Selective Mutism in Children

Persona.

As some of you know, the path that led me to school psychology has not been a straight one. One of the detours I took was going to film school and getting a degree in film studies. This occurred, as my 20-something classmates would say, “back in the day.” As a result, I know a bit about film and film history, and continue to be a life-long film aficionado. So I took note when Sight & Sound magazine recently released their 2012 list of the top 50 films of all time (the list is updated every 10 years). There has been some controversy over the fact that Alfred Hitchock’s Vertigo displaced Orson Wells’ Citizen Kane for the #1 slot. Of course, you always expect controversy when a Top-xyz List is released; that’s what makes lists fun and interesting. But as I reviewed past Sight & Sound Top 10 lists, I noticed that Ingmar Bergman’s Persona used to be in the Top 10 (only once, in 1972; it’s now #17 on the list).

Liv Ullmann plays an actress who becomes mute during a performance.

Being reminded of Persona, I got to thinking about a presentation I saw last semester by a woman who had selective mutism (SM) as a child. SM is defined as, “a psychiatric disorder in which a person who is normally capable of speech is unable to speak in given situations or to specific people.” If you haven’t seen Persona, it’s about an actress who suddenly becomes mute during a theatrical performance. The film chronicles the actress’ “treatment” at a remote beach cottage with a nurse who begins to meld identities with her. It’s a powerful film, and touches on a variety of heavy topics. For one, the actress’ version of selective mutism seems partly induced by her inability to, as film critic Lloyd Michaels puts it, “respond authentically to large catastrophes” (e.g. the Holocaust or the Vietnam war). In a way, you could say her inability to speak is a result of an existential dilemma. In that sense, the actress could not technically be said to have SM, as the condition is usually a result of shyness, social anxiety, or some combination of the two. But the film still provides a nice jumping off point for a discussion of SM. For one thing, the quote at the beginning of this post is from Persona. It’s from a letter the actress’ husband writes in order to try to persuade her to return home.

Anxiety is speculated to be the root cause of selective mutism, and it usually affects children under the age of five. While the exact cause is unknown, some children with the condition also have a form of extreme social phobia. The presenter I saw talked about her experiences with SM, which affected her during her grade school years. One thing that helped her get better was her relationship with a caring school psychologist. It took this woman a few years to overcome it, but now she has such valuable insights to share with me and my colleagues. Her talk was interesting and inspiring, and provided a lot of information about a topic I previously had never heard of.

As I researched selective mutism afterwards, I came across some interesting facts:

  • The symptoms must be present for at least a month, and not including the first month of school, in order to be diagnosed.
  • Cultural issues may play a role, such as children who have recently moved here from another country and are not yet comfortable speaking English.
  • The condition used to be referred to as “elective mutism,” but the name was changed because it implied that people with the condition chose not to speak, when the reality is that they do wish to speak in public situations but cannot. The name was changed to selective mutism in 1994.
  • Selective mutism is estimated to affect 1 in 1,000 people (.1%), although this number is uncertain because of inconsistent diagnoses.
  • Some children with SM may be mistakenly assumed to have Attention Deficit Disorder, inattentive type. Some of the symptoms/behaviors are similar, such as the child appearing “spaced out” and uninterested in her surroundings. These children can also be distracted by their own anxiety, causing further misunderstandings about the true nature of their condition.
  • Children with selective mutism may speak freely at home or in other situations, but not at all in a particular setting, such as school.
  • Approximately 20-30% of children with selective mutism also have an underlying speech or language disorder which exacerbates their anxiety in situations in which they are expected to speak.
  • The condition does not necessarily improve with age. Unless treated early, selective mutism can lead to further anxiety, chronic depression and additional social-emotional problems.

If you work with children, or are interested in finding out more about selective mutism, here are some helpful links:

  1. Selective Mutism – Wikipedia.
  2. Selective Mutism – U.S. National Library of Medicine.
  3. Selectivemutism.org – Selective Mutism Group (SMG); part of Child Anxiety Network.
  4. Selective Mutism – American Speech-Language-Hearing Association (ASHA).
  5. Selectivemutismfoundation.org – Non-profit public service organization.
  6. Selectivemutismcenter.org – “A comprehensive center for families and children that addresses the needs of the child/teen with Selective Mutism.”

Finally, information about the annual SMG conference can be found here, or by clicking the image below. The 2012 conference takes place on October 27th, and will be held in Orlando, FL.

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