By: Joleen Fernald, MS CCC-SLP, Doctoral Student, PediaStaff Clinical Coordinator

All children will experience social difficulties from time to time. This is not only a normal, expected part of growing up, but also an important learning experience for children. As they muddle through social problems with their peers, children will learn to negotiate, compromise and become increasingly more self-aware. Finding the solutions to these social dilemmas, however, can come easily to some children and not so easily to others. Socially “savvy” children tend to be good problem solvers; they seem to have an innate sense of what to do, when to do it, and how to apply it in social situations. These children tend to be more popular with peers as a result of this savvy as they appear more capable. Appearing more capable to their peers can translate to social confidence and a positive sense of self.

Imagine pushing your two-year-old through the grocery store when you happen upon a friend. Your friend bends down and looks at your child, “Hello, what’s your name?” Your child puts his head down and avoids eye contact. “How cute!” Your friend says, “He’s so shy.”

Imagine having to participate with your child in their dance class every week, because she wouldn’t move from her “X” until you physically moved her.

Imagine dropping your child off at preschool every morning and having her scream and hold on to you…every day…for the entire school year.

Imagine helping out in your child’s classroom and having her whisper something to you across the table… another child says, “I didn’t know she could talk.”

For parents of 7 out of every 1000 children, this is more than imagination; this is reality. It is a small glimpse of what some families experience when they have a child with selective mutism.

Selective Mutism is a complex childhood anxiety communication disorder characterized by a child’s inability to speak in select social settings, such as school. These children are able to talk normally in settings where they are comfortable, secure and relaxed. Children and adolescents with Selective Mutism have an actual or perceived FEAR of speaking in social interactions where there is an expectation to talk. They often stand motionless with fear as they are confronted with specific social settings. These children are so anxious they literally freeze, are expressionless, unemotional and often, socially isolated.

When anxious, children with SM may have blank facial expressions, have difficulty with eye contact, and have awkward and stiff body language. These children are not able to initiate play. They often stand on the edge of the classroom, observing everything going on around them, but unable to join in. They follow the rules and try desperately to not be noticed. These characteristics are different than the behavioral manifestations often observed at home. When comfortable, children with SM may be moody and assertive. They may be inflexible and controlling. Frequently, they are extremely talkative and precocious. Most children with SM are intelligent and sensitive to the feelings of and thoughts of others.

The majority of children have a genetic predisposition to anxiety. In other words, they have inherited anxiety from various family members. Very often, these children show signs of severe anxiety, such as separation anxiety, frequent tantrums and crying, moodiness, inflexibility, sleep problems, parental separation issues, and extreme shyness from infancy on. Because most of these children have a persistent fear of performance or social interaction, they manifest symptoms such as freezing, lack of smiling, expressionless face, and mutism as a direct response to fear and anxiety… There is NO evidence that the cause of Selective Mutism is related to abuse, neglect or trauma.

The main goal with treatment is to lower anxiety, increase self-esteem and increase confidence in social settings. Emphasis should never be on ‘getting a child to talk.’ ALL expectations for verbalization should be removed. With lowered anxiety levels and confidence, verbalization will eventually follow. A professional should devise an ‘individualized treatment plan’ for each child. Research indicates that the earlier a child is treated for Selective Mutism, the quicker the response to treatment, and the better the overall prognosis. If a child remains mute for many years, his/her behavior can become a conditioned response where the child literally gets used to non-verbalizing. In other words, Selective Mutism can become a difficult habit to break! However, with proper diagnosis and treatment, the prognosis for overcoming Selective Mutism is excellent!

Joleen Fernald, MS, CCC-SLP, is currently a PhD student studying infant mental health and developmental disabilities. She follows Greenspan and Wieder’s model, DIR/Floortime, when working with children and families. She has a special interest in the social emotional development of young children and its impact on their speech and language skills. As a speech-language pathologist, Joleen works with children who have a variety of communication disorders. She partnered with Easter Seals NH in 2008 to begin an assessment and treatment clinic specifically for children with selective mutism. She enjoys public speaking and has presented nationally on the topics of childhood apraxia of speech and selective mutism. In addition, she also works for PediaStaff as their SLP Clinical Coordinator.

All material Copyright © 2009 Joleen Fernald and Easter Seals of New Hampshire
Reprinted with the express permission of Joleen Fernald.

2 replies
  1. Kelli O'Brien
    Kelli O'Brien says:

    I have a 14 year old Daughter with diagnosed SM (diagnosed age 5 by a teacher to start!!). She entered High School this year with the School being told/identified her with SM. (letter on file by Dr) We brought her to a Dr (psychiatric) at CHEO who wrote the note she had SM. Immediately she wanted my Daughter to start drug therapy, something my Daughter did not want to do. We asked for behavior modification therapy, Dr said “No she would only prescribe drugs” In turn my Daughter refused to go back. She does not want to be ” a changed person just wants people to understand”

    It should be noted she did well in her previous School (Grade 1-8) as they UNDERSTOOD her SM and took the extra time to learn about it and my Daughter as a person.

    Despite all the efforts made with the High School (ex, she is NOT to be called on individually in class to get up and speak on command) it is happening..time and time again. I call the School, always an excuse of (“sorry Teacher did not realize”, etc) Today I called, as yesterday she was called upon in Math (which happens to be the subject she is not comfortable to begin with) to answer in class not once, but twice, and I have now found out 6 times alone this week! My Daughter came home, through the door, into silence, I knew before she even told me… just by her actions.

    I called the School as mentioned, they finally admitted “they have never dealt with students with S.M.” alot of mistakes will be made. I understand not everyone knows or understands SM, however it appears they are not even willing to make the effort on their own. They told me to keep calling in every time they make a mistake (because of course my Daughter will not tell them) but with each mistake they make my fear, that they are driving my Daughter closer to the brink of refusing to go to School as she feels nobody cares that sometimes she “just can’t speak”

    She has a circle of good friends that she speaks too, in addition to us (myself her Mom, her Dad and her older Sister) and some members of extended family.

    Is there any resources you have that can help me make them understand SM is REAL and how these constant mistakes can be very detrimental to her and her future (her dream one day is to be a marine biologist) at this rate I am worried sick she will not make it through this semester of Grade 9.

    We are located near Ottawa Ontario, and trust me there are no specialists in SM (and sorry I do not count a Dr who just wants to stuff drugs into her as a specialist in SM, as she had to keep referring to her textbook about SM as she just deals with Generalized Social disorders)

    Please any and all help would be so appreciated.


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