Struggling with son's selective mutism

Posted by Barbara F. Meltz  January 18, 2010 06:00 AM

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Dear Barbara,
I'm curious to hear what you and other parents have to say about selective mutism. Our two-year-old does not speak, or sometimes interact at all, with his caregivers after several months in a daycare situation. Our doctor does not seem concerned, but for a child who does not stop talking at home and has an advanced vocabulary for his age, it seems a huge shame that he is not using his verbal skills with people outside the family. This is definitely not an autistic situation, or even a slow-to-warm-up one, as I've read online that those children will eventually begin to interact after a month or so. I'd be particularly interested in hearing about therapies that we can implement at the daycare to get our child to communicate. 

From: A Mom, Boston

Hi A Mom,

Coincidentally, a friend who is a speech and language therapist was telling me just the other day that she has had only two cases of selective mutism in her 30+ year career, and the second case was a child of 8 with whom she is working right now. She was excited because she had had a breakthrough that day. He had whispered to her for the first time. She had been working with him since September, so a month may be an optimistic expectation.

As you probably know, selective mutism is not a phase that a child outgrows, it is a social anxiety disorder in which a child is speaks at home but chooses not to talk, generally,  outside the home. It is rare, but not as rare as you might suspect, affecting 7 out of 1000 children.

Selective mutism often first presents during the preschool years. My advice is not to waste any time; early intervention is the way to go. Consult with a licensed speech and language therapist, or with a psychologist who has experience with selective mutism. My friend describes it as "an extreme case of stage fright, and the world outside the home is the stage."

Strategies with school-age children include taping the child at home doing oral homework assignments, such as a book report. This could work with a preschooler as well. Also, allowing the child to choose one friend to whisper to, that is, empowering him/her to be able to whisper is OK.

What you want to avoid is shaming or disciplining him for not speaking. A nurturing preschool could be a wonderful environment for him, as long as no one there is shaming or punitive.

There are many resources on the web which you may have already discovered. I found this segment on the Early Show particularly helpful.

I look forward to to hearing what readers have to say about this, especially strategies and advice.

I answer a question from a reader every weekday. If you want help with some aspect of child-rearing, just write to me here.

 




This blog is not written or edited by Boston.com or the Boston Globe.
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19 comments so far...
  1. My son has selective mustims and is now 5 years old. He is progressing well at school in that he has generalised his whispering to his classmates and fixed teachers. Check out: http://selectivemutism.blogtown.co.nz/using-eft-for-selective-mutism/

    Posted by Rossanne January 18, 10 08:40 PM
  1. My daughter who's almost 7 now was diagnosed as having selective mutism at age 4. She meets with a therapist regularly and has made significant progress. Each year she is doing better and better. In fact, she talks to everyone in her 1st grade class, she raises her hands and answers questions and reads aloud in reading group. She continues to struggle in certain areas such as her after-school care program and birthday parties, etc but all in all she is doing very well. Now that's she's talking, we're seeing that she's behind in her social skills which we're now working on. I've found the best approach is to educate her care givers and teachers on SM and the importance that she not be pressured to speak or labeled as "shy". I have a great tip sheet that I use when introducing Katie to a new teacher. Here is the link to the tip sheet and a great web site I reference on the topic. The doctor is a true expert on the subject and her daughter struggled with SM so she's experienced the challenges of SM first hand. http://www.selectivemutismcenter.org/docs/AAAAAAttachments/helpteacherunder.pdfhttp://www.selectivemutismcenter.org/

    Posted by Lynn January 18, 10 11:28 PM
  1. Hello A Mom,

    I am a mother of a 17 year old daughter with SM as well as a State Coordinator for SM. The advice given to you was right on, regarding not waiting and try and see a specialist.

    Most children who are diagnosed with SM are around 6, 7 years of age during the start of their start of school as Barbara mentioned. Make sure you educate yourself as much as you can (to many children have been misdiagnosed), maintain patience and locate a support group. Believe me, it is truly helpful. We are not alone in this battle to help "rid the silence"
    and my daughter has shared so much with me since I changed and created less anxiety in her life, through my continued drive for knowledge and began a support group.

