|
By:
Dr.Elisa Shipon-Blum
President and Director Selective Mutism Anxiety Research and Treatment
Center (SMART-Center)
Chief Executive Officer ~ Medical Director
The Selective Mutism Group
Childhood Anxiety Network (SMG~ CAN)
Clinical Assistant Professor Family Medicine and Psychology PCOM
SMinfo@selectivemutism.org ~ 215-887-5748
Helping
our Teacher’s Understand
Selective Mutism
Selective Mutism is a childhood anxiety disorder characterized by a
child’s ‘inability’ to speak in various social settings. These children
are able to speak at home, and in settings where they are comfortable,
secure and relaxed.
The etiology of Selective Mutism is due to severe anxiety.
The
majority of Selectively Mute children have severely inhibited
temperaments.
When
compared to the typically shy and timid child, SM children are at the
extreme end of the spectrum for timidness and shyness. So much so, that
when Selectively Mute children confront a social situation where they do
not feel comfortable, they often become mute and possibly noncommunicative.
Some children may have great difficulty pointing/nodding or even mouthing
words while others may be able to respond and initiate nonverbally with
ease and ‘look’ completely relaxed.
According to studies, approx. 90% of SM children meet the DSM-IV
diagnostic criteria for social phobia.
Social
phobia
is a persistent fear of social or performance situations. It can be a
debilitating and a heart wrenching disorder for an adult; imagine what it
can be like for a child who has not yet learned proper coping skills?
Many of these children literally feel like they are ‘on stage’ every
minute of the day! This is evident by their ‘uncomfortable’ body language
when any attention is brought to them. Many children will turn their
heads away, play with their hair, look to the ground, tilt their head,
hide in the corner, suck their finger(s), and pick or scratch sores, moles
or birthmarks on their body. Many will stare at you with a
‘blank-looking’ or ‘expressionless’ face, acting as if they are ignoring
you. And as mentioned above, still other SM children may appear
comfortable and at ease, yet remain silent or perhaps only whispering to
one or few individuals.
Teachers must realize these characteristics are all examples of anxious
Selectively Mute children.
Unlike
adults, who can choose when and where to go, children do not have that
choice; especially when it comes to going to school. Due to their severe
anxiety disorder, Selectively Mute children do not speak. Just as an
individual with agoraphobia avoids going out of the home in order to avoid
the feeling of anxiety, and the person with obsessive compulsive disorder
(OCD) performs rituals and has compulsions in response to their anxiety,
the selectively mute child does not speak as a means of avoiding anxious
feelings, simply because speaking enhances anxiety.
Although
anxiety is the underlying cause for Selective Mutism, the following
propagating factors can exacerbate the tendency towards the development of
mutism:
n
Bilingual SM children who speak a different language at home are often
insecure and afraid to speak when in an environment, such as school, where
a different language is being spoken. Mutism develops as a means
of avoiding the anxious feeling of speaking a language with which they are
not comfortable.
n
Approximately 30-40% of SM children have speech and language
abnormalities, i.e., children with articulation disorders are often
insecure and uncomfortable with their voice. Perhaps peers or adults have
made comments about the sound of their voice or mispronunciation of
certain words. For the socially anxious child who is already insecure in
a social situation, this only worsens their anxiety and fear. Mutism
develops as a means of ‘avoiding’ anxious feelings with the thought of
others commenting or making fun of their speaking. Studies need to be
done to further examine characteristics of speech and language pathology
in the SM child.
n
Negative
reinforcers of Mutism, i.e., continuously asking, bribing, forcing and
threatening a child to speak, only heightens internal anxiety and
perpetuates mutism.
n
Environmental stressors, such as death, divorce, marital discord, etc. can
heighten anxiety, propagating already existing mutism, but RARELY, if
ever, cause mutism.
It is so
important for teachers and school personnel to remember that the
Selectively Mute child is not ‘being silent’ or barely whispering ‘on
purpose,’ or trying to ‘control’ a situation. These children literally
cannot speak. As many selectively mute children have said, “The
words just won’t come out.”
Other
children state, “The words get stuck in my throat,” “My body won’t let me
speak,” etc.
When
asked to describe their feelings about ‘speaking in school,’ it is very
common for children/teens to say, “I get really scared,” “I don’t know,”
“My stomach starts to hurt,” etc.
These
children are not mute because of a learning disability,
Autism, Pervasive Developmental Disorder, Oppositional Defiant Disorder,
etc.
This is
not to say that another disorder cannot occur concurrently with Selective
Mutism, but it is not the cause.
Knowing
that the majority of cases are due to severe anxiety, special education
classes, remedial classes, etc. are often completely inappropriate for
these children.
By understanding the nature of Selective Mutism, a child should be
mainstreamed in a regular class. An IEP can be beneficial in certain
cases of SM, especially as the child progresses through school, and
verbalization is not occurring. The IEP should be designed to help lessen
anxiety for the child, but at the same time, encouraging mainstreaming and
‘normalcy’ as much as possible.
