Selective mutism: suffering in silence

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A non-speaking child has a profound effect on the pre-school environment. Their silence speaks volumes. For the child with selective mutism (SM) it is not their choice. Most children with SM have a great desire to speak, but severe anxiety makes it impossible.

SM is a chronic social anxiety disorder. Typically, these children speak at home but not in school, hence the ‘selective’ part of the disorder. Around 1% of children suffer from SM, with the first symptoms occurring around 1-3 years, where a child hides away or is reluctant to speak to someone unfamiliar. This looks like shyness and isn’t picked up as a problem. However, SM becomes more noticeable around the ages of 4-6 when the child is at primary school.

The cause of SM is unknown but is more common in socially isolated families, bilingual ethnic minority backgrounds, or families with high levels of shyness and anxiety.

Often parents and teachers don’t seek treatment because they assume the condition will go away on its own. After all, many children come to pre-school hesitant to speak.  Sometimes SM does go away. All too often it doesn’t, and continues on through school life and into early adulthood, fear and embarrassment always lurking.

Typically the SM child:

  • Avoids eye contact
  • Visibly freezes when asked to speak
  • Tries to hide or ‘fade away’
  • Looks blank or expressionless
  • Avoids making any sort of noise
  • Does not laugh out loud or giggle

An early assessment of SM and the subsequent support are vital. Often this disorder is not identified until Reception, and even then the child does not get the help they need until two or three years later. This has a significant impact on the child’s long-term outcomes. Research shows clearly that the sooner a child with SM gets identified, the easier it is to treat.

Supporting the SM child

The SM child needs a profound connection with their key person at the setting. The warmth and love offered in this unique relationship reduces the high levels of anxiety. However, too much attention can also trigger anxiety. A warm and friendly presence will support an SM child more than an intensely attentive one; attentiveness itself can be debilitating.

All strategies must start with empathy. The child is not being manipulative or defiant in not speaking. We need to recognise the triggers that increase the anxiety levels, and what best alleviates that anxiety. The best strategy is a home visit where the child is at ease and more likely to speak. This creates a small but vital connection between setting and child.

Alongside empathy comes encouragement and reassurance. Our aim is not to ‘get the child to speak’ but to reduce anxiety. The anxiety created by having to speak shuts down the ability to speak. If we maintain a quiet confidence that the child will speak when they are ready, and we accept wholeheartedly that they find speaking difficult, this will significantly decrease the child’s sense of fear and isolation. Make this explicit, ‘You don’t need to use your words today’.

Choice is a major factor for success in the treatment of SM. In giving the child choices, they gain some control over their anxiety levels. Keep these choices simple, ‘Would you like to play with the cars or the trains?’ ‘Would you like to go outside or stay inside?’ Make sure that the child knows a nonverbal response is acceptable, e.g. ‘Show me which one you want’.

Build up a connection using non-verbal activities. Have some fun making ‘noises’ for toy cars or animals. Provide activities that require using the mouth by expelling air, such as blowing bubbles. Play some noisy games such as ‘What’s the time, Mr Wolf?’ Sing favourite songs over and over. Encourage laughter. The child is more likely to speak when they are unaware of themselves and having a good time.

Praise all efforts to communicate, whether verbal or non-verbal. Keep this praise relevant and gentle, ‘Great waving!’ ‘That’s a nice smile!’

And finally, it is within warm, trusting relationships that SM children can find genuine relief from anxiety, where expectations are realistic, and the child’s complex needs are appreciated. The child wants to speak, but the words just won’t come out.

Anxiety starts to fade when the child realises there is nothing to fear. Fear alleviates when a child realises that they don’t have to speak, that they have a choice, and that someone understands.

At this point, the words will finally have the chance to come out. For good.

About the author

Helen Garnett is a mother of 4, and a committed and experienced Early Years consultant. She co-founded a pre-school in 2005 and cares passionately about young children and connection. As a result, she has written a book, ‘Developing Empathy in the Early Years: a guide for practitioners’. She has also co-written an Early Years curriculum and assessment tool, at present being implemented in India. Helen is also on the Think Equal team, a global initiative led by Leslee Udwin, developing empathy in pre-schools and schools across the world. 

 

 

 

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