    There is tons of useful information on the website for selective mutism: A State Coordinator in your area, signs of SM, List of specialist, and so much more: www.selectivemutism.org

    Because there is so much information, it can be a little overwhelming. If you need assistance in the interim, feel free to reach out to me via e-mail: ivy@halopublicrelations.com

    Posted by Ivy January 19, 10 10:58 AM
  1. My niece had selective mutism up until first grade. I'm happy to say that she's now in second grade and no longer has this problem.

    Posted by Auntie January 19, 10 03:35 PM
  1. Auntie, How did it go away?!

    BFM

    Posted by Barbara F. Meltz Author Profile Page January 19, 10 04:08 PM
  1. My daughter who's almost three is very anxious in public and around other children in preschool. We have a social worker and great preschool teachers trying to draw her out through play, and making her feel comfortable in a public setting. Sometimes it seems to work--we'll hear a word or two--and other times not so much. I hope that there will be lasting progress if we can keep the attention we focus on this issue positive.

    Posted by MM January 19, 10 04:28 PM
  1. When my son started preschool/daycare at around 2.5yrs old; we discovered that he would only speak with adults; he would not speak with other children. He too had very advanced verbal skills and was speaking full sentences quite fluently. He was however, extremely, painfully shy. This was seen as a social anxiety disorder and he started seeing a therapist at around age 3. I cannot say with any confidence that I felt it made much of a difference. He remained quite shy throughout elementary school. In kindegarten & 1st grade; while we would wait in the playground for the school bell to ring the start of school, other children would ask him to join in their games and he always refused. As you might expect, eventually they stopped asking. He did not have a lot of friends, or get invited to many parties, but he did have a few classmates in the neighborhood that he was friends with, and continues to be, all through to high school. He got better in high school and is now an Arabic linguist in the Air Force. He seems to have plenty of friends, with commensurate social life! Accept that shyness is not a character flaw nor is it something you can 'get over' with therapy; help him be as comfortable as he is able to be in certain situations; employ the techniques you learn about (to help him, not you) in a subtle way, be sure there is no message sent that there is something wrong with him. Be gentle and patient for my observations are that these tend to be very sensitive children and people.

    Posted by JoyAnd Laughter January 19, 10 05:07 PM
  1. Barbara, my niece went to some play therapy, but mostly, it was maturity that helped her.

    Posted by Auntie January 20, 10 08:59 AM
  1. This post caught my eye, even though I'm not a Mom, because I definitely had this when I was younger, about kindergarten to junior high ages. I've never heard of it before, my parents just thought it was that I was shy and told me to get over it. But I would get reports sent home from school wondering if I was "slow" because I refused to answer teachers in class. I would sometimes talk to other students, and did have 1 or 2 friends.
    I know now that I developed anxiety and was afraid of all adults other than my parents, and even some of the bigger kids at school. This was a result of abuse I suffered. Your child does not sound like he would have the trauma issue, but probably has anxiety. Be as supportive as you can, that's something I definitely didn't get at home. And eventually I grew out of it, once I felt school was a safe place for me. By the end of junior high I had a large group of friends and was participating in class. And that's with no help or therapy, so your child will probably respond even quicker if you are helping him. Good luck!

    Posted by NotAMom January 20, 10 09:28 AM
  1. We went through this with our now-20-year-old son when he was in preschool. He would not speak a word inside the classroom - not even to tell the teacher when he felt sick. The teachers were convinced he was speech delayed, but at home he talked to everyone and his vocabulary was excellent. He would talk to me the second he stepped outside the classroom. We were very worried that this would continue in kindergarten, so we arranged advance meetings with his teacher in the classroom to make him more comfortable. He was fine from day one in kindergarten. Eventually, he told us that there had been a girl in the preschool who cried all day every day (this turned out to be true, and it was allowed to go on all year). He could not stand all the crying, so he just chose to ignore everything there. I wish I had realized there was something in the preschool classroom that was upsetting him, but he never mentioned this to us at the time. Is there a situation in daycare that might be upsetting to your son?
    I am happy to say that once my son was out of the situation, things improved dramatically, and he has gone on to be a very successful student.

