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.