Selective Mutism in children

Selective Mutism is a relatively rare and complex childhood anxiety disorder.
Children with selective mutism are not dumb but they are fully capable of speech and understanding language.
They are physically unable to speak in certain social situations such as birthday parties, school, family gatherings, shops, etc.
Along with severe anxiety, other common behaviours and characteristics shown by selectively mute children are, shyness, social isolation, sleep problems, difficulty in maintaining eye contact, moodiness, inflexibility, frequent tantrums and crying, blank expression and reluctance to smile or non-stop smiling, difficulty in the expression of feelings, even to family members, tendency to worry more than most people of the same age, sensitivity to noise and crowds.

Selective Mutism in children starts between the ages of two and four and it is more common in girls, affecting about 1 in 140 young children.

All children do not express their anxiety in the same way.
Some children with selective mutism may be completely silent at school for years but speak quite freely or even excessively at home. Such children speak and communicate in situations where they feel comfortable, secure, and relaxed.
Some may speak only few words or whisper and some children may freeze with fear as they are confronted with specific social settings. They may freeze, become expressionless, unemotional and may be socially isolated.
In the case of less severely affected children, they may look relaxed and carefree, and are able to mingle with one or a few children.
Some children may have above-average intelligence, perception, or desire for knowledge, creativity and a love for art or music, compassion and sensitivity to others’ thoughts and feelings and a strong sense of right and wrong.

Brain has an almond-shaped area called the amygdala. It controls fear, excitement, and emotional stimulation and is associated with neuropsychiatric disorders, such as anxiety disorder and social phobias.
The amygdala sends signals in the form of nerve impulses to another part of the brain called the hypothalamus. The hypothalamus, in turn, activates the pituitary gland and the pituitary gland activates the adrenal gland. Then adrenal gland secretes fright, fight and flight hormones — adrenaline, noradrenaline and cortisol which elicit fear and anxiety responses.
In a fearful situation, the amygdala receives signals of danger from the sympathetic nervous system and sends a series of reactions that will help individuals protect themselves.
Social anxiety disorder is caused by the hyperactivity of amygdala. It shows intensified responses to both social and non-social emotional stimuli.

Causes

Excessive controlling or overprotective nature of the parents, parental history of shyness, social isolation, low self-confidence, and social anxiety are the possible risks of Selective mutism.
The exact causes that affect each child may be different and yet unknown.

Treatment

Selective mutism does not go away on its own, and it requires proper treatment in an organized plan between home and school to get a permanent change.
Treatment of selective mutism involves a combination of psychotherapy and medication.
Early treatment can help kids with selective mutism learn to speak up more frequently and improve their academic and social outcomes.
The first recommended treatment for selective mutism is psychotherapy. The most widely used therapeutic treatments for selective mutism are Behavioural strategies and Cognitive Behavioural Therapy (CBT).
A wide variety of strategies are used to reduce the anxiety underneath the behaviour.
These therapeutic behavioural interventions help kids learn gradually speaking behaviours.
Behavioural interventions may be

• contingency management for verbal behaviour from whispering to expressing out loud,
• shaping and strengthening the desired speaking behaviour
• gradually increasing the number of people and places to avoid social anxiety
• gradually exposing to anxiety-producing situations in which speech is expected by giving emotional support and guidance with relaxation exercises.
• building self-confidence through talk therapy and engaging in areas of interest.
• practicing social interaction skills to reduce social anxiety by using nonverbal communication such as eye contact, body language, etc.
• teaching kids to identify anxiety by Cognitive reframing and encouraging them to come up with positive alternative thoughts.
• medication should be administered under the care of a medical doctor and children need not be on medication for long-term. Once, they start talking in a variety of situations and the gains are maintained for a period of time, gradually, the medication can be stopped.

If, selective mutism is not treated in childhood, it will continue into adolescence and adulthood causing isolation, low self-esteem, and social anxiety disorder.
However, if it is diagnosed at an early age and properly treated, a child can successfully overcome selective mutism.