Joleen Fernald Featured in Foster's Daily Democrat

The following article by Joleen Fernald appeared in Foster's Daily Democrat on May 2, 2008. The original article is here.

Selective mutism is complex anxiety disorder

By Joleen R. Fernald
Easter Seals-The Family Place
Article Date: Friday, May 2, 2008

Imagine pushing your 2-year-old through the grocery store when you happen upon a friend. Your friend bends down and looks at your child, "Hello, what's your name?" Your child puts his head down and avoids eye contact.

"How cute!" Your friend says, "He's so shy."

Imagine having to participate with your child in their dance class every week, because she wouldn't move from her "X" until you physically moved her.

Imagine dropping your child off at preschool every morning and having her scream and hold on to you — every day — for the entire school year.

Imagine helping out in your child's classroom and having her whisper something to you across the table. Another child says, "I didn't know she could talk."

For parents of seven out of every 1,000 children, this is more than imagination; this is reality. It is a small glimpse of what some families experience when they have a child with selective mutism.

Selective mutism is a complex childhood anxiety communication disorder characterized by a child's inability to speak in select social settings, such as school. These children are able to talk normally in settings where they are comfortable, secure and relaxed. Children and adolescents with selective mutism have an actual fear of speaking and social interactions where there is an expectation to talk. They often stand motionless with fear as they are confronted with specific social settings. These children are so anxious they literally freeze, are expressionless, unemotional and often, socially isolated.

When anxious, children with SM may have blank facial expressions, have difficulty with eye contact, and have awkward and stiff body language. These children are not able to initiate play. They often stand on the edge of the classroom, observing everything going on around them, but unable to join in. They follow the rules and try desperately to not be noticed. These characteristics are different from the behavioral manifestations often observed at home.

When comfortable, children with SM may be moody and assertive. They may be inflexible and controlling. Frequently, they are extremely talkative and precocious. Most children with SM are intelligent and sensitive to the feelings of and thoughts of others.

The majority of children have a genetic predisposition to anxiety. In other words, they have inherited anxiety from various family members. Very often, these children show signs of severe anxiety, such as separation anxiety, frequent tantrums and crying, moodiness, inflexibility, sleep problems, parental separation issues, and extreme shyness from infancy on. Because most of these children have a persistent fear of performance or social interaction, they manifest symptoms such as freezing, lack of smiling, expressionless face, and mutism as a direct response to fear and anxiety. There is no evidence that SM is related to abuse, neglect or trauma.

The main goal with treatment is to lower anxiety, increase self-esteem and increase confidence in social settings. Emphasis should never be on "getting a child to talk." All expectations for verbalization should be removed. With lowered anxiety levels and confidence, verbalization will eventually follow. A professional should devise an "individualized treatment plan" for each child.

Research indicates that the earlier a child is treated for SM, the quicker the response to treatment, and the better the overall prognosis. If a child remains mute for many years, his/her behavior can become a conditioned response where the child literally gets used to non-verbalizing. In other words, SM can become a difficult habit to break! However, with proper diagnosis and treatment, the prognosis for overcoming it is excellent!

The Selective Mutism Group is proud to host the conference "Treatment Methods to Help Rid the Silence," taking place on Friday, May 9, at the SERESC Conference Center in Bedford. For more information about Selective Mutism, visit www.selectivemutism.org or call Easter Seals Dover Office at 740-3534 or go to www.eastersealsnh.org.