Not all children are “incorrigible whys.” Some people prefer to remain silent because they are shy. And this is normal - when a child relaxes and gets used to the environment, he communicates without problems with peers and adults. But in some cases, a child’s complete silence in a given situation is not a consequence of low self-esteem. This is selective mutism.
The child babbles happily at home, but does not make a sound in kindergarten or school. Or vice versa - he communicates normally with his peers, but in front of his mother and father he becomes silent, so that words cannot be questioned. Situations familiar? Your child may need help speaking.
Selective mutism: what is it?
Selective mutism is also called selective muteness. According to medical references, it is a disorder characterized by a persistent inability to speak in certain situations, despite the preserved ability to speak normally in other situations. Selective mutism in the ICD-10 (International Classification of Diseases) is called selective mutism and is included in the section “emotional and behavioral disorders, usually beginning in childhood and adolescence.”
The topic of selective mutism is not very popular. And often children with this disorder cannot receive quality help for a long time - either parents do not attach importance to the child’s “strange” behavior, or doctors make erroneous diagnoses.
They started talking about selective mutism more loudly thanks to environmental activist Greta Thunberg. She was diagnosed with Asperger's syndrome and obsessive-compulsive disorder at the age of 11.
According to Greta Thunberg, selective mutism for her is a reason to speak only in cases “when it is absolutely necessary.” And indeed, Greta is quite emotional behind the podium, but at home she is mostly silent.
Treatment
The main treatment for selective muteness is psychotherapy.
Its task is to eliminate depression, anxiety, social phobias, and develop social communication skills. The following methods are used:
- Cognitive behavioral therapy. The psychologist works with the patient individually, looking for ways to establish contact. The specialist reads fairy tales, together they sculpt and draw. Creativity helps a child express his negative emotions and experiences. Suggestive therapy (suggestion) allows you to adjust the patient’s attitude towards society, and gaming techniques help to gain communication skills using speech.
- Behavioral group trainings. During their course, the patient comes into contact with people of different ages verbally and personally. This is how he manages to overcome his shyness. Reinforced skills are rewarded with praise.
- Family counseling involves working with parents. They are given full information about selective mutism, taught how to communicate with children, and told how important praise is to children. They also acquire the ability to stimulate expanded expressions in their children. Parents need to support their child and help him.
A speech therapist also takes part in the treatment. It corrects articulation disorders, improves speech, makes it clear and well understood.
Pharmacotherapy is rarely used. It is indicated for depression, social phobias, and anxiety. A psychiatrist can prescribe nootropics, tranquilizers, antidepressants.
How does selective mutism manifest?
In adults, selective mutism is extremely rare. As a rule, the disorder makes itself felt at the age of 2-5 years. However, it often remains unrecognized until the child enters kindergarten or school.
The main complaint of parents of children with selective mutism: “my child is very capable, he speaks and reads at home, but in school the teacher cannot get a word out of him.” At the same time, adults cannot accurately indicate the age when their baby began to have problems with communication. Parents often say that their child has “always been like this”—anxious, withdrawn, shy.
The main symptom of selective mutism in a child is his inability to speak in a given situation. As a rule, these are large crowds of people and communication with adults. At the same time, the baby’s speech, when he is still not silent, may not have any defects at all.
According to the findings of Priscilla Wong, a pediatrician at the Department of Pediatrics in Washington, DC, children with selective mutism often exhibit other symptoms in addition to speech impediment:
- shyness;
- fear of large crowds of people;
- difficulty maintaining eye contact;
- difficulty expressing your feelings;
- sensitivity to noise and crowds;
- reluctance to smile.
Children with selective mutism are afraid of making mistakes and do not like to be the center of attention. Selective muteness is a kind of shield for the baby, which helps him remain invisible, so as not to suddenly attract attention to himself. But psychologists say that children with selective mutism often have high intellectual abilities and love art. But their development is hampered by difficulties in communication.
