Refusal to Speak: Just Shyness?

  • Posted on: Feb 14 2020
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Parents often know their little ones to be chatty and relatively outgoing in the comfort of their homes. When the same child who was engaging in lively conversation with a parent or sibling in the car suddenly goes wide-eyed and mute in the grocery store or even with extended family, a parent may wonder about their child’s excessive shyness. Here, we discuss what may cause a child not to speak in certain situations and how this anxiety-based condition may be managed.

When a child seems to refuse to speak to a family member, teacher, or another person, it is natural to consider them shy. However, for 1 in about 140 children, this shyness is actually extreme anxiety that is referred to as selective mutism. In this situation, the child is not refusing to speak, they literally cannot. Their fear prevents them from doing so.

What is Selective Mutism?

Clinically, selective mutism is categorized as a complex childhood anxiety disorder. It is characterized by an inability to communicate in social or academic settings. When there is an expectation to speak, the child may shut down to both verbal and nonverbal communication. In a secure, comfortable setting in which the child feels relaxed, speech is not an issue.

The challenge of selective mutism is that it may be expressed in a number of different ways. Some children become completely mute and incapable of any form of communication, while others may whisper. Some children may freeze and be expressionless when overwhelmed by the expectation to communicate, while others may appear quite carefree around certain people but remain unable to speak to teachers and some/most peers.

Diagnosing Selective Mutism

There are parameters in which selective mutism lies. A thorough evaluation of the child may include a psychiatric interview with the child and family, a home video, direct observation in the therapeutic setting, and input from family, friends, and teachers. Diagnostic criteria include:

  • Consistent inability to speak in certain situations, not related to unfamiliarity with topic or language.
  • Interference with social or educational milestones.
  • At least 1-month duration beyond the first month of school.

Intervention for Selective Mutism

Early intervention is ideal for children with selective mutism. Once a child begins school, the inability to speak may be addressed locally by calling in the school’s speech-language pathologist. The problem with this approach is that selective mutism is not a speech and language issue, it is a mental health issue. Therefore, a mental health professional needs to be involved in facilitating support for the child. In many cases, a combination of traditional pediatric therapy and psychopharmacology achieves the best results.

Dr. Aubergine is a child and adolescent psychiatrist with experience diagnosing and treating selective mutism and other anxiety disorders. For more information, call our Burr Ridge office at 630-325-4899.

Posted in: Psychiatric Evaluation

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