MANY OF us are familiar with the anxiety that comes with talking to strangers or a large group of people. The prickling sensation of eyes trained on us make us self-conscious about every word we murmur. We dread such situations and may do anything to avoid them. People always tell us that, with time and practice, it is something that we will grow out of. However, for people suffering from selective mutism, such a simple solution is too good to be true. These stressful situations can paralyze them with fear, unable to utter a word.

Grasping the situation

   People with selective mutism are perfectly capable of communicating in a comfortable setting but clam up whenever they feel pressured to speak. The Diagnostic and Statistical Manual of Mental Disorders characterizes this as a rare anxiety disorder, usually diagnosed in children between two and five years old. In an interview with The Yonsei Annals, Lee Hun-jo, Director of the Multicultural Coaching Network Global Diaspora said, “It is considered a disorder when it is consistent and persists for more than a month. While it affects less than 1% of the population, it is an interesting field of study to those in counseling psychology.” He explained that disorders stemming from anxiety and self-consciousness not only disrupt a child’s development but pose a significant risk to the child’s wellbeing.

   Because selective mutism is distinguished by the patient being unable to speak only in certain situations, it can be mistaken as shyness and something that the child will eventually grow out of. These misconceptions are exacerbated by how this disorder is portrayed in popular media. While there are some movies that portray it as the result of a traumatic experience, it is usually used as a running gag in comedies such as The Big Bang Theory, in which one of the main characters, Rajesh Koothrapali, is shown to have selective mutism when it comes to speaking to women. However, the show does not delve deeper into the disorder and simply shows that Rajesh can overcome his disorder when intoxicated. In fact, he is fully cured without explanation later in the series. In this regard, Alison Wintgens, author of Can I Tell You About Selective Mutism?, stated that “situational mutism” is a better name for this disorder because the word “selective” can imply that the patient has a measure of control over it*.

To be affected

   The way we understand mental health has changed, which has helped us diagnose the different kinds of disorders there are. “Social anxiety disorders are more of a spectrum rather than a simple ‘box’ you fit in,” said Lee. “For selective mutism, there are many factors that play a role in its development, such as shyness, phobia of embarrassment and an inability to cope with stress.” A child with selective mutism can develop other disorders, such as emotional disturbance or sensory processing disorder, due to the severe anxiety that they experience. Lee also stressed that children living in a foreign country may be especially susceptible to this disorder, as both the culture shock and the need to learn a foreign language may cause anxiety when speaking in a public setting. This was the case of a 10-year-old Korean boy in the United States, identified as C., who developed selective mutism because of his fear of being judged for his noticeable accent when speaking English**.

    C exhibited various symptoms that initially caused him to be misdiagnosed with autism. He only spoke to his parents and communicated through body language to other people, such as pointing and nodding. This affected his interaction with his peers considerably, as he was often withdrawn and didn’t show interest in group activities. Even when he participated in games of chase, he was lethargic and needed constant prompting. As the child was becoming highly dependent on his parents to the point that he could not do anything without their encouragement, the boy needed his parents to remain in the same room with him at all times for him to cooperate with his teachers or his therapist. The symptoms C displayed are characteristic of a child with selective mutism, which is how he was properly diagnosed later on.

Being treated

   Having anxiety disorders like selective mutism can make life very difficult, as it can become an obstacle when one is interacting in a new environment. According to the Child Mind Institute, because of the consequences a patient with anxiety disorder can experience, it is important to diagnose the condition early on and follow proper therapy treatment that addresses the cause of their disorder. Psychologists have developed several therapy treatments to lessen the symptoms, but their effectiveness vary depending on the person and the severity of their anxiety disorder. Through the right treatment, a 11-year-old Korean girl, who expressed her fears by drawing them in a sand tray during therapy, was able to actively communicate with other people***. 

   In the case of C, his psychologist at the Morning Glory Treatment Center for Children implemented several therapy techniques. His parents were advised to talk to him about his daily schedule before leaving the house, and to reward desirable behavior with allowance or privileges at home. Additionally, to wean him off his parents, his therapist required C to adhere to a routine at home and at school to learn how to do things alone. As the sessions progressed, his parents stopped attending his classes at school and he began to open up to his therapist and listen to his teachers’ instructions with less reluctance. Unfortunately, his treatment was interrupted by his parents’ financial situation before he could show further signs of improvement.

   Because treatment is catered to each individual, patients require the use of different techniques during therapy sessions with a speech-language pathologist. In some special cases, they may even be prescribed medication, according to the American Speech-Language-Hearing Association (ASHA). One of the most effective therapy techniques, called stimulus fading, encourages the children to speak in public settings in the presence of people they are comfortable with. Once the children are more comfortable speaking in public, psychologists gradually increase the range of people they interact with and begin tackling the root cause of their selective mutism.

   Lee recommended mindfulness-based cognitive therapy, which is using meditative techniques alongside traditional therapy methods like drawing in crayon to express how they think or feel. “Mindfulness-based cognitive therapy”, says Lee, “focuses on increasing the patient’s self-awareness.” An effective technique he described was encouraging children to stretch in a comfortable but small space to be aware of their body and their mind, while listing their fears out loud as they exhale.

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   Being unable to speak in certain situations can be a very debilitating experience, particularly for children who are still learning about the world. Thankfully, while this can be a serious issue, it does not have to be a permanent one. With the right treatment, people with selective mutism have been shown to improve. As psychologists continue to research this condition, new techniques are being developed to treat individuals who suffer from it.

*The Telegraph 

**The Morning Glory Treatment Center for Children in Texas, United States

***The Korean Journal of Child Studies