Treating Selective Mutism
Selective mutism is a somewhat uncommon disorder that is often found in patients who also have social anxiety or a social phobia. With selective mutism, the child is able to speak and communicate effectively in setting that make them feel comfortable and secure. When they are in social settings such as school, church, or play groups, they may be unable to communicate or speak effectively.
This disorder is especially debilitating for children because the fear of speaking makes it impossible for them to engage with peers or educators even though they are able to understand what is going on around them. Many of these children are also unable to respond in a nonverbal manner when in social settings, making communication that much more difficult.
As with most speech disorders, there are varying levels of severity. The most severe occurrences manifest as a complete inability to speak at all. Other patients may be able to whisper or say a few words to those around them. They might be able to talk to one or two people even in the social setting, yet be unable to respond to a teacher or a peer with whom they are not comfortable. Unsurprisingly, this can lead to self imposed isolation as the child tries to avoid the situations which makes them feel the most vulnerable.
There are a number of other issues that may be present in patients with selective mutism such as a sensory processing disorder, severe anxiety, speech abnormalities, language delays, auditory processing disorder, and inhibited temperaments.
Interestingly, there is a small percentage of patients with selective mutism that do not exhibit any indications of shyness. These children will often seek out interaction and communicate with gestures with little or no reservations.
The difference between selective and traumatic mutism, is that those with selective mutism will speak in at least one setting. Children with traumatic mutism will refuse to speak in all settings.
Treatment often begins with introducing techniques to reduce the anxiety associated with speaking with others, enhancing self-esteem, and building social confidence. Treatment may involve several components delivered by a group of professionals, including behavior modification, play therapy, cognitive behavioral therapy, socialization, drug therapy, school accommodations, a supportive home environment. Speech therapists are best suited to work with behavior modification to improve functional communication.
Stimulus fading or acclimation is one approach that has been effective with some patients. To begin, the child is introduced into a social situation with a person with whom he or she is comfortable speaking. The individual is slowly pulled back and interaction increases with other members in the social setting. This is not something that will happen in a single session; it must occur slowly as the child’s anxiety decreases.
Reinforcing is another option. With this, the child is given something he or she really wants when they attempt communication. The greater the attempt, the more of the reinforcement the child receives. For this to be effective, it must be something that truly motivates the child, and that they are only given to reinforce speech and communication efforts.
It is important to be aware that because there have been very few studies into the most effective treatment of selective mutism. Therefore, gathering data and being adaptive in treatment will play a significant role in the efficacy of therapy.