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When my daughter, Alyssa, started kindergarten four years ago my wife and I grew concerned when several months had elapsed and she had not spoken to her teacher or other students to express her needs or for the purpose of socialization. She refused to use the bathroom, which resulted in classroom accidents, would not maintain eye contact with those who were speaking to her, and was unresponsive when asked questions by her teacher and peers. In the beginning we assumed these manifestations were the result of extreme shyness, but as her teacher did more research on Alyssa’s behavior she discovered an anxiety-related disorder known as Selective Mutism, or SM, the signs of which seemed to match what we were seeing of Alyssa in her school-related functioning.
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Diagnosing Selective Mutism
Doctor Alan Barnett, a licensed psychologist in upstate New York who has worked with many cases involving Selectively Mute children defined Selective Mutism as an anxiety-based disorder with extreme manifestations that go beyond shyness, is persistent over a long period of time, and inhibits the afflicted person’s ability to perform at all in select settings. Barnett went on to add that the affliction was “directly related to social anxiety disorder."
In the beginning my wife and I thought Alyssa was simply overly shy, and that in time she would grow more comfortable in the classroom experience. However, we understood that although some children will transition into new situations quietly, in a relatively short period of time they tend to grow more comfortable and begin to interact. Given the fact that several months had passed and Alyssa had not communicated with teachers it became obvious that something else was happening.This observation happens to be one of the key determinants that a child is Selectively Mute. Doctor Barnett diagnoses children with Selective Mutism by each case history. “The Selectively Mute child seems to be normal in all developmental aspects, but once she reaches school we look at the child’s comfort through time." He also added that he likes to weed out other problems like autism.
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Steps to Tackle the Problem
Where Alyssa is concerned, her kindergarten teacher, after having done some research on her own, removed her expectation that Alyssa should talk in class, allowed fellow students to speak for her, and developed a set of cards with pictures that Alyssa could hold up when she wanted something. Without having to speak, Alyssa grew comfortable using the cards and communicating this way. Gradually she grew more comfortable in the class, finding the courage to leave papers out on the floor close to the teacher’s desk where she could see them. Eventually this plan led to Alyssa feeling safe enough to speak to her teacher by year’s end. This method of treatment resembles the plan Doctor Barnett uses with his patients. In fact, he doesn’t treat Selective Mutism in one-one counseling sessions, noting that Selective Mutism has to be treated in the location where the child is not engaging.
In Alyssa’s case this involved the school psychologist and speech therapist. My wife started the sessions with my daughter at school and with each session the school personnel got closer and closer and became increasingly engaged in the activities they were doing together. Gradually my wife was phased out of the sessions and Alyssa continued the activities with the school personnel, who first tried to maintain communication with non-verbal cues in the hope that it would lead to verbal communication. That small step would eventually lead to their moving into the classroom with the goal of progressing her verbal communications skills into the classroom.
Aside from treating the disorder in the school anti-anxiety medications have also been used to treat Selective Mutism. “Research has shown the benefits of anxialytic medications," added Doctor Barnett.
Recognizing that a child has SM is an important step in treating it successfully. The prognosis for children with SM is good if it is treated properly at an early stage. Alyssa still continues treatment for Selective Mutism. Now going into fourth grade she has only communicated with her one teacher from kindergarten, and each year another teacher strives to break the silence caused by the anxiety of being in that setting.