Treating Selective Mutism

Children with selective mutism may behave normally at home and around friends or relatives with whom they are comfortable. In less comfortable situations however, such as being at school, they can shut down communication altogether, not speaking or making eye contact with anyone. The diagnosis for “elective mutism” formerly implied that children with the condition were “stubborn, oppositional kids” who’s “refusal to speak was a manifestation of that.” Today, doctors have concluded that selective mutism is more a manifestation of social anxiety disorder and “the perception - real or imagined - that they are in danger.”

Both medication and behavioral or cognitive therapies have been used to treat selective mutism with some success. Antidepressants such as Prozac and other selective serotonin reuptake inhibitors have helped children overcome their anxiety and therefore their problems with communication. However, because of the loosening of inhibitions caused by antidepressants, the drugs have also caused children to engage in inappropriate and equally disruptive behaviors. “Classic desensitization or the gradual exposure to frightening situations, with a lot of positive reinforcement” has been the preferred choice of many parents, particularly those with young children. The two treatments can, of course, be used in combination with one another.

As teachers, it is important to be able to recognize selective mutism and take action as soon as possible. Parents often mistakenly assume that the disorder is shyness, or that it is just a phase and that the child will grow out of it. Research actually shows that if the disorder is present in a young child, he or she is likely to struggle into adulthood. Furthermore, most experts advise that “the earlier the treatment, the better the outcome.” Although the condition only occurs in around 7 out of every 1000 children, it is still an important disorder to be able to recognize and advise upon as a teacher.

Contributed by: Michael Lederman

Brown, Hariet. (April 12, 2005). "The Child Who Would Not Speak a Word"
http://www.nytimes.com/2005/04/12/health/psychology/12mute.html?ex=1185854400&en=4178387ab59cf186&ei=5070