“Sometimes the most powerful think you can say is nothing at all.” – Mandy Hale
One in every 140 children in the United States has a severe anxiety disorder that inhibits speech. From 1980, when the DSM III described Elective Mutism to the most recent DSM where the disorder has evolved to Selective Mutism, the reasons for not speaking have evolved as well. From refusal to speak to a failure to speak, the physiological component of this disorder is now acknowledged. In addition, previous trauma is not always present in the diagnostic criteria.
According to the DSM 5, published in 2014, Selective Mutism is a failure to speak in stressful situations that impacts social and educational outcomes of the child and lasts for more than one month. Additionally, the child must show that he or show is comfortable and fully fluent in situations outside of those specific ones identified. Each child is different, and this might easily be misdiagnosed as a speech disorder or just being shy. However, this condition does not respond to speech therapy or the gentle prodding of parents.
The treatment is a slow ramp up on conditioning first with parents and then bringing in outside friends, teachers, or family to get the child used to progressively more stressful social situations and allowing the child to engage on his or her own terms. This can be a long and difficult process, especially with older children who are not so cut and dry on when their disorder shows itself.
There have been studies that show that during these time of stress, the throat muscles will tighten and fully inhibit speech, even when the child has a desire to speak. This is, however, not always the case. Pressuring the child to speak, disciplining the child for not speaking, or drawing negative attention to the condition only makes it worse. It teaches the child to feel shame and guilt for something they cannot control. And, it will only raise the anxiety level of the situation, furthering the periods of mutism.
Additionally, parents most often fall into the habit of guessing what the child is thinking or answers questions for them. That, too, is a negative action because it reinforces the cycle of mutism, allowing the child to feel that not speaking then releases the stress because the parent will answer on their behalf.
There is common comorbidity with autism spectrum disorders, social anxiety, and specific phobias. Communication disorders and speech delays may also appear in these children sometimes.