    Posted by Mom of 5 January 20, 10 11:13 AM
  1. I too suffered from some form of this as a child. I did not speak until age 3. The Dr. told my parents it was a result of older siblings doing everything for me and encouraged them to send me to preschool which they did. I would not speak at my first preschool but felt comfortable there as the teacher was very warm and kind. My second preschool was a very structured pre-k program. Everyday when they called attendance I sat in my chair silently. This was a horrible experience as I felt humiliated everyday. If we were doing a craft project and I wasn't given materials I would sit and cry rather than ask for them.

    When I went to kindergarten with my neighborhood friends I became much more comfortable in school and did start speaking a little. I was a good student and the teachers always liked me which boosted my confidence. I recently found my grade school report cards and they all mention being a quiet child. I was fine in school until some point in high school when I started having panic attacks when I was called on. This started after a humiliating experience reading something out loud that I felt was embarrassing.

    Through college, I would drop classes and change majors based on whether there was class participation or a required speech class. Ultimately I did seek out help after my first job when I realized that I couldn't avoid all public speaking forever.

    I'm sharing this because the most important thing I learned was self acceptance. We can't all be public speakers. People are different. Some are outgoing and others are not. Teachers who are warm and compassionate and feel that shyness is not something that needs to be fixed would be wonderful for this child. I also got a lot of comfort from watching Mr. Rogers and hearing him say "I like you just the way you are." (now I've dated myself)

    Fortunately I haven't had to deal with this with my own children. Although they are all very sensitive and at least one is a little anxious. But if I did have a child with SM I would not push them to speak when they are not comfortable (like my parents did). This just creates more anxiety. These kids may always be somewhat sensitive and anxious and that is o.k.

    Posted by shymom January 20, 10 11:30 AM
  1. I was extremely shy as a child with certain relatives. One time I hid in the bathroom until they left.

    Posted by sophie08 January 20, 10 01:41 PM
  1. Ha! I got to the 7th comment from Notamom and had to laugh...my parents were asked the same questions about me but were confused because though they thought there might be something wrong with me my performance in class was far above the other children. To the original LW, does your child not speak at all during the day, even to other children? I think there are more questions to be asked before going the therapy route. I'm not a professional but I think we are too quick to medicate or put a child in therapy these days. Makes for a paranoid and overmedicated society. Anyway, my point is that I too was an extremely shy and introverted child. I had plenty of friends but would not respond to my kindergarten teacher for some reason. It wasn't 100% of the time but often enough that they noticed and questioned my parents. I turned out fine; good grades, strong career and am now a successful, independent woman. Sure, I still have my shy moments but am otherwise a well rounded individual. Without knowing more about your situation, I think your child is ok and will more than likely grow out of it as I did along with many other responders. Good luck!

    Posted by Notamom2 January 20, 10 06:01 PM
  1. Hi, I have a 13 y.o. old son with selective mutism. Could any suggest a qualified psychologist. I reached out to several but don't have experience or don't accept our insurance. We live in norton ma. thanks

    Posted by Cheryl January 21, 10 01:26 PM
  1. Sorry, Cheryl, I am not able to make specific recommendations. Check out the link in my answer, above.

    Barbara Meltz

    Posted by Barbara F. Meltz Author Profile Page January 21, 10 05:52 PM
  1. I am now a teenager but when I was 4 years old I was diagnosed with selective mutism. By the time I was 8 years old I was talking in class just as much as the other children. But I had a case so bad that I didn't even talk to my own grandparents, aunts and uncles, and most of my cousins. If he continues to not speak in public by the time he is 3 or 4, I would recommend going to a therapist or speech pathologist to work with him on social anxiety. The one thing to ALWAYS remember is to not pressure him into speaking, this will only make things worse. He will speak in public when he feels comfortable, but if you pressure him into speaking he will feel even more timid to speak. Hope this helps!

    Posted by kayla April 26, 10 07:43 PM
  1. Hi Kayla!
    My daughter has been diagnosed with SM and she is 6 now. How did you get through it? I feel that she is making some small progress on her own but we are being pressured by her teachers to get professional help. What worked for you? Thanks for any help you can offer!

    Posted by Trish May 18, 12 05:56 AM
  1. Hi All,

    I really some advice! My daughter (Lexi) will be four in August. She has been attending preschool for over a year and does not speak there or interact with the other children. Her stomach gets so sick the days she has to go school and she does not want to be there. There are approx. 10 kids in the class.

