Question
What is selective mutism?
Answer
According to the DSM-5, selective mutism is a specific anxiety disorder. I think it's easiest to think about selective mutism as similar to a specific phobia, the same way that we have specific phobias of dogs, blood, heights, and flying. These children have a very specific fear of speaking. Sometimes it can be generalized even further than that, and it's a specific fear of communicating. For some of these children, it's not just talking, it's even things like gesturing, writing, or nodding and shaking their heads. Even those ways of communication can be really anxiety-provoking for them.
It's the consistent ongoing failure to speak in specific social situations, especially in school. Most of the children that I see generally have a hard time speaking in all social situations including in school and in the community. This means they have a hard time talking to the doctor and the dentist, a hard time ordering at the restaurant, and a hard time speaking to their teacher at church school. They also tend to have a hard time talking to extended family members or family friends, particularly when they don't see those people very frequently. I think that school is a perfect storm for these children because there is a mix of performance anxiety because children are being judged and graded, the social anxiety that goes along with interacting with peers and being socially judged. For a lot of these children, their symptoms are first noticed at the beginning of their time in school. Preschool and kindergarten are often times the first moments of awareness that caregivers and parents have that something is different and something may be wrong. Perhaps being away from parents is a new experience so maybe there's even some separation anxiety mixed into it.
Selective mutism is not due to primary language disorder however, it is very co-occurrent with language disorders. It's very common that children who are diagnosed with selective mutism will have some sort of speech disfluency or speech issue, that might include things such as articulation, tone, or being able to speak fluently (putting together sentences). About 50% to 70% of children who are diagnosed with selective mutism also have a language disorder. Other disorders like stuttering or autism, have been ruled out as the primary cause of not speaking. That doesn't mean that children can't have selective mutism and autism. It simply means that it can't be better explained by autism.
Selective mutism is relatively rare, affecting only about 1% of children in elementary school settings. There is some suggestion that prevalence is growing. I don't know if it's because we're getting better at identifying it or because it's like all other anxiety disorders in childhood, which all tend to be growing recently.
Finally, behavior is deliberate self-protection, not deliberate oppositionality. It can look quite oppositional, in fact, but we don't believe it to be driven by oppositionality. In other words, we don't think that these children are choosing not to speak or that they're doing it out of manipulation, defiance, oppositionality, or to get out of something they don't want to do. We really believe that it’s driven by anxiety and an overwhelming fear of speaking and being the center of attention.
This Ask the Expert is an edited excerpt from the course, Unlocking the Mystery of Selective Mutism, by Aimee Kotrba.
