To be mute means that you cannot talk. There are many causes of mutism, but selective mutism (also called elective mutism) happens only to children under five years old. The patients are able to speak but only when they feel relaxed and sometimes in private.
Talking in public or where there are many people such as at school or church is too frightening for them. It may take months to diagnose selective mutism so doctors and therapists can rule out other causes of refusing to talk such as hearing loss, autism or stuttering.
Although the exact cause of selective mutism is unknown, most children with it also suffer from an anxiety disorder such as social phobia. Other children may have speech problems or problems with their senses that compound their fear of speaking.
Symptoms can differ with each child but the main symptom is a total refusal to speak in social situations. This may also be accompanied by a blank stare, stiffening of the body and any behavior the child usually does when anxious. The child can speak when happy and relaxed when there are not do many people around. Talking to a doctor may also be difficult for a child.
Uncommon symptoms include loss of bladder control, refusing to eat in public, sudden diarrhea, sudden abdominal cramps and nausea with or without vomiting.
An inherited predisposition to anxiety is the general consensus as to the cause for selective mutism. The amygdala consists of two areas of the brain which are a part of the limbic system, and it is probably an over-excitability of these areas which leads to inhibited temperaments in the children who are affected by this syndrome. The fight-or-flight response is mostly regulated by the amygdala area of the brain, and so this excess agitation leads to problems. It has been proposed that social anxiety disorder is likely the cause of selective mutism because of the fact that there is a very high overlap between the two conditions in a great majority of the cases which have been diagnosed. Trouble processing sensory information is also seen in many cases of SM, and so it is that many of these people have anxiety and a sense of being overwhelmed in many different situations.
There is no specific cure or therapy for patients with selective mutism but many children grow out of it with therapy and positive reinforcement. Many types of therapy are available to help relieve anxiety and boost the child’s self-esteem. Speech therapy can help reassure the child that he or she is speaking normally.
Since the patient is so young it is usually too dangerous to give the child anti-anxiety medications.
Working with the child’s teachers can also help the child learn that communication brings rewards. Perhaps writing down answers, using flash cards or gestures may help. Having the child work in small groups of kids instead of having to talk to the whole class may also help.
School psychologists may play a key role in helping to prevent selective mutism by providing the proper screening and treatment options to intervene early enough so that it does not become unmanageable. Even changing to a different school might be a good option if the new location is highly supportive. An accommodating and supportive environment is one of the most important factors in any instance of selective mutism treatment in order to prevent the condition from worsening. Self-modeling is one of these treatment options which involves bringing the affected child into a classroom where there is trouble speaking and then videotaping. Once the child refuses to answer then the teacher is replaced by a parent or another figure who the child is more comfortable with. There are also treatment and prevention mechanisms known as mystery motivators, stimulus fading, desensitization, as well as some drug treatments.