    Lexi is the most talkative , vibrant little girl at home.

    After passing her hearing, speech and language tests, her doctor feels she may have selective mutism. Although he is a pediatrician and cannot make this diagnosis.

    Do you think I should pull her out of this school and put her in something smaller, like more of a daycare setting? I am so nervous because she starts kindergarten in one year.

    Any advice will help. Thank you guys very much!

    Katie

    Posted by Katie July 6, 12 09:52 AM
  1. Barbara,

    It is inaccurate to say that the child "chooses" not to speak outside of the home. SM is an anxiety disorder that causes the child to experience such intense anxiety that they cannot speak. This is a huge distinction. There are many myths about SM, and one is that the condition is "elective" instead of "selective." This could not be further from the truth. These children are not being obstinate or willful, instead they are experiencing such extreme anxiety that it renders them incapable of speaking in certain situations.

    Posted by Sarah August 31, 13 12:08 PM
 
19 comments so far...
  1. My son has selective mustims and is now 5 years old. He is progressing well at school in that he has generalised his whispering to his classmates and fixed teachers. Check out: http://selectivemutism.blogtown.co.nz/using-eft-for-selective-mutism/

    Posted by Rossanne January 18, 10 08:40 PM
  1. My daughter who's almost 7 now was diagnosed as having selective mutism at age 4. She meets with a therapist regularly and has made significant progress. Each year she is doing better and better. In fact, she talks to everyone in her 1st grade class, she raises her hands and answers questions and reads aloud in reading group. She continues to struggle in certain areas such as her after-school care program and birthday parties, etc but all in all she is doing very well. Now that's she's talking, we're seeing that she's behind in her social skills which we're now working on. I've found the best approach is to educate her care givers and teachers on SM and the importance that she not be pressured to speak or labeled as "shy". I have a great tip sheet that I use when introducing Katie to a new teacher. Here is the link to the tip sheet and a great web site I reference on the topic. The doctor is a true expert on the subject and her daughter struggled with SM so she's experienced the challenges of SM first hand. http://www.selectivemutismcenter.org/docs/AAAAAAttachments/helpteacherunder.pdfhttp://www.selectivemutismcenter.org/

    Posted by Lynn January 18, 10 11:28 PM
  1. Hello A Mom,

    I am a mother of a 17 year old daughter with SM as well as a State Coordinator for SM. The advice given to you was right on, regarding not waiting and try and see a specialist.

    Most children who are diagnosed with SM are around 6, 7 years of age during the start of their start of school as Barbara mentioned. Make sure you educate yourself as much as you can (to many children have been misdiagnosed), maintain patience and locate a support group. Believe me, it is truly helpful. We are not alone in this battle to help "rid the silence"
    and my daughter has shared so much with me since I changed and created less anxiety in her life, through my continued drive for knowledge and began a support group.

    There is tons of useful information on the website for selective mutism: A State Coordinator in your area, signs of SM, List of specialist, and so much more: www.selectivemutism.org

    Because there is so much information, it can be a little overwhelming. If you need assistance in the interim, feel free to reach out to me via e-mail: ivy@halopublicrelations.com

    Posted by Ivy January 19, 10 10:58 AM
  1. My niece had selective mutism up until first grade. I'm happy to say that she's now in second grade and no longer has this problem.

    Posted by Auntie January 19, 10 03:35 PM
  1. Auntie, How did it go away?!

    BFM

    Posted by Barbara F. Meltz Author Profile Page January 19, 10 04:08 PM
  1. My daughter who's almost three is very anxious in public and around other children in preschool. We have a social worker and great preschool teachers trying to draw her out through play, and making her feel comfortable in a public setting. Sometimes it seems to work--we'll hear a word or two--and other times not so much. I hope that there will be lasting progress if we can keep the attention we focus on this issue positive.

