Shy, quiet, or scared? When a child has selective mutism, it could be a combination of all three, and it’s a condition that needs to be addressed, our writer discovers after learning that her daughter, who enters Primary 1 this year, has selective mutism.
At her preschool’s Parent-Teacher Meeting last year, my daughter Rachel’s teachers told me that she was not cooperative in class. She would not answer her teacher’s questions, and she didn’t seem to be paying attention to lessons either. Sometimes she would even turn away from the teacher. When her classmates met me, they would ask questions like: “Why is Rachel so quiet?” “Why she never talks to the teacher?” “You know she never want to answer me, too?”
At home, upon coaxing, Rachel told me that she already knew most of what the teachers were talking about in class. Rachel also revealed that while she was gathering up her courage to answer a question, the teacher would have already moved on to the next student.
I know that my daughter has been leading a double life. She is bubbly at home and deathly quiet anywhere else. She seems to bottle up all her frustrations from school, only to let them all out the minute she exits the school gate. These frustrations are expressed through bursts of uncontrollable emotions (the-world-doesn’t-understand-me crankiness) and exasperating (for me) clinginess.
Her preschool, a learn-at-your-own-pace Montessori-style school, has been good for her. But she is in Primary 1 this year and it will be a game-changer. Her preschool teachers were concerned that she would not be able to cope in primary school. So we sought and got help. The preschool had an in-house therapist who suspected that Rachel may have a mild case of Selective Mutism. This was the first time I’d ever heard of it!
What is Selective Mutism?
Selective mutism is “a form of anxiety disorder in children who consistently have a fear to speak in certain situations and environments, yet speak freely at home with their close family and friends,” Dr. Sanveen Kang-Sadhnani, Principal Clinical Psychologist and Centre Manger of Thomson Paediatric Centre explained.
Although rare – this disorder affects less than one person in every 100 people – it has to be taken seriously as children will not outgrow it naturally. It can be caused by self-esteem issues and an underlying speech, language, or hearing problem.
“The onset of selective mutism is usually between two and five years of age although symptoms may not be obvious until the child enters school, where there is a clear expectation to speak,” Dr. Natasha Riard, a psychologist with the Department of Child Development of KK Women’s and Children’s Hospital, added.
Could it just be that my child is slow get into the mood of things? Not really, said Dr Riard. Selective mutism is more than just being shy or slow to warm up. Selective mutism could also run in the family. A large number of children with selective mutism have a genetic predisposition to anxiety.
How is Selective Mutism treated?
Should you worry if you child is diagnosed with selective mutism or seems to show a tendency towards the condition? Yes, said Dr. Sanveen. She recommended the following treatment – “Psychological Treatment, Speech and Language Therapy, possible use of medications, and support at home.”
It is also important to encourage the child to be independent, Dr. Sanveen added. She warned that many of these children with selective mutism – 90 per cent of them – also have social phobia or social anxiety. Therefore, transitions and new social settings can be challenging for them. The child may appear to be shy, but in actual fact, for the child, speaking and social interactions cause debilitating fear.
The child could also be overwhelmed in settings where “they sense a feeling of expectation,” cautioned Dr. Sanveen. Indeed. Rachel enthusiastically took up ballet two years ago to follow in her older sister’s footsteps, only to freeze during the first class performance for parents. She stopped going for ballet lessons soon after. She also has the habit of digging at her fingernails during situations that she find dreadful, such as arriving at school! Her fingernails are now terribly short and jagged.
What can Parents Can Do?
My daughter’s therapist observed that in preschool, Rachel only spoke with one particular classmate. The therapist concluded that Rachel tended to stick only to what she knew and was familiar with. To help her get through her fear of uncertainty, the therapist suggested that I involve Rachel in planning her days. This meant letting her plan her timetable for the day, since If she she knew what to expect at what time, she would not be caught unaware when it happened, and panic.
Dr. Riard suggested showing Rachel how I enjoy interacting with others, like talking with other parents at the school gate and making small talk with the cashier at the supermarket. I also set up playdates with a classmate whose company she enjoys.
The key, Dr. Riard emphasised, is to have a balance between creating an atmosphere that is relaxed, with no pressure to speak, yet not be too overprotective and speak for the child. “If a child is unable to communicate his or her choice or wants, he or she will have to learn the natural consequence of having a want unfulfilled,” Dr. Riard said.
Where do We Go from Here?
Rachel has just completed her first week of primary school. She went though the week quietly following her recess buddy around. She would not tell me how her day went or whether she likes her classmates, but she did share that her buddy was nice. Dr. Sanveen shared these tips to make the transition easier for children who, like her, have selective mutism.
- Make sure all adults involved are aware of the child’s difficulty
- Decreasing the child’s anxiety level by not forcing the child to speak
- Keeping the child in regular mainstream classes
- Allow the child to communicate in other ways, such as through gestures or text-messages
- Keep the child’s routine consistent. Let her have the same partner(s) for classroom work and provide the child with activities that do not require speaking, like silent reading, writing, board games, etc
I have a friend who suspects that one of her twin boys has selective mutism, even though it was never diagnosed. He would prepare and practice for show-and-tell assignments, only to clam up with during show time. Luckily he had a form teacher who went the extra mile to get to know and to understand each child in her class. She handed out questionnaires to each child’s parents and took their sharing seriously. She gave the boy extra time to compose himself for show-and-tell assignments, and gave him small duties to build his confidence.
Another friend has a daughter with whom Rachel shares similar traits. This girl, who is in Primary 4, recently told her mother that she does not know how to make friends. Aside from going through the motions of daily school life, she remains alone. For her, even a classmate asking to borrow something from her is a source of happiness. I worry that Rachel could be in her shoes a few years down the road.