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The Sound Of Silence

C.B. Gavant

Being quiet is the only way some little children know how to scream for help. A closer look at selective mutism — the causes, the hardships, and how parents can help their kids find their voice again.

Wednesday, May 04, 2011

At four and a half years old, Adina* is a friendly — if shy — preschooler. When she’s at home, she loves to color, play with her dolls, and “read” to her baby brother. In school, however, things are entirely different. Whenever anyone speaks to Adina, the only response they receive is a shake of the head or a nod. Adina won’t participate in show-and-tell, and she sits alone at circle time, never opening her mouth to daven, sing, or shout out answers like the other little girls. She won’t even whisper. In fact, Adina’s teachers and classmates have never once heard her voice.

Adina is a selective mute. She can speak normally and does so freely at home, where she feels safe and protected. But in the classroom setting, she retreats into a shell and refuses to verbally communicate, no matter how hard her teachers try to draw her out.

Behind the Silence

The American Psychiatric Journal defines selective mutism as a child’s inability to speak in a social setting, generally a classroom, despite a clear ability to speak in familiar places, such as the home. To be diagnosed with selective mutism, specialists look for a pattern of speechlessness that lasts for more than one month, not including the child’s first month in school.

The disorder can have a range of manifestations: from mild cases, where children won’t talk to teachers but have no problem chatting with peers, to extremely severe cases, where a child will speak only to immediate family members and not communicate with others at all, even through nonverbal means such as gestures or facial expressions.

Contrary to popular belief, research has shown that selective mutism is more than just extreme shyness. The Diagnostic and Statistical Manual of Mental Disorders (DSM) lists selective mutism as an anxiety disorder, and most mental health professionals recommend treatment accordingly.

“Most cases of selective mutism are not the result of a single traumatic event, but rather are the manifestation of a chronic pattern of anxiety,” writes Dr. Robert L. Schum, a clinical psychologist and associate professor in the department of pediatrics at the Medical College of Wisconsin.

“Research shows that most children with selective mutism were anxious in social situations from an early age,” notes Dr. Richard Gallagher, co-director of the selective mutism program at the New York University Child Study Center, in an article he wrote about the disorder. “Their history often includes a toddler period of appropriate language development at home, but clingy, dependent behavior in the presence of unfamiliar or infrequently encountered people … For children for whom English is a second language, case studies usually indicate that the children were not comfortable speaking with people in their first language either.”

Thirty percent of selective mutes may also have a language delay that contributes to the problem, notes Ruth Perednik, a Jerusalem-based psychologist who heads a selective mutism clinic and has published a manual on the disorder called Still Waters Run Deep. Due to their inability to express themselves clearly, these children close up when they enter the school setting.

Usually, selective mutism develops because a child doesn’t have the skills to cope with his or her fears. But there are cases where a child who successfully speaks in school may gradually withdraw as a result of ridicule or excessive teasing. Interestingly, girls are more likely to develop selective mutism than boys, and children with an overprotective or shy parent are also predisposed to this condition.


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