What is this
Such muteness, caused by psychological factors, is also called selective, psychogenic, partial, situational, characterological, voluntary. This disorder is quite rare - it occurs in 1 in 150 children, regardless of gender, geography, or social level. As a rule, it is characteristic of a child starting the educational process: in many nursery groups and primary schools there is at least one such child.
However, recently a trend has been identified: selective mutism has begun to appear more often among children of migrants (girls) who have recently moved from their home country.
This disorder, classified as an anxiety disorder, makes itself felt at an early age, but then it is usually attributed to the child’s character traits, excessive shyness, etc. It manifests itself more strongly during the period when the child begins to leave the family circle and interact with those not close to him. him people (kindergarten, school). The situation and surroundings change and this is very scary for the little man.
The basis of selective mutism is passive aggression, which the child cannot express in any other way due to self-doubt and timidity. He still has few means of self-expression; he cannot fully express his feelings, desires, and problems. In silence, the baby protests against the pressure of society, parental control and misunderstanding, overprotection, a situation that traumatizes his psyche. He does not want to establish contact, since he is not understood here, and becomes silent for a while, believing that problems will be solved by themselves.
This selective muteness lasts up to several months and goes away on its own. But there are also cases when the disorder lasts much longer, remains and can manifest itself in a teenager and an adult, being much more severe than at a “tender” age. Phobias, social anxiety disorders, and self-isolation are also added to it. Life becomes unbearable. Therefore, this pathology must be treated.
Reasons for the development of selective mutism
Scientists have so far refrained from identifying specific reasons for the development of selective mutism. But experts often associate the appearance of the disorder with increased anxiety in the child. In children diagnosed with selective mutism, the medical history in most cases is burdened by various anxiety conditions and social phobias.
Scientists have identified cases in which selective mutism syndrome developed after a child suffered psychological trauma. Little patients withdrew into themselves, stopped speaking in certain situations or were completely silent all the time.
Psychologists do not abandon another theory that would explain the development of selective mutism - heredity. It is believed that the disease can appear in children whose parents have anxiety disorders.
About 20-30% of children diagnosed with selective mutism have speech impairments, which only adds stress to situations in which the child must speak.
But doctors have not yet discovered a connection between autism and selective mutism. A child can have both diagnoses, but neither of them provokes the development of the other.
Causes
Selective mutism develops based on a person’s psychological characteristics, and the trigger is environmental influences.
Risk factors:
- mental disorders - mental retardation, speech defects, schizophrenia at the initial stage;
- neurological disorders - unstable nervous system, hysterical neurosis, traumatic brain injury, tumors, neuroinfections and other organic brain lesions;
- emotional component of character - vulnerability, natural silence, indifference, shyness, impressionability, love of solitude, anxiety, habit of suppressing aggression;
- peculiarities of upbringing: uncomfortable climate in the family - complete control of the child’s life, overprotection, lack of attention, aggression, violence;
- heredity – insecure parents with depressive disorders and high levels of anxiety;
- stressful psychotraumatic situation - parental divorce, death of a loved one, violence, accident, family moving to another, unfamiliar country.
There is a misconception that psychogenic muteness is associated with autism. In fact, these are completely different pathologies. Moreover, both of them can develop in the same child.
“Like a lump in the throat”: how children with selective mutism explain the inability to speak
To further study selective mutism, children with the disorder are often asked what prevents them from speaking in a given situation.
The answers are very different. “I can’t start talking, because then everyone will immediately pay attention to what I’m doing,” this is how a teenage girl explained her condition at an appointment with an American psychologist who was treating her.
Some older children describe the feeling of a large lump in their throat that prevents them from speaking.
