Understanding selective mutism: what causes it and how to treat it

УДК 616-009.88

Understanding selective mutism: what causes it and how to treat it

Kamysheva S.M., 2nd year student

Scientific adviser: Naumova E.V., senior lecturer, Science and Education Center of Foreign Languages and Cross-Cultural Communication

(ORCID: 0000-0002-6829-3079)

St. Petersburg State Chemical and Pharmaceutical University

14, Prof. Popov St., St. Petersburg, 197022, Russian Federation

E- mail : sofya.kamysheva@spcpu.ru 

The article discusses the concept of selective mutism, its possible causes and treatment methods. Studies of various years are presented, proving the relevance of this topic.

Keywords: selective mutism; elective mutism; treatment; cognitive-behavioral interventions

Introduction

Nowadays the world is so fast and loud, everyone expects you to be the same: always on move, always ready to talk and communicate in the fastest way possible. People pay attention to how good one is at talking, how understandable can one convey the meaning of something in quick succession. But there are people, who have troubles in communicating with others due to something called selective mutism. In this paper we’ll explain what is selective mutism, what can cause it, how people, affected by it, deal with it and how one can help people with selective mutism.

Definition of selective mutism

Selective mutism is a mental disorder where individuals (most commonly children) do not initiate speech or reciprocally respond when spoken to by others. This lack of speech occurs in both social interactions with children or adults. Children will however, speak in their home in the presence of immediate family members (DSM-5)[ https://www.psychdb.com/anxiety/selective-mutism].

In DSM-5 there are five criteria for diagnosing one with selective mutism:

• Consistent failure to speak in specific social situations in which there is an expectation for speaking despite speaking in other situations.
• The disturbance interferes with social communication.
• The duration of the disturbance is at least 1 month (cannot be during first month of being at new environment (example: school)).
• The failure to speak is not attributable to a lack of knowledge, or comfort with the spoken language required in the social situation.
• The disturbance is not better explained by a communication disorder (e.g. - childhood-onset fluency disorder) and does not occur exclusively during the course of autism spectrum disorder, schizophrenia, or another psychotic disorder.

Selective mutism also can affect not only verbal communication, but also other ways of it [3], which leads to even more difficulties with socialization. Person, affected by selective mutism, may experience troubles with written communication too, being unable to write text messages.

What may cause selective mutism?

Usually, selective mutism is said to appear at age of 2-4, when parents can notice that their child has troubles speaking with other people or in new environments. But according to a study run by Melfsen selective mutism may appear in later years too. There are many theories of what could cause selective mutism from genetic Stein’s study [2] to Melfsen’s [1] “unsafe world” model, but currently, due to the lack of studies of selective mutism, there is no certain way to define what exactly causes it.

Though needed to be said that selective mutism usually is paired with social anxiety or other anxiety disorders.

Also speaking more than one language may cause selective mutism since people, who speak multiple languages or are in environments with people speaking languages other than their first language are more likely to experience selective mutism, even when they can speak the language. Being multilingual doesn't cause selective mutism, but for children who are anxious, having to speak a language they are less familiar with may put them more at risk for selective mutism [5].

Mutism occurs as a symptom of post-traumatic stress, it follows a very different pattern and the child suddenly stops talking in environments where they previously had no difficulty [6].

Manifestation of selective mutism in children and adults

Selective mutism can be seen as rudeness in usual communication between people, especially children, since they do not yet possess enough of social understanding. Person with selective mutism may avoid social settings, avoid eye contact, appear nervous before any social contact or experience intense emotions thinking about it [5]. Those treats are mostly shared between selectively mute children and adults. However, adults with selective mutism may experience some of those effects more extreme due to years of reduced socialization.

Selective mutism treatment

According to Melfen’s paper, “Treatment of selective mutism” [4], and other studies, the most used treatment of selective mutism is Cognitive Behavioral Therapy, since many suggest that selective mutism usually connected to one’s anxiety/anxiety disorders. Melfsen divides selective mutism treatment into eleven steps:

1. Understanding of therapy goals.
2. Start of treatment, which need to be done as soon as one’s been diagnosed.
3. Finding connection with the patient despite possibility of them not being able to communicate with therapist verbally; therapist need to be careful not to react badly to their patient being silent.
4. Therapist needs to help the patient understand that selective mutism is probably the cause of loneliness that often follows this diagnose.
5. Allowing of non-verbal connection.
6. Reduction of mimic-gestural compensation strategies.
7. Therapist should praise the patient for progress, yet not overdo it, since people with selective mutism often might be afraid of being under too much attention that comes with the praise. It proves to be beneficial to treat the patient as if they had always spoken.
8. In case of patient having any other disorders along with selective mutism, therapist should think about increasing amounts of therapy.
9. People, who are close to the patient, need to be sure to be supportive of the patient, even if therapy might be long and hard.
10.  Therapist should promote social contacts to the patient, since socialization can be essential in healing of selective mutism.
11. The patient should attend to other specialist to rule out hearing and other physiological problems from being the cause of their selective mutism.

Conclusion

Selective mutism is a topic that doesn’t currently have enough fundings or research done to, there is a variety of behavioral therapy methods for the treatment of selective mutism, such as contingency management, shaping, stimulus fading, escape avoidance, self-modeling or learning theory approaches. However, a clear diagnostic classification of the disorder as an anxiety disorder or oppositional behavioral disorder has so far been lacking. It is an essential first step in developing effective treatment and counselling for parents, which also takes sufficient account of the child's different environments, such as school or kindergarten, family, friends and acquaintances who contribute to the maintenance of mutism.