Being shy as a child can be so hard, can’t it? I remember when I was quite young, feeling so anxious about speaking to anyone I didn’t know (even people I DID know) and how everyone used to say to my mum: “Oh isn’t your little girl shy” and then proceed to make me feel even worse by making me answer silly questions when all I wanted to do was hide behind my mum and cover my face with my arm! So why are some of us shy as little ones? Well, there are many different reasons.
Shyness is partly a result of genes a person has inherited. It’s also influenced by behaviours they have learned – the way people have reacted to their shyness, and life experiences they have had.
In my children’s therapy clinic, I often get mums and dads asking me “Does my child’s shyness and social anxiety mean that he has autism?”
That’s always a difficult question to answer because to get a diagnosis of autism we need to look at many other aspects of the child’s a personality/behaviour/environment.
So, what exactly is selective mutism?
When a child has selective mutism, they are usually talking normally at home with their parents and siblings but “choose” to stay quiet at school or elsewhere. Selective mutism is not the child being controlling, or naughty or even manipulative – it is an anxiety disorder that usually starts at around three or four years old, however, it might not be diagnosed until the child is a little older. I have known many children go for very long periods (sometimes a year) without speaking at school at all, not to the teachers nor his little classmates. At first, the teacher might simply assume that the child is just very shy, and tell the parents not to worry, that it’s just a phase, and it’s only when it has gone on for a good length of time that the parents take action and visit the GP.
So, what are the actual signs of selective mutism?
- Not being able to speak to familiar people that he knows even with the parents there.
- Appearing as if in a trance when faced with a social situation
- Using gestures, like nodding or shaking his head to communicate
- Doesn’t talk to his classmates
- “May” talk to his best friend but only in a whisper
- At school he will not speak to teachers
- Wetting himself at school because he won’t ask for the toilet
- Won’t engage in any games that involve talking
- Won’t go on play dates or sleep overs
- Teacher notices it is affecting child’s learning at school
Some people wrongly think that the child with selective mutism is being naughty or sulky and just doesn’t want to talk. The reality is – he is so anxious he can’t talk, he can’t get the word’s out. So, he’s not being oppositional or controlling, he literally just can’t do it. Some people also think that just because a child is selectively mute that he may have been traumatised in some way (neglected/abused/abandoned) but if this were the case he would more likely be totally mute in all situations, even at home, not just specific social environments.
What treatment is there for a child with selective mutism?
The treatment for a child who has SM has to be a team effort with the parents, the teachers at school and grandparents and other family members. Once the child has seen the GP he will normally refer the child to either a speech and language therapist to establish if there are any speech delays, or may refer to CAMHS to be seen by a paediatric psychiatrist who can rule out other conditions such as autism, or trauma related psychosis.
Alternative therapies such as children’s hypnotherapy sessions are brilliant for working with the child’s subconscious mind ( that’s where all the anxiety is) and I have treated many a child with SM and social anxiety, with very high success rates. Sometimes we never know the root of the problem – it could be something the child has heard/seen/felt – and then decided it was best he didn’t speak! (not consciously deciding though) once we have dealt with the anxiety the child usually starts talking fairly quickly.
For example one of the mums who brought her son Jacob (4) to me said:
“Jacob hadn’t spoken at school or in any social places for over a year and spoke very little to me and his dad as well, and I was getting worried as he would be starting school soon so I took him to see Elaine as she is a very well- known Children’s Behavioural Therapist. Jacob didn’t speak for the first three or four sessions but in the car, on the way there once he said: ‘I like going to see Elaine and the monkey – she’s a funny lady!’ and from that day he just started speaking normally. I almost crashed the car when he said that I was so surprised!”Sarah Wilcox
I used different techniques with Jacob, for example I used glove puppets and he had one on his hand and I had the other and we pretended we were in the classroom of his new school and he was speaking to the teacher. He would speak to the puppet at first but not to me but that was fine – that was my aim – to make him feel at ease. Sometimes we would pretend we were in a café or a pizza restaurant and mummy was there too, so I taught her not to order his meal for him but to allow him to do it. It’s a case of getting the child to feel comfortable in different social surroundings. Parents and carers must learn not to keep “rescuing” the child when someone speaks to him or asks him a question as he needs to be exposed to all sorts of communication.
Getting the school on board
It’s important to get the school involved when a child is having therapy for SM. Many teachers may not have even heard of SM or they may not realise that its not something that the child is doing on purpose.
Also, the child’s teacher may simply get used to the child not saying anything, they almost “adapt” to the child’s silence, or even get used to other children answering for him, which of course is not going to help him improve.
Three good tips for helping your SM child to talk
- Use specific (labelled) praise such as “Well done Johnny! Great that you asked to go to the toilet!”
- Ask a question that is going to prompt a verbal reply such as “Would you like a chocolate biscuit or a plain biscuit?”
- Wait for a response; Sometimes we don’t give our children enough time to respond to us – if you can wait around 5-7 seconds before you repeat the question or answer for him, it will help him tolerate those anxious feelings.
How can other family members help a selectively mute child?
Children with selective mutism are often unable to speak around some extended family members or close family friends, which can be stressful for everyone and can cause some problems, particularly if the child is thought to be naughty stubborn, or even manipulative, which isn’t nice for the child at all.
Explaining to family members what selective mutism is and getting them to understand how they can help is important. Some therapists meet with grandparents and other important members of the family to teach them how to help the child. I’ve done this myself in my own clinic and we have had such a great response from the family members. I even had one grandma say to me that she felt awful because she had accused her daughter of being “too soft” with her son! When family members are included in a child’s treatment, they are usually very keen to help him get better.