writing characters with speech impediments

selective mutism

What is it?

Selective Mutism is a complex childhood anxiety disorder characterized by a child's inability to speak and communicate effectively in select social settings, such as school. These children are able to speak and communicate in settings where they are comfortable, secure, and relaxed.

More than 90% of children with Selective Mutism also have social phobia or social anxiety. This disorder is quite debilitating and painful to the child. Children and adolescents with Selective Mutism have an actual FEAR of speaking and of social interactions where there is an expectation to speak and communicate. Many children with Selective Mutism have great difficulty responding or initiating communication in a nonverbal manner; therefore, social engagement may be compromised in many children when confronted by others or in an overwhelming setting where they sense a feeling of expectation.

Not all children manifest their anxiety in the same way. Some may be completely mute and unable to speak or communicate to anyone in a social setting, others may be able to speak to a select few or perhaps whisper. Some children may stand motionless with fear as they are confronted with specific social settings. They may freeze, be expressionless, unemotional and may be socially isolated. Less severely affected children may look relaxed and carefree, and are able to socialize with one or a few children but are unable to speak and effectively communicate to teachers or most/all peers.

When compared to the typically shy and timid child, most children with Selective Mutism are at the extreme end of the spectrum for timidity and shyness.

Why does a child develop this?

The majority of children with Selective Mutism have a genetic predisposition to anxiety. In other words, they have inherited a tendency to be anxious from one or more family members. Very often, these children show signs of severe anxiety, such as separation anxiety, frequent tantrums and crying, moodiness, inflexibility, sleep problems, and extreme shyness from infancy on.

Children with Selective Mutism often have severely inhibited temperaments. Studies show that individuals with inhibited temperaments are more prone to anxiety than those without shy temperaments. Most, if not all, of the distinctive behavioral characteristics that children with Selective Mutism portray can be explained by the studied hypothesis that children with inhibited temperaments have a decreased threshold of excitability in the almond-shaped area of the brain called the amygdala. When confronted with a fearful scenario, the amygdala receives signals of potential danger (from the sympathetic nervous system) and begins to set off a series of reactions that will help individuals protect themselves. In the case of children with Selective Mutism, the fearful scenarios are social settings such as birthday parties, school, family gatherings, routine errands, etc.

Some children with Selective Mutism have Sensory Processing Disorder (DSI) which means they have trouble processing specific sensory information. They may be sensitive to sounds, lights, touch, taste and smells. Some children have difficulty modulating sensory input which may affect their emotional responses. DSI may cause a child to misinterpret environmental and social cues. This can lead to inflexibility, frustration and anxiety. The anxiety experienced may cause a child to shut down, avoid and withdraw from a situation, or it may cause him/her to act out, have tantrums and manifest negative behaviors.

Some children (20-30%) with Selective Mutism have subtle speech and/or language abnormalities such as receptive and/or expressive language abnormalities and language delays. Others may have subtle learning disabilities including auditory processing disorder. In most of these cases, the children have inhibited temperaments (prone to shyness and anxiety). The added stress of the speech/language disorder, learning disability, or processing disorder may cause the child to feel that much more anxious and insecure or uncomfortable in situations where there is an expectation to speak.