Diagnosis of mutism
Sometimes it is quite difficult to recognize a disease, especially when it comes to children, because the line between a whim, an act of protest and a psychological disorder can be very arbitrary. To avoid the disease becoming chronic, the following diagnostic tests are carried out at the first alarming symptoms:
- General medical history;
- Examination by a neurologist. A number of studies are being carried out, which will include an assessment of the quality of speech, reflexes, breathing rhythm, and an analysis of the presence/absence of neurological pathologies;
- Craniogram. To draw conclusions about what the patient's brain looks like, an X-ray of the skull is taken;
- CT and MRI;
- Electroencephalography. Without analyzing the level of electrophysiological processes that occur in the brain, it is impossible to create a complete clinical picture;
- Urine and blood analysis.
As necessary, the patient must undergo a number of additional studies and consultations with related specialists.
Treatment of selective mutism
When parents attribute a child's complete silence in certain situations to shyness and withdrawal, they miss the opportunity to take timely measures to help their child communicate normally.
Clinical psychologist and ABA therapist Ekaterina Olegovna Matsapura explains how selective mutism in children is treated.
“If the disorder is not corrected, selective mutism will continue to develop into adulthood. It is very important to understand: mutism is not a temporary phenomenon; it cannot be “outgrown”!
What should parents do if their child suddenly stops speaking in kindergarten, school, or with some relatives? First of all, we need to conduct a mini-diagnosis in order to make sure that we are dealing with mutism and not another disorder similar to it. Observe your child's behavior.
- Assess what situation causes silence and whether this behavior is permanent for her. For example, you know for sure that at home the child learned this verse and told it to you perfectly, but at school or kindergarten he simply cannot utter a word.
- See how the child behaves in a comfortable situation, when he is alone or with loved ones. Is he involved in games, can he support and initiate dialogue?
- Does the inability to speak interfere with a child’s normal adaptation to society?
- The inability to speak lasts at least a month and is situation-specific.
- The inability to speak is not a consequence of other mental and behavioral disorders, such as autism spectrum disorder.
If these diagnostic criteria reflect your situation, it's time to intervene.
Only you yourself, your hard work, and inclusion in therapy completely and completely can help your child. Under no circumstances should you wait for a magic pill. Even the most qualified specialist will not “fix” a child without proper parental support.
Because the nature of the disorder is unclear, treatment for selective mutism is best approached through psychotherapeutic behavior modification. For example, ABA therapy, cognitive behavioral therapy and direct behavioral therapy.
The emphasis in correcting the disorder is precisely on changing the behavior of parents and a supporting group of people - teachers, speech therapists, educators, nannies. A child with selective mutism is most often afraid of any attention to himself, as this causes him to feel severe anxiety. Therefore, it is most painless and effective to teach parents new behavior strategies.
It is important that loved ones can promptly and delicately encourage the child’s behavior and retreat when necessary. The basis of behavioral intervention is the gradual elimination of unwanted behavior through reinforcement and training in replacement behaviors.
With prolonged exposure to selective mutism, other mental disorders may occur - anxiety, depression, phobias. And therefore you should seek medical help from a psychiatrist. This is especially important for children with advanced mutism, as well as for adults with this disorder. Pharmacotherapy helps alleviate the condition, increasing the chances of successful psychotherapy.
The effectiveness and result of assistance will also depend on the coherence of the team. All adults around him should participate in the child’s adaptation and teaching him to “speak.”
How can I help a mutista?
The process is reminiscent of a joke: the class was late for class. The surprised teacher asked everyone a question, and was even more surprised when she learned that the whole class was helping the old lady cross the street. Where is there to laugh? The fact is that she categorically did not want to cross the street!
The state of mutism in both a child and an adult is often dictated by a feeling of fear, resentment and “betrayal,” and the pathology itself is revenge on the “offenders” for the moral and mental damage caused. And the mutist indulges in this revenge with fierce ecstasy.
Therefore, the “old lady” often has to be “transferred across the street” “with the whole class.” And all the means that can help are good here.
Treatment of mutism is a complex of skillfully combined psychotherapeutic and medicinal effects, provided both in an outpatient and inpatient setting. After understanding the reason that gave rise to the phenomenon of mutism, it is eliminated.
