when the child watches videos of themselves communicating well to emulate and boost their confidence. Shaping is another method that uses a structured approach of reinforcing all communication efforts made.

A 2019 study conducted by researchers at Al-Hussein Bin Talal University in Jordan found that integrating cartoon drawing was also effective in reducing the severity of SM in a sample of kindergarten students

If you are a parent of a child with SM, it is important to remain patient and remember that their inability to speak is not a choice but a genuine fear.

Stay closely involved with their therapy and follow all recommendations provided by the professional working with your child. Find ways to structure situations outside of your home to encourage and increase communication. Keep lines of contact open with their school — and specifically their teachers — to make sure your child is in an encouraging environment that understands their condition and supports their growth.

When your child begins to show progress, rather than expressing surprise, welcome the communication with the same warmth you would any other child, and praise all efforts made by them to interact with others, even if it is just a nod.

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