Category: Selective Mutism

The Quiet Child: At What Point is Shyness… “Too Shy?”

By Sara Berlin, LMSW

It is common for people, especially children, to struggle with transitioning to the fall season. At the start of each school year, many children present as shy and struggle to interact with peers and teachers. While the majority of such children will “open up” over the first month of school, some children remain sheepish such that their parents and teachers become concerned. At what point is shyness “too shy”?

Intense shyness that lasts beyond the typical 1-month adjustment period to school may be a sign of Social Anxiety Disorder, an anxiety disorder that affects 4-9% of children and adolescents, or approximately 1 in 10-20 children. While feelings of anxiety in social situations are a normal part of life (and even healthy in some cases!), Social Anxiety Disorder is characterized by persistent and excessive fears about being negatively evaluated by others, which causes notable distress or impairment in everyday life. Children with Social Anxiety Disorder often struggle to attend school, perform as required, and/or socialize with peers, since they tend to be overly quiet and avoid activities that may draw attention to themselves.

In other cases, children may show signs of Selective Mutism, another anxiety disorder in which children refuse to speak in situations where talking is expected or necessary. Children with Selective Mutism may turn their heads away when others approach them or chew/twirl their hair in order to avoid eye contact. They may also stand motionless and expressionless or withdraw into a corner to avoid talking. Interestingly, children with Selective Mutism can be talkative and display normal behaviors at home or other places where they feel comfortable, such that parents are sometimes surprised to learn from a teacher that their child refuses to speak at school.

Here are some practical tips for parents with children who are struggling with social anxiety or selective mutism:

 Understand Your Child’s Intentions

Know that socially anxious or selectively mute children are not trying to be troublesome by ignoring friends and teachers. In fact, such children are usually highly compliant, since they are afraid of being judged or evaluated negatively by others. Avoidance of social situations or speaking are simply (maladaptive) ways of not feeling distressing feelings of anxiety. Almost all socially anxious children would do anything to stop being so anxious and “difficult!” So, be compassionate and validate their feelings of anxiety and fear.

 Give Praise (even) for Small Social Interactions!

Overcoming social anxiety and selective mutism involves a child gradually facing their fears and interacting more with others over time. As such, give your child praise right away whenever they try to interact with or communicate to others (verbally or even non-verbally). Any baby steps your child takes towards overcoming their anxiety should be reinforced. So, when you see your child struggling to speak in spite of their fear, make sure to praise them right away! And needless to say, refrain from making negative comments when you see them struggling. Punishing good behavior (trying to interact with others) can make things much worse, since socially anxious kids tend to be very sensitive to criticism. In addition, it is very important to identify and “label” your child’s specific behavior as you praise them. For example, if you see your child struggling to speak, instead of giving a generic praise such as “great job” you can say something like “I can see how hard it is to speak to these unfamiliar people in your class, and I’m proud of how you made sure to ask the entire question.” In sum, (1) praise your child ASAP after they do something hard, (2) be as specific as possible when praising, and (3) do it often.

 Don’t Probe, Validate

Parents naturally want to ask children questions about their fears (probe) when they start noticing them getting tense in certain social settings. Believe it or not, asking questions to children to alleviate anxiety can actually have the opposite effect, since it directs a child’s thoughts even deeper into their anxiety. Instead of probing, ignore the negativity and focus on praising positive behavior. With that said, it’s important to validate your child’s anxiety, especially if he feels overwhelmed. For example, note that they are overcoming an emotional challenge when they resist the urge to avoid. For example, you can say, “I know that speaking with your classmate was really hard for you today and I am proud that you are practicing your bravery.”

 Resist the Urge to Speak for Your Child

When you see that your child is feeling uncomfortable and anxious, it’s common to want to intervene and speak on their behalf. After all, what parent wants to see their child in distress?! However, saving your child from anxiety will make it harder for them to learn how to speak – if you communicate for them when they are anxious they will never learn to manage their anxiety! Instead, try to encourage them to speak or, if they are really struggling, you can tell guests that your child is working on bravely talking and he’ll try again in a minute or two. Just make sure you do in fact come back to it a minute or two later, though! If you don’t, and you simply “save” your child from speaking, it will reinforce their silence by preventing them from ever having to learn to speak for themselves.

 Make Talking Fun!

There are some games you can play that encourage continued speech, like Go Fish, Battleship, Surveys of “Favorites,” Hangman, Spot It, and Tell Tale. Be patient and positive as your child finds new ways to cope! Secure attachment and strong social support are huge protective factors for all children, particularly those experiencing anxiety disorders. Continue to provide a warm, safe, loving, and fun environment for your child!

 Seek Help

Finally, and perhaps most importantly, childhood anxiety disorders are easily treated and many families can benefit from consulting a mental health professional. A therapist can help assess, diagnose, and treat the anxiety disorder and help you create a plan to help your child cope and overcome their fears. Cognitive-behavior therapy (CBT) is the gold standard to treat childhood anxiety disorders as it helps children learn new ways to think in anxiety provoking situations, and teaches them concrete techniques to manage and tolerate their anxiety. If you are concerned about your child’s anxiety, seek help from a trained professional who can help you and your child.

Let’s Talk About Selective Mutism

Written by Regine Galanti

Child anxiety disorders tend to look a lot like their adult counterparts – children can experience Generalized Anxiety Disorder, Social Anxiety, Panic Disorder, and OCD in very similar ways to adults. This, however, is not always the case: sometimes anxiety in children presents very differently from the symptoms that we tend to see in adults. A prime example of this is Selective Mutism (SM), an anxiety disorder in which a child has difficulty speaking to some people.

One difference between SM and many other anxiety presentations is its selectivity. While someone with general anxiety is likely to experience symptoms in most setting, Selective Mutism, as its name implies, is selective. A child may speak comfortably and loudly at home with friends, for instance, but has difficulty speaking at all, or only whispers, when in a school setting – even when speaking to those same individuals to whom he or she speaks comfortably outside a school setting.

Because of its presentation, there are often misconceptions about what SM is and what it is not. Parents and teachers often initially see children with SM as strong willed, oppositional, and defiant – that they are refusing to speak. To a child with SM, however, he or she feels unable to speak, even in a case of true need, such as to ask to go to the bathroom. Children with SM are often labeled shy, but their social communication problems tend to move beyond shyness to something more serious. These children often are misdiagnosed with behavior disorders, autism spectrum disorders, or told that they will grow of these behaviors. This lack of awareness among the public, educators, and professionals leads to delayed diagnosis and missed opportunities for treatment – especially important in a disorder in which early treatment is associated with higher success rates!

Once SM is detected and correctly diagnosed, treatment involves addressing the underlying anxiety using a variety of Cognitive-Behavioral techniques. A therapist will work with a child with SM, as well as his or her parents and teachers, to develop a step-by-step plan to gradually introduce speaking behaviors. At the same time, therapists use copious amounts of positive reinforcement to help the child succeed.

In sum, SM is best characterized as a childhood anxiety disorder that limits a child’s social communication in one or more settings. SM is NOT a child’s refusal to speak, or an attempt to manipulate adults. Treatment is available to help children experiencing SM, but correct diagnosis is a key first step in the path to treatment.