In adulthood, this may be the elimination of a hematoma or surgical excision of a tumor or cyst that affects the functioning of the brain, leading to healing from the akinetic and apalic modification of mutism.
In the case of a psychiatric illness leading to muteness, it is appropriate to use “tongue loosening” antipsychotic and other specially used drugs:
- neuroleptics;
- antidepressants;
- benzodiazepine drugs;
- selective serotonin reuptake inhibitors.
To regulate the functioning of the vessels that supply the brain with nutrition and to enhance metabolism in its tissues, medications are used:
- antispasmodic;
- pain reliever;
- sedative effect;
- nootropic drugs.
Providing psychological assistance to the patient (in the case of selective mutism) consists of:
- in conducting conversations that distract him from living in a traumatic situation, such as a plane crash or an incurable disease in a close relative;
- in working with worries and anxiety, learning actions to overcome stressful situations, mastering social communication skills;
- in the correction of facial expressions and similar measures.
In addition to drug therapy and psychological assistance, additional techniques are used in the form of:
- breathing exercises;
- massage;
- therapeutic and corrective gymnastics;
- art therapy;
- phototherapy.
Instilling social skills is also necessary.
In the case when a mutist patient is bedridden, measures are taken to ensure careful care of the skin, oral cavity and respiratory organs, as well as nutrition (if necessary, tube or parenteral).
How parents can help their child
Do not put pressure on your child, do not force him to speak!
It is better to support your child and talk to him about topics that concern him, showing in every possible way that you are on his side.
Encourage your child to communicate by changing the environment. Visit places that resonate with your child more often. Focus on pleasure. Let him talk excitedly about the movie he watched or his trip to the water park.
Play with your child, learn to receive positive emotions and give them. Praise for interacting and playing with other children.
Praise delicately! Selective mutism does not tolerate aggressive encouragement. It is better to change the usual verbal praise into tokens or stickers. Create a reward system at home that will be clear to your child. Answered today at school - keep the chip. Collected 7 chips in a week? Get the ice cream! Be sure to ask the little person what he would like as a reward for his own work.
Create a visual schedule so your child knows what to expect during the day. Write it down in as much detail as possible, especially paying attention to those situations in which it is difficult for the child. Try to be neutral in your description, showing only the facts and giving the child ways to cope with the situation. For example: “if you want to leave the class, raise your hand, wait for the teacher’s question and ask if you can leave.” These measures will help reduce anxiety.
Don't be too emotionally surprised when your child does speak. Let this be the norm. Don't focus on the fact that there was something "wrong" with him.
For older children, individual support and approach are recommended, since mutism at this age is strongly mediated by the environment. In this case, it is imperative to consult a psychologist.”
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Experts: Ekaterina Olegovna Matsapura
My experience working with children with selective mutism
The boy Timur came to kindergarten at the age of 3.2 years. Mom immediately warned: he is silent, does not speak. After finding out the details, it became known that speech is fine at home, but in the presence of strangers it completely disappears.
For the first two weeks, the baby, while in kindergarten, did everything automatically: he ate himself, dressed himself, fulfilled all requests and instructions. Mom, seeing how independent he was, was very surprised: at home she had to feed him with a spoon - he didn’t eat on his own. It was most likely related to anxiety as well. In kindergarten, he tried to do everything in such a way as to interact less, so as not to be scolded. I missed my mother, but I also cried silently, only the tears flowed. He practically did not smile, there was almost no facial expression. I understood the speech perfectly.
After a few months, he began to behave more calmly in the garden, interacted with the children, played, participated in joint activities, but was still silent. A kindergarten psychologist worked with him, relieving muscle and emotional tension, and the child was also observed by other specialists outside the kindergarten. He began speaking in kindergarten only at the age of 6, thanks to the long-term help of doctors, psychologists and speech therapists. Today the boy is no different from his peers.