School
is usually the most difficult place for Selectively Mute children to be.
Teachers and peers expect all children to interact and participate in
classroom activities. When children do not, attention is brought to
them. This is exactly what happens to the selectively mute child. This
is quite ironic, considering the last thing an anxious child wants to do
is bring attention to him/herself.
Understanding that the SM child’s ‘silence’ is due to anxiety, it should
be quite obvious that ‘pressuring,’ ‘punishing,’ ‘coercing’ or ‘bribing’
an SM child to speak is completely counterproductive and inappropriate.
By doing this, the SM child often feels more anxious and uncomfortable,
causing them to regress even further.
Asking
an SM child to speak is similar to asking a child confined to a wheelchair
to get up and walk. Proper treatment needs to be implemented for the SM
child to speak comfortably, just as the child in the wheelchair needs
treatment and support to get up and walk.
It is of
utmost importance that the school approach the SM child from an
understanding and accepting perspective. The main objective should be to
do whatever is possible to make the child feel comfortable and relaxed.
What can
a teacher do to help the anxious Selectively Mute child?
First,
teachers should consult their school psychologist and/or school counselor
to discuss their concern over the child’s ‘silence’ and their suspicion
about Selective Mutism. Then, arrange a meeting with the parents to
discuss the child’s ‘inability to talk.’ Including the school
psychologist and/or counselor is a good idea so various options for proper
evaluation/assessment and potential treatments can be discussed.
Providing parents with informational handouts that describe Selective
Mutism is a gentle approach to conveying reasons for your suspicions for
this diagnosis. Parents have often never heard of the term, Selective
Mutism, and hearing such a term, without truly understanding the meaning,
can be very frightening and intimidating to families.
A
teacher should work with the parents to help alleviate as much anxiety as
possible. By doing so, many children will often make progress more
readily than if they are completely misunderstood and mismanaged.
There
are varieties of methods that teachers can use to help the Selectively
Mute child feel more comfortable and less anxious in the classroom.
Primarily, a teacher should try to get to know the child in a completely
unobtrusive and accepting manner. Visiting the child at home before the
start of the school year is often beneficial. There is certainly no
better place for children to feel more comfortable then in their own home!
Visiting the children on their own turf will certainly allow for a more
comfortable way of getting to know each other. I recommend sitting in the
child’s room, asking them to show you their favorite books, artwork, CD’s,
games, etc. Allow them to lead and direct the visit. It may take a few
visits to the home before the child starts to open up.
If
visiting the home is difficult, another tactic would be to meet the child
at school, possibly before school starts in the morning. Have the parent
bring the child as early as possible so the child does not feel so
overwhelmed when a group of children is in the class at the same time.
For the younger SM child, having their parent around is very comforting
and helps the child feel more comfortable. When alone with the parent and
the child, the teacher can try to engage the parent in conversation and
allow the child to just observe. Just let the child know they are part of
the conversation and that any kind of nonverbal communication is okay with
you. Interacting with the child in an informal manner, with as little eye
contact as possible, is strongly recommended. Having the child help you
organize the room or setup activities is a wonderful way to connect
without the pressure of direct questioning, which tends to intimidate the
SM child.
Important advice is to NEVER make the child feel as though
you are ‘waiting’ for him/her to speak. This expectation is anxiety
provoking. In addition, it is important for teachers to not make a ‘big
deal’ over any verbalization that does occur. Very often, the SM child
will speak to a peer before a teacher. In this case, do not make mention
that you ‘hear’ their voice. SM children will often pull away when that
approach is taken!
Enabling
for small group interaction is important and should be implemented
as much as possible within the classroom. Pairing the SM child with a
close friend or child that is accepting is also essential. As the SM
child feels comfortable and begins communication, introducing other
children, one by one, is encouraged.
As a
comfort level is being reached, the teacher and parent(s) should agree on
a ‘plan’ to help the child. A qualified professional, such as a
physician, psychologist, social worker, or school counselor who is
competent in treating Selective Mutism, is a definite necessity in helping
develop a ‘plan’ for the child.
The
process of ‘helping a child overcome Selective Mutism’ is a step-wise
process that must be approached with patience and confidence.
There is no over-night miracle cure for selective Mutism. With the
guidance of school professionals, children will build various behavior and
coping skills that will allow them to slowly emerge out of their anxious
state.
Please
contact the Selective Mutism Group Childhood Anxiety Network SMG-CAN)
For further information contact
www.SelectiveMutism.org and
www,childhoodanxietynetwork.org
215-887-5748 ~ SMinfo@selectivemutism.org
Please visit
the 501( c )3, nonprofit organization the Childhood Anxiety Network, Inc.
Copyright SMART-CENTER and Dr. E Shipon-Blum©. Users are responsible for
complying with all copyright and licensing restrictions associated with ©
data.
|