Has a teacher reported that your child does not speak regularly or readily at school? Does your usually-talkative, bubbly child suddenly clam up when you arrive together at a larger family gathering or when you drop them off at dance class?
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If your child appears to be a completely different person at home than they are in other social settings, they may have selective mutism. Selective mutism is often misunderstood and can be misdiagnosed, but early detection and treatment are crucial for better outcomes down the road.
Child psychologist Kristen Eastman, PsyD, says that in the past, children who were thought to be “just shy” or “defiant” for not talking, may actually meet the criteria for selective mutism.
Selective mutism was always believed to be rare, however, more children may meet the criteria of a diagnosis than previously thought.
“Many seemed to think that a child would grow out of the behavior, which is not always the case,” says Dr. Eastman.
“What may appear as shyness actually has its roots based in anxiety, specifically an underlying fear of the expectation to talk,” she says.
“Shy kids may not volunteer to read aloud to the class, but when they need to do things, they can,” Dr. Eastman says. “The main difference is that shy children can still navigate everyday tasks, whereas children with selective mutism cannot.”
A child with selective mutism may not communicate in select social settings (often school), but they can comfortably talk in at least one other place (typically home).
Both girls and boys can be affected, though the condition tends to impact girls more than boys. The average age of onset is under age 5, but it’s often more evident when a child enters a structured social setting (such as preschool or daycare).
Children with selective mutism are overcome with anxiety at the prospect of giving a book report, saying hello to a classmate or talking with their coach at soccer practice. So they’re rendered frozen and unable to initiate and/or respond. Because of this, their experience at school and in other social settings may be hindered, teachers may be unable to assess them and they may struggle socially.
It’s important to understand that there’s much variability in how it appears — from day to day, from person to person and from setting to setting.
It’s important for parents to trust their instincts. If you feel like your child is acting very differently in select social settings outside of your home, and/or with select people, it’s important to talk to your healthcare provider.
“The earlier you can make a diagnosis and start intervening, the better the prognosis long-term,” Dr. Eastman says.
Dr. Eastman says that when she works with children with selective mutism, her goal is “to help the child to start associating social settings with less anxiety and increased comfort as soon as possible.”
She suggests the following initial strategies:
It’s also important not to completely refrain from placing any demands on your child or avoid all social situations because of your child’s selective mutism. A child with selective mutism won’t improve while sitting at home with their immediate family, as they are already comfortable and talking here.
“Though dealing with the problem may seem stressful at first, your child’s anxiety will reduce with time and you will see progress,” Dr. Eastman says.
Talk with your provider who can help you create a plan of action. Selective mutism typically does not go away on its own, and can lead to worsened anxiety and social difficulty if not addressed. Treatment is most successful when there is a cohesive plan between home and school to produce lasting change.