I feel like the words are locked behind a door and I don’t have a key,” says a child suffering from selective mutism (SM). In a relaxed, familiar setting like home, children with SM are usually fluent speakers, but they fail to utter a word the moment they step outside their comfort zone. They are misunderstood to be shy, or worse, defiant and stubborn, because of their inability to speak.
However, their condition goes deeper than shyness. It’s not like children with SM choose not to speak; they simply cannot, due to an overwhelming anxiety. It is not a phase they outgrow, and without help and timely intervention they are in danger of withdrawing and shutting out the world.
SM is a relatively rare anxiety disorder that usually gets noticed during early childhood, when children begin school. Children with this disorder can only talk in select, non-threatening social settings and with a few family members or a friend or two with whom they feel secure. In a place like the classroom, these children are likely to communicate non-verbally, through nods, gestures, or by writing out their responses.
Children with SM are genetically predisposed to anxiety and their condition is not necessarily due to emotional trauma, abuse or neglect. Not being able to speak in select social settings, despite being fluent in the spoken language and having the ability to talk normally, is a manifestation of this anxiety. “I find it incredibly sad to think my little girl must be so anxious she can’t speak,” says the mum of a child suffering from SM. Once the children fall into a pattern of not speaking, it becomes a habit, and mutism is entrenched.
Children with SM can go without diagnosis for years, making it harder to treat. According to Dr Elisa Shipon-Blum, president and director of the Selective Mutism Anxiety Research and Treatment Center, Pennsylvania, SM is “the most misdiagnosed, mismanaged, and mistreated anxiety disorder of childhood. Children with selective mutism truly suffer in silence, and yet most people completely misunderstand the child’s silence.”
However, the condition can be diagnosed by health professionals based on observations such as the child’s consistent inability to speak for over a month. The Child Assessment Service of the Department of Health and the Institute of Mental Health at Castle Peak Hospital in Hong Kong can offer assessment and treatment of anxiety disorders.
SM can be cured with therapy and occasionally medication helps. Therapy focuses not on speaking, but helping the child overcome anxiety, the root cause of the problem. Techniques such as ‘stimulus fading’ are used, where the child talks to a parent and a new person is gradually introduced until the child is comfortable talking to him or her. Another method is desensitisation, where the child is encouraged to build conversations using emails and text messaging, until they feel ready to take on direct verbal communication.
The process might be painfully slow and require immense patience, but it helps release the child from the grip of a social phobia which, when left unchecked, can lead to a lifetime of isolation and suffering.