    Posted by MM January 19, 10 04:28 PM
  1. When my son started preschool/daycare at around 2.5yrs old; we discovered that he would only speak with adults; he would not speak with other children. He too had very advanced verbal skills and was speaking full sentences quite fluently. He was however, extremely, painfully shy. This was seen as a social anxiety disorder and he started seeing a therapist at around age 3. I cannot say with any confidence that I felt it made much of a difference. He remained quite shy throughout elementary school. In kindegarten & 1st grade; while we would wait in the playground for the school bell to ring the start of school, other children would ask him to join in their games and he always refused. As you might expect, eventually they stopped asking. He did not have a lot of friends, or get invited to many parties, but he did have a few classmates in the neighborhood that he was friends with, and continues to be, all through to high school. He got better in high school and is now an Arabic linguist in the Air Force. He seems to have plenty of friends, with commensurate social life! Accept that shyness is not a character flaw nor is it something you can 'get over' with therapy; help him be as comfortable as he is able to be in certain situations; employ the techniques you learn about (to help him, not you) in a subtle way, be sure there is no message sent that there is something wrong with him. Be gentle and patient for my observations are that these tend to be very sensitive children and people.

    Posted by JoyAnd Laughter January 19, 10 05:07 PM
  1. Barbara, my niece went to some play therapy, but mostly, it was maturity that helped her.

    Posted by Auntie January 20, 10 08:59 AM
  1. This post caught my eye, even though I'm not a Mom, because I definitely had this when I was younger, about kindergarten to junior high ages. I've never heard of it before, my parents just thought it was that I was shy and told me to get over it. But I would get reports sent home from school wondering if I was "slow" because I refused to answer teachers in class. I would sometimes talk to other students, and did have 1 or 2 friends.
    I know now that I developed anxiety and was afraid of all adults other than my parents, and even some of the bigger kids at school. This was a result of abuse I suffered. Your child does not sound like he would have the trauma issue, but probably has anxiety. Be as supportive as you can, that's something I definitely didn't get at home. And eventually I grew out of it, once I felt school was a safe place for me. By the end of junior high I had a large group of friends and was participating in class. And that's with no help or therapy, so your child will probably respond even quicker if you are helping him. Good luck!

    Posted by NotAMom January 20, 10 09:28 AM
  1. We went through this with our now-20-year-old son when he was in preschool. He would not speak a word inside the classroom - not even to tell the teacher when he felt sick. The teachers were convinced he was speech delayed, but at home he talked to everyone and his vocabulary was excellent. He would talk to me the second he stepped outside the classroom. We were very worried that this would continue in kindergarten, so we arranged advance meetings with his teacher in the classroom to make him more comfortable. He was fine from day one in kindergarten. Eventually, he told us that there had been a girl in the preschool who cried all day every day (this turned out to be true, and it was allowed to go on all year). He could not stand all the crying, so he just chose to ignore everything there. I wish I had realized there was something in the preschool classroom that was upsetting him, but he never mentioned this to us at the time. Is there a situation in daycare that might be upsetting to your son?
    I am happy to say that once my son was out of the situation, things improved dramatically, and he has gone on to be a very successful student.

    Posted by Mom of 5 January 20, 10 11:13 AM
  1. I too suffered from some form of this as a child. I did not speak until age 3. The Dr. told my parents it was a result of older siblings doing everything for me and encouraged them to send me to preschool which they did. I would not speak at my first preschool but felt comfortable there as the teacher was very warm and kind. My second preschool was a very structured pre-k program. Everyday when they called attendance I sat in my chair silently. This was a horrible experience as I felt humiliated everyday. If we were doing a craft project and I wasn't given materials I would sit and cry rather than ask for them.

    When I went to kindergarten with my neighborhood friends I became much more comfortable in school and did start speaking a little. I was a good student and the teachers always liked me which boosted my confidence. I recently found my grade school report cards and they all mention being a quiet child. I was fine in school until some point in high school when I started having panic attacks when I was called on. This started after a humiliating experience reading something out loud that I felt was embarrassing.

    Through college, I would drop classes and change majors based on whether there was class participation or a required speech class. Ultimately I did seek out help after my first job when I realized that I couldn't avoid all public speaking forever.

    I'm sharing this because the most important thing I learned was self acceptance. We can't all be public speakers. People are different. Some are outgoing and others are not. Teachers who are warm and compassionate and feel that shyness is not something that needs to be fixed would be wonderful for this child. I also got a lot of comfort from watching Mr. Rogers and hearing him say "I like you just the way you are." (now I've dated myself)

    Fortunately I haven't had to deal with this with my own children. Although they are all very sensitive and at least one is a little anxious. But if I did have a child with SM I would not push them to speak when they are not comfortable (like my parents did). This just creates more anxiety. These kids may always be somewhat sensitive and anxious and that is o.k.

