Issue 6, Page 4: Shyness or Selective Mutism?

A new term can be both an exciting and daunting time. Teachers are used to some children taking longer than others to settle in. But when children don’t speak freely, is it normal reticence, or the anxiety disorder selective mutism (SM) which can lead to long-term difficulties such as school avoidance, social anxiety disorder and depression. If ignored or handled inappropriately? Knowing the difference is essential to providing the right support and overcoming SM before the child suffers academically, socially and emotionally.

SM is a real, but irrational fear (phobia) of talking to certain people. It is not ‘reluctance to talk’; these children would love to talk if they could. But the expectation to talk to anyone other than close family or friends triggers a panic reaction and freeze-response, rather like a bad case of stage fright. Few people see the child as they really are – sensitive, thoughtful, chatty, fun-loving and outgoing.

What to look for

The main feature of SM is the sudden stillness and frozen facial expression whenever the fear-reflex is triggered – typically in response to being asked a question. The body stiffens and the throat constricts – children may not even be able to laugh or cry. In time, they learn to anticipate the situations that trigger their fear and do all they can to avoid them. They become afraid of certain people even hearing their voice in case it increases their obligation to talk.

Shy children don’t demonstrate this body-tension or avoidance. They respond well to a friendly face and gentle encouragement to join in and soon talk to adults on a one to one basis. They are wary of new situations, but not physically afraid to talk.

Top Tips: What to do if you suspect SM

• Remember that phobias get worse with any form of pressure – children will only master their fear if allowed to talk in their own time.
• Don’t take it personally! Children don’t choose to have SM.
• Make sure that no-one applies pressure to talk using rewards, persuasion or negative comments.
• Talk to parents immediately – does their child talk freely to some people but not others? Are there activities they enjoy at home that could be introduced at school? Are there friends they talk to at home that they sit with? Could the child talk to their parents at school as a step towards joining in class activities?
• Set up a home-school journal for two-way communication through parents.
• Tell children privately that you know they want to talk but are finding it difficult at the moment. Reassure them that they will talk when they are ready and feel less anxious. Until then, they can join in by listening, pointing, nodding, etc.
• Let children know they can talk to their friends – you won’t interrupt or ask questions.
• Build rapport with the child on a one-to-one basis. Talk about what you are doing and pause so children can join in when they feel ready: “Wow, look how tall you made your tower!”; “This is fun, isn’t it?”; “I wonder where this goes….”
• Ensure that children can access the toilet, drinking water and first aid without asking.
• Ask ‘Is _______ here?’ at registration, so that the whole class can answer together.
• Actively support the development of friendships and inclusion in pastoral activities. Show by your own example how to involve quiet children and have fun.
• Do not draw attention when the child speaks; respond as if they have always spoken.

Seek advice and support from:

• NHS choices www.nhs.uk/conditions/selective-mutism
• Selective Mutism Information and Research Association (SMIRA) www.smira.org.uk

Book Preview

The Selective Mutism Resource Manual (2nd Ed), Speechmark Publishing Ltd.

By Maggie Johnson & Alison Wintgens (Publication Date: October 2016)

Twenty years ago, I met the first child with selective mutism (SM) in my clinical practice. I still remember the unpleasant feeling of incompetence and the literature gave few answers. This triggered me to start researching SM for the next two decades.

In 2016, the literature and knowledge about SM have improved considerably, and there is greater agreement among clinicians on how to understand and treat the condition. Maybe the most important progress has been to categorise SM as an anxiety disorder. Nevertheless, it is still a challenge to offer adequate help for these children.

This excellent resource manual presents updated information on important aspects of SM and – above all – practical and detailed information on how to deal with the problem that is relevant for clinicians, teachers, children and adolescents with SM and their family members. It also provides lots of useful handouts. The case stories are representative, illustrate the variation of symptoms in SM and emphasise the importance of tailoring interventions for each child.

The two authors have an extensive and unique experience with children and adolescents who have SM, and their deep respect for each individual is reflected in all of the chapters. They also address muteness in all relevant arenas and the impact on important people in each child’s life. This is essential for treatment success and is a clear message to our colleagues not to restrict their intervention to clinical settings.

“This book contains a wealth of knowledge!” – Hanne Kristensen, MD, PhD, Centre for Child and Adolescent Mental Health, Southern and Eastern Norway (March 2016)