Selective mutism, introversion: Why doesn’t my child speak at summer camp?

It’s like the default switch of silence goes off and she cannot speak to strangers. At home, Rena, whose name has been changed upon request, is a bright spark. She loves to talk and giggle, her eyes twinkling with mischief. At school, the five-year-old’s eyes dim with fear; it’s paralytic to her vocal chords. Rena, says her mum, has selective mutism (SM).

Mandeep Jassal, Behavioural Therapist at Priory Wellbeing Centre, Dubai and Abu Dhabi, explains: “Selective mutism is typically diagnosed around the age of five years and is a severe anxiety disorder. According to the DSM-5 [Diagnostic and Statistical Manual of Mental Disorders], individuals with this disorder fail to speak when spoken to when expected to in social situations e.g. at school or with relatives they do not see very often. This failure to speak typically lasts for at least a month.”

The diagnosis criteria, explains the American Speech-Language-Hearing Association (Asha), are:

A parent’s natural urge is to shield their child, so when put in a situation where a child is behaving like a ‘deer in the headlights’ and asking to be rescued, it’s only natural that they would come to their aid. However, this reinforces the behaviour of the child, ultimately making things worse. Website Anxiety Canada explains the vicious cycle as

Stella Antoniou, child and family therapist and parent coach at Stellantoniou.com, explains: “Being selectively mute is a disorder, a developmental difficulty. Being an introvert meanwhile is a personality trait. It has nothing to do with a disorder, anxiety, trauma or anything else that has to do with your life.”

Jassal adds: “Introverts are not unable to speak and become ‘frozen’ with anxiety, which is what happens with selective mutism.”

US-based Selective Mutism Association (SMA) debunks common misnomers

SMA explains that while studies point to at least 7.1 out of every 1,000 kids having the condition, it’s often misdiagnosed as the child may be called ‘shy’ or ‘autistic’. The number of cases is likely to be falsely low, it says.

While trauma may feed the anxiety, it’s not a given that it’s in play. It’s just that children may be more on edge because of the anxiety.

SMA explains that this is far from the truth. “Despite looking oppositional, selective mutism is more often the result of anxiety, avoidance behaviour, and well-learned patterns of removing themselves (or being rescued) from speaking situations to decrease this anxiety,” it says.

Cognitive behavioural therapy and play therapy are known to help children suffering from SM.

“Shyness is marked by a tendency to withdraw from people, particularly unfamiliar people, but shy kids are able to function adequately in society,” says SMA. “Rather, selective mutism is characterised by extreme inhibition and an inability to adapt to social situations that interferes with a person’s daily functioning and communication with others.”

While symptoms may seem similar when looking from afar, they are far from it? But if you are wondering which one your child has, says SMA, “One of the best ways for clinicians to rule out autism is to observe video of the child in his or her comfortable environment (usually in the home) to determine the extent of the lack of speech and a thorough understanding of the child’s true language abilities (recognising that more broad mutism may be more directly linked to language deficits and autism).”

While some do contend with social anxiety, you will also find kids with SM who will laugh and engage with their peers – they’ll just be non-verbal while they do it.

How do you evaluate a child who will not respond to an answer in the conventional verbal method? It’s difficult and feeds this myth. “Alternative testing methods and use of accommodations such as recordings usually allow for a more accurate assessment for these children,” explains the association.

Jassal’s top tips for parents are:

Antoniou calls for acknowledging their children’s feelings. “They should validate the way the kids’ feel and not push the child to talk. Because selective mutism has nothing to do with speech. It all has to do with social anxiety.”

However, this doesn’t mean a vacuum when it comes to educating them. “Let the children be the way they are without pushing them and also make sure they are having discussions, reading stories, playing different activities based on their anxieties,” she adds.

Antoniou explains that the role of the teacher is paramount in helping kids with SM. They can, she suggests:

On the information-sharing platform Reddit, user @kitobich explained that their son has SM. “When he was a toddler in kindergarten he would not reply at all to any of the adults working there, at first also not the children. At school it also kept happening mainly with the adults, with kids it got better. He has been going to therapy for a year now and it's getting better. One big factor might be in our case, aside from him being very shy and somewhat socially anxious, that he is growing up trilingual and the language of the adults in kindergarten and school was not one spoken at home with either parent. Anyways having a therapist acknowledge it is SM helped a lot for the teachers to stop pushing him or putting him on the spot because that only makes it worse,” they wrote.

According to US-based Child Mind Institute, SM is more common among children who speak a second language, but bilingualism isn’t the cause of it. “For kids who already have an anxious temperament, being expected to use a language they are less comfortable with can put them at additional risk,” it explains.

Priyanka Dang, Clinical Psychologist at Open Minds Psychiatry Counselling and Neuroscience Centre, Dubai, explains: “Children typically progress though the stages of second language acquisition:

Dang says that a child’s ability to move through these phases depends on personality. “Behavioural inhibition to the unfamiliar is one of these personality factors with significant potential impact on multilingualism. Children who are timid, frightened, and/or inhibited and who are expected to operate in a second, foreign language may be more likely to exhibit mutism as a response to this trait,” she adds.

Antoniou, who uses play therapy to help children with SM, integrates art, music and even doll houses in her sessions to connect with kids, analyse their fears and rehabilitate them. She recalls a little girl who she treated after a bemused mum brought her to her practice. She explains: “I had a little girl who was completely mute at school and very, very loud at home. And the mother was depressed, because she was like, ‘She doesn’t communicate her needs at school, won’t say she needs the toilet’.

“So what I did in play therapy was I used creative visualisation – so what this is a technique through which a child using various transcripts that I have visualizes a world where they have no anxiety, they speak, they talk, and then after they’ve visualised it, they put it down on paper (drawing, painting). This helped her a lot. Gradually, she put herself in a situation where she talked, she visualised it. It was a long journey but it worked.”

The silent switch went off – she could talk again.

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