Do
Individuals Experiencing Selective Mutism Have Associated
Behaviors?
Yes.
Associated behaviors may include no eye contact, no facial
expression, immobility, or nervous fidgeting when confronted
with
general expectations in social situations.
These symptoms do not indicate willfulness, but rather
an attempt to control rising
anxiety.
Some
may withdraw by pulling back when approached or touched and
exhibit different forms of body language.
In many cases the
body language has been misinterpreted
as abuse, however, we have found that these behaviors stem
from anxiety. Based
on
responses to the Foundation, we suspect that some may have
Obsessive-Compulsive Disorder (OCD) or Tourette Syndrome type
symptoms, and a variety of phobias as well.
Is There a
Relationship Between Selective Mutism and Autism?
No.
Selective
Mutism is sometimes erroneously mistaken for Autism.
The striking difference between the two is that
Autistic
individuals have limited language ability, while
individuals experiencing Selective
Mutism are capable of speaking and normally do
so in
comfortable situations.
What
is the Diagnostic and Statistical Manual of Mental Disorders
(DSM IV)?
How
has the classification of Selective Mutism
in the DSM IV affected diagnosis and treatment?
The
DSM IV is the most widely used diagnostic reference book
utilized by mental health professionals in the
United States
. The
DSM is usually revised at 10 or more year intervals. Due
to the lack of research on Selective Mutism, the diagnostic
criteria had to
be ascertained by examining existing
publications. The
previous available publications presented various theories,
many of which
described children experiencing Selective Mutism
as refusing to speak, and displaying controlling,
manipulative, oppositional, and
angry behaviors.
Due to this, as we perceive, mischaracterization of
Selective Mutism children, Selective Mutism’s association
with anxiety had been neglected, and parents had been
frequently blamed for causing Selective Mutism.
The efforts of this Foundation, including providing research
participants for published, legitimate scientific studies was
instrumental
in influencing important changes, including
improved diagnostic guidelines and renaming the disorder from
Elective Mutism (DSM III
and DSM III-R) to Selective Mutism
313.23 in the DSM IV (1994).
Another important change brought about by our efforts
resulted in
replacing the term “refusal to speak” with
“failure to speak”; thereby eliminating the notion that
non-verbalization is intentional.
How is
Selective Mutism Treated?
Behavior
management programs based on the treatment of phobias have
proven to be somewhat successful.
Techniques should
be consistent, and should include
desensitizing the child by providing short-term goals,
positive reinforcement, and rewards to
motivate the child to
speak. Pressure,
including punishment, bribery, or consequences are harmful.
One-word responses should
be elicited at first, with
gradual requests for more.
After extensive treatment, some have been able to speak
spontaneously in
some, if not all social situations.
Various
medications, known to be effective in treating adults with
anxiety and/or social anxiety have been effective for many
children, usually in conjunction with behavioral treatment.
Several articles, which provide behavioral strategies,
can be found in
major libraries and journals that publish
studies.
Is Selective
Mutism Limited to Children?
No. Some
children do experience Selective Mutism for short periods of
time while others experience this problem for many years.
Based upon some literature and individual responses to
the Foundation, Selective Mutism can be a persistent disorder,
which can
become intractable over time.
Some adults report they are still struggling with
symptoms of Selective Mutism, while others have
overcome it.
Many adults, who now able to speak socially, report
having one or a combination of anxiety, depression and panic
attacks.
When Should
Selective Mutism be Treated?
There
are 2 chief factors in determining when treatment is
necessary, age and severity.
If the mutism persists for more that 2
months, or
another dominant language is not interfering, and if there are
no verbal responses at all, treatment should begin
immediately. For
the child who exhibits mild symptoms, such as responding in a
soft voice, and interacts with others, treatment
may not be
necessary unless the symptoms continue for many months.
It is sometimes difficult to know if or when to
intervene, as
there are variant degrees of the disorder.
Many children improve over time without treatment,
while with others, the disorder
becomes intractable.
For those experiencing severe forms of Selective Mutism,
immediate intervention is advisable because the symptoms can
increase. Generally
speaking, a younger child has a good chance of recovering, if
treated, because of the shorter interval of time
where no
verbalization has occurred in school or in other major
settings.
How Can
Parents Help Their Child Who is Experiencing Selective Mutism?
Parents can help
their child by providing every opportunity for socialization
and speaking.
Behavioral techniques should be
implemented in all
social environments where verbalizing is difficult.
Parents should consider contacting their teachers,
principal,
school psychologist, school counselor, or social
worker. These
individuals can play a very important role in assisting
families and
implementing a consistent treatment plan in
school.
Do Children
Experiencing Selective Mutism Have Special Education Needs?
Selective
Mutism is not associated with learning or other impairments,
therefore, special education programs should be cautiously
considered. There
are no special education programs in public schools available
for these children. Individual programs would need
to be
designed. Most
programs can be implemented within the regular education
environments. Others
may require coordination
between regular and special
education, a 504-accommodation plan, or school staff,
depending on the skill level and resources
available within
the school district.
How Can
Educational Evaluators Assess the Skills of a Child
Experiencing Selective Mutism?
Professionals will
need to modify their typical assessment strategies when
working with these children.
As these children may fail
to verbalize, evaluation
scores do not reflect their true academic levels, IQ’s, or
potential. In
order to avoid placing these children
into inappropriate
educational settings, evaluators need to be particularly
cautious. An
effort should be made to evaluate the child
at home with the
parent present. The
child can be asked to read into a tape recorder at home.
Some skills and speech and
language samples may be
obtained and assessed over the telephone, as many children
experiencing Selective Mutism will
verbally
respond. Testing material that is used for the
hearing impaired should be utilized as well. One of our goals
is to promote the
development of appropriate testing material
for those children who may have additional disabilities.
How Can
Teachers Assist a Student Who is Experiencing Selective
Mutism?
Teachers play an
integral part in helping students who are experiencing Selective
Mutism. By
understanding that the symptoms
are not intentional will
reduce the frustration and anger which teachers often
disclose. Consistent
behavioral strategies should and
can be easily implemented in
the classroom. Strategies
should focus on encouraging, not forcing the child to speak.
Praise and
rewards for speaking, and participation in
classroom tasks (e.g. monitor), will all contribute to
lowering the anxiety, while helping\
the child to feel
integrated, positive, and independent.
How Many
People Have Selective Mutism?
Some published
literature suggests that Selective Mutism is rare, and found
in less than 1 percent of child guidance, clinical, and
school
social casework referrals. However, based on the overwhelming
responses to the Foundation, we suspect that it is far more
prevalent than originally assumed. Some publications suggest a
slightly higher percentage of females experiencing Selective
Mutism than males. However, due to unreported, undiagnosed and
misdiagnosed cases, the ratio is unknown.
