Understanding and Managing Selective Mutism

Have you ever found yourself getting nervous and freezing in the moment during a group activity because it feels like your brain has gone blank and won’t let you communicate? If you said yes, you’re not alone. There are times when we all experience such a situation, and it takes a couple of minutes before we’re back in form to engage with the group. While this may be a momentary and occasional experience for some of us, there are individuals who face it throughout their lives resulting in prolonged distress in social situations. 

What is selective mutism?

Selective mutism is an anxiety disorder that begins during childhood and is characterised by the child’s inability to communicate or speak up in certain social situations such as at school or in the community. The same child may be perfectly comfortable with interactions at home or around people they are familiar with because they feel safe and secure to communicate. 

When left untreated, selective mutism persists into their adult life where it can cause the individual to freeze in public settings such as the workplace or in the presence of a larger community. Children or adults avoid speaking in situations where they fear that they will be judged or criticised for what they say.  

Selective mutism often occurs with social anxiety disorder due to the individual’s discomfort and inability to communicate effectively and adjust in social situations. 

Selective mutism in children

Children who develop selective mutism often have a genetic predisposition for anxiety and inherit the tendency to be anxious from a member in the family or someone in their immediate vicinity that they are close to. This usually sets in when the child is about to begin school or when they start engaging with people beyond their immediate family. These children often display signs of separation anxiety and may be moody, have frequent tantrums and experience sleep problems or extreme shyness. Some children with Sensory Processing Disorder may also have selective mutism as the difficulty in processing sensory input causes a child to misinterpret environmental and social cues, thereby causing frustration and anxiety.

Selective mutism in adults

Untreated selective mutism from childhood can lead to selective mutism in adulthood and increases the risk of developing other anxiety disorders. While these people may feel confident enough to communicate in some social situations, they may experience difficulty in unfamiliar ones. For these individuals, it can become impossible to talk as they get overwhelmed with anxiety and tend to shut down. This condition affects multiple facets of an individual’s life. For example, they may face difficulty in speaking during job interviews or hesitate in asking strangers for help with finding an item in the grocery store. At the workplace, they may get stressed by the pressure to present their work or to give a quick response to a topic being discussed. It can also cause them to try their best to avoid situations they perceive as risky as they require them to step out of their comfort zone and have the potential to provoke questions from others in case they make a mistake. Such instances can lead to a diminished growth in their profession or career. 

Signs and symptoms of selective mutism

Selective mutism can lead to an impairment in one’s daily functioning due to the fear of speaking in social and occupational settings. While often mistaken as shyness in an adult, it is much more than just that. 

Let us take a look at some of the common signs observed in individuals with selective mutism:

1. They are perceived as shy or withdrawn and distant
2. They struggle to make eye contact, have a blank expression or are fidgety when they become the focus of attention
3. They are unable to speak in specific situations and respond to questions through non-verbal forms of communication such as pointing, nodding or writing. Additionally, they may speak very softly, almost as if they are whispering
4. They express the desire to speak but hold themselves back in fear of judgement and embarrassment
5. They are able to communicate easily in certain situations that are familiar to them, but face difficulty in speaking in group settings where speaking is expected such as at the workplace
6. They seem irritable, disinterested or rude when approached 
7. In certain cases, due to frustration over their situation, they may be stubborn, angry or violent when they feel challenged by others. This manifests in temper tantrums at home or among people with whom they feel safe to express themselves.

Individuals with selective mutism often tend to develop coping strategies which will help them avoid situations that cause them to feel anxious. Some of these are:

1. Avoidance of the situation by not being present physically 
2. Avoiding eye contact to ensure they don’t draw attention
3. Declining invitations to social events 

Tips for managing selective mutism

Selective mutism is a unique condition and can often cause confusion for the parents or family of the individual experiencing it. Lack of awareness, incorrect diagnosis or inaccessibility to a specialist with an understanding of the condition are a few issues that make it difficult for the family to provide the individual with the help they need. It is important to stay on the lookout for the signs of selective mutism mentioned above, which can in turn help the family to understand how to manage the condition. Here are some tips for parents and families of individuals with selective mutism.

• Be supportive and compassionate: 

When it is observed that the individual is open to interacting with the family or in a familiar place but shuts down around strangers or in a new place, it's best not to force them to interact until they begin to get accustomed to the new environment. Have a conversation with them to understand why they are feeling anxious and how you can help.

• Acknowledge their achievements: 

Encourage them to face situations that induce fear. Acknowledge and reward their achievement when they are able to function in these situations so that they gradually begin to build confidence. 

• Accompany them to social events:

While it may be difficult for individuals with selective mutism to interact in social situations, having someone familiar around can help them ease into the new environment and feel safe to interact with others.

• Be patient and avoid pressurizing them:

It is important to remember that people struggling with selective mutism will take some time to get comfortable and additional pressure from family and friends can cause a great deal of distress. Hence, give them time and space to get comfortable in case they freeze up and are unable to communicate.

• Allow for non-verbal communication:

There may be times when the individual wants to communicate non-verbally such as through writing or gestures. Understanding how they communicate non-verbally can help cope with the frustration of not receiving a response from the individual.

Treatment for selective mutism

It is best for selective mutism to be identified and diagnosed in childhood so that the child can overcome the concerns and develop healthy ways of dealing with the anxiety and fear in social situations. However, due to the lack of awareness, selective mutism is often left untreated. While it can be overcome in adulthood, such individuals may experience the effects of having spent many years without social interaction and may not be able to reach their full potential academically or professionally. 

While there are many options for the treatment of selective mutism, it requires a trained mental health professional to understand what suits each individual the best.

Psychotherapy and medication are the most common treatment options and sometimes a combination of the two may be recommended. Psychotherapy includes incorporating strategies of Cognitive Behavioural Therapy (CBT), behavioural management and speech-language therapy. Along with this, psychoeducation is also important to help the individual and their family understand how the condition can be managed effectively.  

How can Wysa help?

Psychotherapy is one of the most effective ways to work on overcoming selective mutism as it helps the individual understand the root cause of their fear to interact in public spaces and how they can overcome it in a phased manner. Wysa is a mental health app based on CBT techniques. At Wysa, you will have access to therapists who work with the CBT strategies and can help individuals work through behaviour modification, anxiety and building coping skills. Apart from being able to speak to a therapist during sessions and asynchronous messaging between sessions, you can access a library of resources and tools that can help with management of behaviours in your daily life. They can help you work through the symptoms of selective mutism, such as worrying about interacting with unfamiliar people or how to cope with the stress of being in public spaces.

Conclusion

While selective mutism disorder can be overcome, it is important to be vigilant for the signs early on in childhood to ensure that a child gets the opportunity to develop into a healthy social being. Due to the impact the condition has on an individual’s life, the support system needs to be empathetic and mindful so the individual can feel safe and secure. Psychoeducation helps build awareness and compassion towards individuals with selective mutism. It is recommended that families approach a mental health professional who specialises in the disorder as soon as its symptoms are observed to ensure that treatment can begin at the earliest.

Image Credits: Photo by Joice Kelly on Unsplash