Selective mutism

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**Selective mutism**
*Classification & external resources*
ICD-10	F 94.0
ICD-9	309.83 313.23

Selective mutism is a social anxiety disorder, in which a person who is normally capable of speech is unable to speak in given situations.

1 Description
2 Treatment
3 References in pop culture
4 See also
5 References
6 External links
7 Other Organisations

[edit] Description

In the Diagnostic and Statistical Manual of Mental Disorders selective mutism is described as a rare psychological disorder in children. Children (and adults) with the disorder are fully capable of speech and understanding language, but fail to speak in certain social situations when it is expected of them. They function normally in other areas of behavior and learning, though appear severely withdrawn and might be unwilling to participate in group activities. It is like an extreme form of shyness, but the intensity and duration distinguish it. As an example, a child may be completely silent at school, for years at a time, but speak quite freely or even excessively at home.

The disorder is not regarded as a communication disorder, in that most children communicate through facial expressions, gestures, etc. In some cases, selective mutism is a symptom of a pervasive developmental disorder or a psychotic disorder.

In diagnosis, it can be easily confused with autistic spectrum disorder, or Aspergers, especially if the child acts particularly withdrawn around his or her psychologist. Unfortunately, this can lead to incorrect treatment.

Selective mutism is usually characterised by the following:

Consistent failure to speak in specific social situations (in which there is an expectation for speaking, e.g., at school) despite speaking in other situations.
The disturbance interferes with educational or occupational achievement or with social communication.
The duration of the disturbance is at least 1 month (not limited to the first month of school).
The failure to speak is not due to a lack of knowledge of, or comfort with, the spoken language required in the social situation.
The disturbance is not better accounted for by a Communication Disorder (e.g., Stuttering) and does not occur exclusively during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder.

The former name elective mutism indicates a widespread misconception even among psychologists that selective mute people choose to be silent in certain situations, while the truth is that they are forced by their extreme anxiety to remain silent; despite their will to speak, they just cannot make any voice. To reflect the involuntary nature of this disorder, its name had been changed to selective mutism in 1994. However, misconceptions still prevail; for instance, the ABC News erroneously attributed the cause of selective mutism to trauma and described it as willful in a report dated May 26, 2005.^[1]

The incidence of selective mutism is not certain. Owing to the poor understanding of the general public on this condition, many cases are undiagnosed. Based on the number of reported cases, the figure is commonly estimated to be 1 in 1000. However, in a 2002 study in The Journal of the American Academy of Child and Adolescent Psychiatry, the figure has increased to 7 in 1000.

No single cause has been established, but there is some evidence that there is a hereditary component and that it is also more common in girls than boys. Typical sufferers have some of the following traits when anxious, all of which are often perceived as rudeness:

They find it difficult to maintain eye contact. (anxiety)
Often don't smile and have blank expressions. (anxiety)
They move stiffly and awkwardly. (anxiety)
They find situations where talk is normally expected particularly hard to handle. Answering school registers, saying hello, goodbye, thank-you.
They tend to worry about things more than others
They can be very sensitive to noise and crowds
Find it difficult to talk about themselves or express their feelings

On the positive side, many sufferers have

Above average intelligence, perception, or are inquisitive
Are sensitive to others' thoughts and feelings (empathy)
Have very good powers of concentration (focused)
Often have a good sense of right/wrong/fairness (justice)

Wristbands: Many wear the turquoise wristband in an attempt to raise awareness for Selective Mutism which have been sent all over the world.

[edit] Treatment

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Contrary to popular belief, people suffering from selective mutism do not necessarily improve with age, or just grow out of it. Consequently, treatment at an early age is important. If not addressed, selective mutism tends to be self-reinforcing, with the person being known as the one who doesn't speak which makes it all the harder to then speak. Sometimes in this situation, a change of environment (such as changing schools) to a place where the condition is not known can make the difference.

Occasionally, treatment in teenage years becomes more difficult, though not necessarily.

Forceful attempts to make the child talk are not productive, usually resulting in higher anxiety levels and so reinforcing the condition. The behaviour is often viewed externally as willful, or controlling, as the child usually shuts down all communication and body language in such situations, which is perceived as rudeness.

The exact treatment depends a lot on the subject, their age and other factors. Typically stimulus fading is used with younger children.

Some in the psychiatric community believe that anxiety medication may be effective in extremely low dosages and that higher doses may just make the problem worse. Others in the field believe that the side-effects of psychiatric medications- in any dose and on any child- are so dangerous as to negate any temporary benefit, preferring behavioral and psychological interventions.

[edit] Stimulus Fading

In this technique the sufferer is brought into a controlled environment with someone who they are at ease with and can communicate. Gradually another person is introduced into the situation involving a number of small steps.

These steps are often done in separate stages in which case it is called the sliding-in technique, where a new person is slid into the talking group. This can take a relatively long time for the first one or two faded in people.

[edit] Desensitization

The subject is allowed to communicate via non-direct means to prepare them mentally for the next step. This might include email, phone, taped recordings, webchat, until they are in a position to try more direct communication.

[edit] Drug treatments

Some practitioners believe there's some evidence indicating that antidepressants such as fluoxetine (prozac) may be effective in treating children with selective mutism. Though many in the medical community believe that psychiatric medications decrease the anxiety levels enough to allow communication to take place in cases of selective mutism, other practitioners and activists (see articles on Peter Breggin and David Healy (psychiatrist)) stringently decry any use of psychiatric medications on children and note the lack of medical proof of genetic links to behavioral disorders. The denunciation of psychotropic intervention on children with behavioral anxiety disorders has intensified particularly since lawsuits against several drug companies—current to 2005—have exposed previously unseen internal research documents linking fluoxetine and other SSRI antidepressants with increased risk of suicide, psychosis and—ironically enough—damage to areas of the brain which could affect language production and normal social development.

[edit] References in pop culture

In A Nightmare on Elm Street 3: Dream Warriors the character Joey Crusel is selectively mute, his scream kills Freddy. In the sequel he appears to be over it.

Zeke Kinski, a character in the Australian show Neighbours is selectively mute as he thought he killed his father by wishing that he was the one who died instead of his mother, but when his sister was electrocuted by a faulty kitchen appliance, Zeke was forced to speak to an emergency operator and has since resumed speaking as normal.

In the Disney Channel original series Lizzie McGuire the character Lanny Onassis, a friend of Matt McGuire, is selectively mute and only communicates to Matt.

The song "She's Given Up Talking" by Paul McCartney (from the album Driving Rain) conforms almost perfectly to a clinical description of selective mutism in childhood, describing a young girl who is mute at school yet normally talkative at home ("When she comes home it's a yap yap yap/ words start to flow like water from a tap").

In the film 'Trapped In Silence'; Kiefer Sutherland plays a boy traumatized by things in his past, who is selectively mute because of what's happened to him, etc. In the film; a psychologist works with him. Although he has chosen not to talk because of what he's been through; he slowly but surely starts to open up.