    Posted by shymom January 20, 10 11:30 AM
  1. I was extremely shy as a child with certain relatives. One time I hid in the bathroom until they left.

    Posted by sophie08 January 20, 10 01:41 PM
  1. Ha! I got to the 7th comment from Notamom and had to laugh...my parents were asked the same questions about me but were confused because though they thought there might be something wrong with me my performance in class was far above the other children. To the original LW, does your child not speak at all during the day, even to other children? I think there are more questions to be asked before going the therapy route. I'm not a professional but I think we are too quick to medicate or put a child in therapy these days. Makes for a paranoid and overmedicated society. Anyway, my point is that I too was an extremely shy and introverted child. I had plenty of friends but would not respond to my kindergarten teacher for some reason. It wasn't 100% of the time but often enough that they noticed and questioned my parents. I turned out fine; good grades, strong career and am now a successful, independent woman. Sure, I still have my shy moments but am otherwise a well rounded individual. Without knowing more about your situation, I think your child is ok and will more than likely grow out of it as I did along with many other responders. Good luck!

    Posted by Notamom2 January 20, 10 06:01 PM
  1. Hi, I have a 13 y.o. old son with selective mutism. Could any suggest a qualified psychologist. I reached out to several but don't have experience or don't accept our insurance. We live in norton ma. thanks

    Posted by Cheryl January 21, 10 01:26 PM
  1. Sorry, Cheryl, I am not able to make specific recommendations. Check out the link in my answer, above.

    Barbara Meltz

    Posted by Barbara F. Meltz Author Profile Page January 21, 10 05:52 PM
  1. I am now a teenager but when I was 4 years old I was diagnosed with selective mutism. By the time I was 8 years old I was talking in class just as much as the other children. But I had a case so bad that I didn't even talk to my own grandparents, aunts and uncles, and most of my cousins. If he continues to not speak in public by the time he is 3 or 4, I would recommend going to a therapist or speech pathologist to work with him on social anxiety. The one thing to ALWAYS remember is to not pressure him into speaking, this will only make things worse. He will speak in public when he feels comfortable, but if you pressure him into speaking he will feel even more timid to speak. Hope this helps!

    Posted by kayla April 26, 10 07:43 PM
  1. Hi Kayla!
    My daughter has been diagnosed with SM and she is 6 now. How did you get through it? I feel that she is making some small progress on her own but we are being pressured by her teachers to get professional help. What worked for you? Thanks for any help you can offer!

    Posted by Trish May 18, 12 05:56 AM
  1. Hi All,

    I really some advice! My daughter (Lexi) will be four in August. She has been attending preschool for over a year and does not speak there or interact with the other children. Her stomach gets so sick the days she has to go school and she does not want to be there. There are approx. 10 kids in the class.

    Lexi is the most talkative , vibrant little girl at home.

    After passing her hearing, speech and language tests, her doctor feels she may have selective mutism. Although he is a pediatrician and cannot make this diagnosis.

    Do you think I should pull her out of this school and put her in something smaller, like more of a daycare setting? I am so nervous because she starts kindergarten in one year.

    Any advice will help. Thank you guys very much!

    Katie

    Posted by Katie July 6, 12 09:52 AM
  1. Barbara,

    It is inaccurate to say that the child "chooses" not to speak outside of the home. SM is an anxiety disorder that causes the child to experience such intense anxiety that they cannot speak. This is a huge distinction. There are many myths about SM, and one is that the condition is "elective" instead of "selective." This could not be further from the truth. These children are not being obstinate or willful, instead they are experiencing such extreme anxiety that it renders them incapable of speaking in certain situations.

    Posted by Sarah August 31, 13 12:08 PM
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Barbara F. Meltz is a freelance writer, parenting consultant, and author of "Put Yourself in Their Shoes: Understanding How Your Children See the World." She won several awards for her weekly "Child Caring" column in the Globe, including the 2008 American Psychological Association Print Excellence award. Barbara is available as a speaker for parent groups.

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