Our globally successful, evidence-based treatment approach, Social Communication Anxiety Treatment® (S-CAT®), is grounded in the understanding that Selective Mutism is so much more than just not speaking in social settings. A major component of S-CAT® is understanding that every child/teen is different; therefore, an individualized treatment plan needs to be developed that incorporates the child’s/teen’s unique needs, and home (parent education and environmental changes) and school modifications (teacher education and appropriate accommodations/interventions). Your loved one with Selective Mutism and/or Social Communication Anxiety developed this disorder and remains “stuck” from one or more contributing factors.
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Most children with Selective Mutism have a genetic predisposition to anxiety. They frequently show signs of severe anxiety, e.g. separation anxiety, excessive tantrums and crying, moodiness and inflexibility, problems sleeping, and extreme shyness from infancy on.
Children with SM often have severely inhibited temperaments. Studies show that individuals with inhibited temperaments are more prone to anxiety than those without. As a result, symptoms of Selective Mutism are most prevalent in social settings, e.g. birthday parties, school, family gatherings, routine errands, etc.
Approximately 30% of children with SM have subtle speech and/or language abnormalities such as language delays. Our research shows that as children age and remain mute or minimally verbal, their ability to express themselves is compromised. This leads to an acquired expressive language disorder, primarily in narrative speech, because they aren’t participating in the typical responding-and-initiating of a conversation in social environments or where the use of more complex language is expected such as in school.
Some children with Selective Mutism may have subtle learning disabilities including auditory processing disorders. Many come from bi- or multilingual families, have spent time in a foreign country, and/or have been exposed to another language during their formative language development years (2-4-years old). These children are usually innately temperamentally inhibited but the additional stress and insecurity of having to learn another language can cause an increased anxiety level and ultimately mutism.
Research from the Selective Mutism Research Institute (SMRI) indicates many children who present with Selective Mutism also have sensory sensitivities and meet the criteria for Sensory Processing Disorder (SPD). Thus, SPD can be an underlying reason for mute behavior.
In larger, more crowded environments where multiple stimuli are present (e.g. the classroom setting), a child may have difficulty processing sensory input. As a result, anxiety is produced. As anxiety increases, the child may actually feel fear. In these situations, children with Selective Mutism tend to “shut down,” avoid interacting, freeze, and become mute. They may appear like a “deer-in-headlights.”
Typical symptoms of children with SM who have sensory challenges present with:
- Oversensitivity to being touched by fabrics, hair washing and brushing, hugging, hand-holding, etc.
- They often pull out tags from their clothes and prefer elastic band pants compared to buttoned pants.
- Tendency to misinterpret touch in the classroom. For example, they will indicate another child pushed them when they were only gently nudged.
- Oversensitivity to sounds, lights and/or smells (sounds are the most common sensitivity)
- Picky eating tendencies
Within the classroom, a child with sensory difficulties may demonstrate one or more of the following symptoms:
- Social withdrawal/playing alone or not at all
- Physical discontent sitting close to or near others
- Group activity avoidance
- Hesitation in responding (including nonverbally)
- ADHD-like symptoms may manifest when in school and in group settings but not in a quieter, calmer and more predictable environment such as at home
Sensory Processing Disorder may cause a child with SM to misinterpret environmental and social cues. This can lead to inappropriate social responses, frustration, and anxiety. Their inability to effectively communicate reinforces this. Modulating sensory input tends to affect the child’s emotional responses. As a result, many sweet-natured children can also seem quiet, stubborn, or inflexible.
Children with SM who also have sensory processing difficulties often have emotional regulation challenges as well. Challenging behavioral patterns can manifest such as:
- Crying spells and tantrums
Experience at the Selective Mutism Anxiety and Related Disorders Research and Treatment Center (SMart Center) indicates sensory processing disorder may or may not lead to learning or academic difficulties. Many children, especially highly intelligent children, can compensate academically and perform quite well. Many focus on their academic skills, often leaving behind the social interaction within school. This tends to be more obvious as the child ages.
So, it is not atypical for a child with SM to be timid, have sensory sensitivities, emotional regulation challenges, and/or a subtle speech and language disorder. What is crucial to understand is that many of these symptoms may not exist in a comfortable and predictable setting, such as at home.
Children are rarely “just mute.” Emphasis needs to be put on the causes and propagating factors of mutism. You cannot simply treat to speak. Understanding the causes as to why a child developed SM is needed to develop an appropriate treatment plan and school based accommodations and interventions.
There is no evidence to prove the cause of Selective Mutism is related to abuse, neglect or trauma.
Fortunately, individuals with Selective Mutism can (with proper treatment) develop the necessary coping skills to combat their anxiety and overcome their silence, finally allowing the rest of the world to see what their parents tend to see within the confines of their comfortable home environment: a chatty, confident and assertive child. To schedule an appointment or learn more about our treatment services, contact us today: (t) 215-887-5748 | (e) firstname.lastname@example.org