Selective mutism: symptoms, causes and treatment

When he is at home, Javi is a very lively and happy child, who is always asking his parents about how things work and telling them his thoughts and dreams. However, one day the teachers at his school call his parents to tell them that the child does not talk to his classmates or teachers, remaining mute in the face of others' attempts to interact with him despite the fact that he often responds based on gestures.

Although at first they believed that it was mere shynessThe truth is that he has not spoken a word since the beginning of the course two months before. After arranging and carrying out a medical and psychological examination of the child, it is diagnosed that Javi suffers from the disorder known as selective mutism.

• Related article: "The 16 most common mental disorders"

Selective mutism: definition and characteristic symptoms

The aforementioned disorder, selective mutism, is a form of childhood disorder linked to anxiety in which the individual who suffers from it is unable to speak in certain contexts.

The symptoms of selective mutism They are the decrease and disappearance of the ability to speak in certain circumstances or before certain people, generally before people outside the circle closest to the minor. This apparent lack of capacity only occurs in such circumstances or situations, so that in other contexts or with relatives in which they feel safe, the child communicates normally. It is not, therefore, that communication skills are lacking or that they have deteriorated for some reason, the minor simply cannot start them.

These symptoms occur for at least a month without any relevant change that justifies the appearance of possible shyness. Nor is it a difficulty caused by a medical illness that could justify the lack of oral communication.

Although the term selective may make the lack of speech appear to be intentional, in a large number of cases it is not. In fact, it is common that the minor actually wants to express himself despite being unable to do so, and sometimes resorts to strategies such as the use of gestures. Despite this, in some cases it does occur intentionally, as an attempt to show opposition to a situation or person.

Thus, selective mutism involves a high level of anguish and suffering, in addition to producing a significant alteration in the social and academic life of the minor.

• You may be interested: "Avoidant Personality Disorder: extreme shyness?"

Causes of this disorder

The diagnosis of selective mutism requires that the presence of medical diseases is ruled out or that the lack of speech is due to insufficient development of this ability to allow oral communication.

The causes of this problem are mainly psychological, specifically the presence of anxiety. It is an affectation similar to social phobia (in many cases comorbid with selective mutism), in which there is also a fear of being judged and evaluated. Risk and pressure when they are the center of attention prevent the subject from acting, which has been understood as a response learned through conditioning.

It has also been observed that there is some hereditary family influence, since it is a more common disorder in families with anxiety or mood problems.

Due to the absence of speech, selective mutism can make the sufferer able to appearing sullen and uninterested in communication, with which social contact decreases and rejection towards the minor in question may appear. This fact feeds back the situation of silence by producing greater tension and anxiety when being judged negatively by others

Treating selective mutism

Although in some cases the disorder subsides after several months, in other cases it can last for years, which makes it difficult for the child in question to adapt socially. The participation of the family and the environment is essential. It is especially important not to criticize the child's lack of speech, which can lower his self-esteem and worsen the picture. Teaching ways to socialize, highlighting your strengths, and supporting your efforts are helpful.

One of the most common types of psychological treatment in case of selective mutism is the use of different therapies for exposure to phobic stimuli together with the management of contingencies that may affect the emission or non-emission of speech.

Forms of psychological intervention

Exposure to situations must be gradual and careful. Progressive immersion is also useful, for example by transferring people with whom the child don't be afraid to communicate to environments that are more problematic for you. Over time, a stimulating fading will be made of the stimulating fading, in which they are gradually removed stimuli and people that provide security to the child so that over time it begins to communicate with others contexts.

Filmed and rigged self-shaping It is also a fairly common technique: in it the child is recorded interacting with his close ones in the situations in which he those that do communicate verbally to later modify the recording so that it appears that they are communicating with others. In the video you will progress in a hierarchical way, making him respond first in a monosyllabic way and little by little increasing the level until he speaks spontaneously.

It also seems to be effective the use of modeling and theater activities, in which the child can see how others interact and at the same time can start little by little to express words that are not his but those that come in the script, so its content cannot be court. Little by little the infant will be able to incorporate his own ideas into the conversation. The level of complexity can be increased by changing the place where the videos are made, first making videos in very safe environments and gradually moving away from them.

There are also some programs social skills training that can help the child to gradually let go and express themselves. Cognitive behavioral therapy has also been shown to be effective in helping the child to restructure his thoughts and beliefs regarding how he is seen by others.

• You may be interested: "Top 14 Soft Skills for Success in Life"

Bibliographic references:

• American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders. Fifth edition. DSM-V. Masson, Barcelona.

• Thief, A. (2012). Child Clinical Psychology. CEDE Preparation Manual PIR, 03. CEDE: Madrid.

• Rosenberg, D.R.; Ciriboga, J.A. (2016). Anxiety disorders. In: Kliegman RM, Stanton BF, St Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics. 20th ed. Philadelphia, PA: Elsevier.