Selective mutism: what it is, symptoms, causes and treatment

Selective mutism is an anxiety disorder, most common in children between 2 and 5 years old, especially girls. Children with this disorder can only communicate with people close to them, having difficulty talking to other people in certain situations, such as at school, for example.

The diagnosis of selective mutism is generally made after the age of 3, as the child at this age has already developed the ability to speak and begins to have difficulty carrying out some social activities.

It is important that selective mutism is diagnosed and treated with the help of a psychologist and psychiatrist, as this way it is possible to identify whether there is any other associated problem that could be causing the disorder, such as hearing problems or brain disorders, allowing you to better adapt the type. of treatment.

Symptoms of selective mutism

The main symptoms and characteristics of selective mutism are:

• Difficulty interacting with other children;
• Lack of communication with teachers;
• Difficulty expressing yourself, even through gestures;
• Excessive shyness;
• Social isolation;
• Difficulty going to the bathroom in an unfamiliar environment, peeing your pants, or eating at school.

Despite being more common in children, selective mutism can also be identified in adults and, in these cases, is called social phobia, in which the person feels very anxious in normal everyday situations, such as eating in public. , for example, or when thinking about establishing some type of communication. Learn how to identify social phobia.

How to confirm the diagnosis

The diagnosis of selective mutism is made by a child psychologist or psychiatrist, through the assessment of the child’s behavior in different situations, through reports from parents and teachers.

In addition, questionnaires can be administered to the child, such as the Selective Mutism Questionnaire or the School Speech Questionnaire, which allow the characteristics of this disorder to be assessed.

To confirm the diagnosis, the psychologist or psychiatrist must take into account that the absence of speech in special situations must be present for at least 1 month, as, unlike shy children, in selective mutism there is no progressive adaptation to new environments, such as a new school or a children’s party, for example. Shy children can become comfortable over time and can interact with other people.

Possible causes

Selective mutism does not have a specific cause, however, it can be triggered by some situations, such as:

• Negative experience or trauma from the past, such as starting a new school;
• Living in a super protective family environment;
• Having very authoritarian parents;
• Genetic factors.

Selective mutism can also be influenced by the beginning of school life or changes to a city or country, for example, as a consequence of a cultural shock. However, in these cases, it is important that the child’s development is observed, as often the lack of communication is not due to selective mutism, but to a period of adaptation of the child to the new environment.

Therefore, to be considered selective mutism, the characteristics of this disorder must be present before the change or last an average of one month.

How the treatment is carried out

Treatment for selective mutism consists of psychotherapy sessions, in which the psychologist outlines strategies that encourage the child’s communication, in addition to exploring techniques that evaluate their behavior. Thus, the psychologist can make the child feel more comfortable in the environment so that their communication is favored.

In some cases, it may be recommended by the psychologist that the child also be monitored by a child psychiatrist or that sessions be held with the family.

Furthermore, treatment for selective mutism can be continued at home, according to the guidance of the psychologist, in which recommendations are made for parents, such as:

• Do not force the child to speak;
• Avoid responding for the child;
• Praise when the child demonstrates progress in their communication skills;
• Encourage the child to do things that are more difficult, such as buying bread, for example;
• Make the child comfortable in their surroundings, to prevent them from feeling like they are the center of attention.

This way, the child can gain more confidence to communicate and not be so uncomfortable in strange environments.

When there is no response to treatment or evident improvements, the psychiatrist may recommend the use of selective serotonin reuptake inhibitors, SSRIs, which act at the brain level. These medications should only be used under the guidance of a doctor and in very well evaluated cases, as there are not many studies that prove their effect in treating children with this disorder.