advice
I
feel like the words are locked behind
a door and I don’t have a key,”
says a child suffering from selective
mutism (SM). In a relaxed, familiar
setting like home, children with SM
are usually fluent speakers, but they
fail to utter a word the moment they
step outside their comfort zone. They
are misunderstood to be shy, or worse,
defiant and stubborn, because of their
inability to speak.
However, their condition goes
deeper than shyness. It’s not like
children with SM choose not to
speak; they simply cannot, due to an
overwhelming anxiety. It is not a phase
they outgrow, and without help and
timely intervention they are in danger of
withdrawing and shutting out the world.
Anxiety
SM is a relatively rare anxiety disorder
that usually gets noticed during early
childhood, when children begin school.
Children with this disorder can only
talk in select, non-threatening social
settings and with a few family members
or a friend or two with whom they feel
secure. In a place like the classroom,
these children are likely to communicate
non-verbally, through nods, gestures, or
by writing out their responses.
Children with SM are genetically
predisposed to anxiety and their
condition is not necessarily due to
emotional trauma, abuse or neglect.
Not being able to speak in select
social settings, despite being fluent
in the spoken language and having
the ability to talk normally, is a
manifestation of this anxiety. “I find it
incredibly sad to think my little girl must
be so anxious she can’t speak,” says
the mum of a child suffering from SM.
Once the children fall into a pattern of
not speaking, it becomes a habit, and
mutism is entrenched.
Diagnosis
Children with SM can go without
diagnosis for years, making it harder
to treat. According to Dr Elisa Shipon-
Blum, president and director of the
Selective Mutism Anxiety Research
and Treatment Center, Pennsylvania,
SM is “the most misdiagnosed,
mismanaged, and mistreated anxiety
disorder of childhood. Children with
selective mutism truly suffer in silence,
and yet most people completely
misunderstand the child’s silence.”
However, the condition can be
diagnosed by health professionals based
on observations such as the child’s
consistent inability to speak for over a
month. The Child Assessment Service of
the Department of Health and the Institute
of Mental Health at Castle Peak Hospital
in Hong Kong can offer assessment and
treatment of anxiety disorders.
SM can be cured with therapy
and occasionally medication helps.
Therapy focuses not on speaking, but
helping the child overcome anxiety,
the root cause of the problem.
Techniques such as ‘stimulus fading’
are used, where the child talks
to a parent and a new person is
gradually introduced until the child
is comfortable talking to him or her.
Another method is desensitisation,
where the child is encouraged to build
conversations using emails and text
messaging, until they feel ready to take
on direct verbal communication.
The process might be painfully slow
and require immense patience, but it
helps release the child from the grip
of a social phobia which, when left
unchecked, can lead to a lifetime of
isolation and suffering.
Breaking the silence is the hardest thing to do for children
suffering from selective mutism, writes
Shikha Bansal
.
Speaking up
“
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