Selective mutism (SM) is a communication disorder in which a person, most often a child, who is normally capable of speech is unable to speak in given situations, or to specific people. Selective Mutism often co-exists with shyness or (often severe) social anxiety. Selective mutism is a disorder affecting both children and adults, but mostly children. Children and adults with the disorder are full
y capable of speech and understanding language, but can fail to speak in certain social situations when it is expected of them. It is in presentation an inability to speak in certain situations. They function normally in other areas of behavior and learning, though appear withdrawn and some are unable to participate in group activities. As an example, a child may be completely silent at school for years but speak quite freely or even excessively at home. There appears to be a hierarchical variation among those suffering from this disorder in that some children participate fully in school and appear social but don't speak, others will speak only to peers but not to adults, others will speak only to adults when asked questions requiring short answers but not to peers in social situations, and still others speak to no one and participate in few, if any, activities presented to them. In its most severe form known as "progressive mutism", the disorder progresses until the child no longer speaks to anyone at all, even close family members. Particularly in young children, SM can sometimes be confused with an autism spectrum disorder, especially if the child acts particularly withdrawn around his or her diagnostician; this can lead to incorrect treatment. Individuals with SM can communicate normally when in a situation in which they feel comfortable, as can many individuals on the autism spectrum, especially those with Asperger syndrome. Although children on the autism spectrum may also be selectively mute, they display other behaviors—hand flapping, repetitive behaviors, social isolation even among family members (not always answering to name, for example)—that set them apart from a child with selective mutism. If a child is simply not speaking in social situations, this is likely not an autism spectrum disorder, but may be SM. Children with SM are not necessarily autistic, but children with autism frequently are nonverbal. Many people with selective mutism have social phobia or other anxiety disorder such as obsessive compulsive disorder. Selective mutism is by definition characterized by the following:
Consistent failure to speak in specific social situations (in which there is an expectation for speaking, e.g., at school) despite speaking in other situations. The disturbance interferes with educational or occupational achievement or with social communication. The duration of the disturbance is at least 1 month (not limited to the first month of school). The failure to speak is not due to a lack of knowledge of, or comfort with, the spoken language required in the social situation. The disturbance is not better accounted for by a communication disorder (e.g., stuttering) and does not occur exclusively during the course of a pervasive developmental disorder, schizophrenia, or other psychotic disorder. The former name elective mutism indicates a widespread misconception even among psychologists that selective mute people choose to be silent in certain situations, while the truth is that they are forced by their extreme anxiety to remain silent; despite their will to speak, they cannot. To reflect the involuntary nature of this disorder, its name was changed to selective mutism in 1994. These views on the involuntary nature of this disorder are not without some controversy. Some researchers have contended that it is mainly caused by oppositional behaviour, while others maintain that it is the result of anxiety and shyness in general and social anxiety in particular. The incidence of selective mutism is not certain. Due to the poor understanding of this condition by the general public, many cases are likely undiagnosed. Based on the number of reported cases, the figure is commonly estimated to be 1 in 1000. However, in a 2002 study in The Journal of the American Academy of Child and Adolescent Psychiatry, the figure has increased to 7 in 1000 or 0.7%. Causes
Most children with selective mutism are believed to have an inherited predisposition to anxiety. They often have inhibited temperaments, which is hypothesized to be the result of over-excitability of the area of the brain called the amygdala. This area receives indications of possible threats and sets off the fight-or-flight response. Some children with selective mutism may have sensory integration dysfunction (trouble processing some sensory information). This would cause anxiety, which may cause the child to "shut down" and not be able to speak. Many children with SM may have some auditory processing difficulties. About 20–30% of children with SM have speech or language disorders that add stress to situations in which the child is expected to speak. There is no evidence that children with SM are more likely to have suffered abuse, neglect, or trauma though these cannot be ruled out. Children with SM nearly always speak in some situations (though their mutism may progress to the point where they cannot speak anywhere) while children with trauma-induced mutism usually suddenly become silent in all situations. Despite the change of name from "elective" to "selective", a common misconception remains that a selectively mute child is defiant or stubborn. In fact, children with SM have a lower rate of oppositional behavior than their peers in a school setting. Treatment
Contrary to popular belief, people suffering from selective mutism do not necessarily improve with age. Consequently, treatment at an early age is important. If not addressed, selective mutism tends to be self-reinforcing: those around such a person may eventually expect him or her not to speak. They then stop attempting to initiate verbal contact with the sufferer, making the prospect of talking seem even more difficult. Sometimes in this situation, a change of environment (such as changing schools) may make a difference. In some cases, with psychological help, the sufferer's condition may improve. Treatment in teenage years may, though not necessarily, become more difficult because the sufferer has become accustomed to being mute. Forceful attempts to make the child talk are not productive, usually resulting in higher anxiety levels, which reinforces the condition. The behavior is often viewed externally as willful, or controlling, as the child usually shuts down all vocal communication and body language in such situations, which can often be wrongly perceived as rudeness. The exact treatment depends mainly on the subject, his or her age, and other factors. Typically, stimulus fading is used with younger children, because older children and teenagers can recognize the situation as an attempt to make them speak. Some in the psychiatric community believe that anxiety medication may be effective in extremely low dosages but that higher doses may just make the problem worse. Effective treatment is necessary for a child to develop properly. Without treatment, selective mutism can contribute to chronic depression and other social and emotional problems. (Source from Wikipedia)
