The talking "little mute"

Author: Wu Meitong Guangzhou Women and Children's Medical Center

Reviewer: Cha Caihui, Chief Physician, Guangzhou Women and Children's Medical Center

Tingting is a 5-year-old girl who came to see a doctor because she was "silent in kindergarten for more than 2 years." The child is a child of migrant workers. She is lively and cute at home, eloquent, and communicates well with others. The child said that she wet her pants in the kindergarten and was criticized by the teacher in public. Since then, she has been quiet in kindergarten and did not answer the teacher's questions. She can play with her peers but does not communicate with them. She talks to her peers immediately after leaving the kindergarten. She is often asked by her peers: "Why are you dumb in kindergarten?" The child is about to go to elementary school. The mother is worried that she will have the same problem after going to school, so she brought the child to the clinic.

In fact, there are many examples like this. Many parents will feel angry when they see their children being silent outside of home, and they can't help but scold their children for being "impolite."

Many of these children do not speak because they are shy, but it is also possible that the child suffers from selective mutism.

What is Selective Mutism?

Selective mutism is a social anxiety disorder. Patients with selective mutism have normal speaking ability, but do not speak in certain situations. For example, they can speak and communicate at home where they feel comfortable, safe and relaxed, but do not speak at school. This situation mostly occurs in childhood and has not been widely studied. Some children may remain completely silent in social situations, while others can communicate with others through whispers or gestures. These children do not refuse to speak, but remain silent in public because of internal factors (such as fear). Since they can speak and communicate when they are with their families, they are usually discovered by teachers in kindergartens or schools. These children are generally misunderstood as being overly shy or impolite, and even wonder if the child is "autistic." Studies have shown that selective mutism generally occurs between the ages of 2 and 5, with a high incidence at the age of 5, but the prevalence of this disease is very low.

Copyright images are not authorized for reproduction

How to determine whether a child is selectively mutist?

According to the criteria of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (5th Edition) (DSM-5), the following items must be met for diagnosis.

(1) A persistent inability to speak in specific social situations (e.g., school) where speaking is expected, despite being able to speak in other situations.

(2) The problem interferes with academic or occupational achievement or other social interactions.

(3) The duration of the problem is at least one month (not limited to the first month of enrollment).

(4) The inability to speak cannot be attributed to lack of knowledge of or discomfort with the language required in social situations.

(5) The disturbance cannot be explained by a communication disorder and does not occur only in the context of autism spectrum disorder, schizophrenia, or other psychiatric illnesses.

Causes of Selective Mutism

Congenital factors mainly include genes and heredity. When there are family members with selective mutism or a family history of anxiety, the probability of developing selective mutism will increase.

As for the acquired factors, in the child's cognition, the child will worry about whether he will say the wrong thing, be afraid of losing control of the situation, and be afraid of seeing other people's negative reactions. Therefore, the child will establish some wrong beliefs, such as "I am not good enough" or "I am stupid". In addition, negative thoughts such as "people will yell at me" and "I will hurt others when talking to others" lead the child to develop some behaviors that he thinks are safe, such as keeping silent and avoiding eye contact to prevent negative situations from happening. If no one changes these dysfunctional ideas of the child, it will cause the child to have selective mutism after a long time.

Ways to help a child with selective mutism

Selective mutism can be treated with cognitive behavioral therapy, psychotherapy (such as music therapy, art therapy, sand tray therapy, etc.), medication, or behavioral therapy (such as exposure, systematic desensitization, and stimulus elimination).

In your daily life, you can try the following methods.

(1) Use positive reinforcement (reward) to help children regain their ability to speak in specific situations. For example, when a child takes the initiative to greet others, you can give him a candy or some small gift to increase his motivation to try to communicate with others.

(2) Take it step by step. Start with some small changes. At first, allow your child to respond with gestures or paper and pen, and then slowly increase eye contact and talk in short and long sentences.

(3) Increase children’s self-confidence. Children are reluctant to speak in certain environments mostly because they lack confidence in themselves and are afraid of being laughed at. At this time, the elders should help them build their self-confidence, rebuild their wrong beliefs, and reframe unnecessary negative thoughts or ideas with a more positive attitude.

(4) Chat with your children more often. Let your children know that talking with others does not necessarily lead to "negative criticism" and let them understand that we may not be liked by others, but this is "normal."

I hope everyone can better understand the situation of children who don’t speak, give them appropriate help, understand their inner thoughts, and help children improve their self-confidence.