When he is at home, Javi is a very active and happy child, who is always asking his parents about how things work and telling them his thoughts and dreams. However, one day the teachers at his school call his parents to tell them that the boy does not speak with his classmates or teachers, remaining silent in the face of others’ attempts to interact with him despite the fact that he usually responds based on gestures.
Although at first they believed that it was mere shyness, the truth is that he has not spoken a word since the beginning of the course two months before. After arranging and carrying out a medical and psychological examination of the child, it is diagnosed that Javi suffers from the disorder known as selective mutism.
Selective mutism: definition and characteristic symptoms
The aforementioned disorder, selective mutism, It is a form of childhood disorder linked to anxiety in which the individual who suffers from it is unable to speak in certain contexts.
Symptoms of selective mutism They are the decrease and disappearance of the ability to speak in certain circumstances or in front of certain people, generally in front of people outside the minor’s closest circle. This apparent lack of capacity only occurs in these circumstances or situations, meaning that in other contexts or with loved ones where they feel safe, the child communicates normally. It is not, therefore, that communication skills are lacking or that they have deteriorated for some reason, the minor simply cannot put them into action.
These symptoms occur for at least a month without any relevant change having occurred that justifies the appearance of possible shyness. Nor is it a difficulty caused by a medical illness that could justify the lack of oral communication.
Although the term selective may make it seem that the lack of speech is intentional, in a large number of cases it is not. In fact, It is common for the minor to actually want to express himself despite being incapable of doing so, and sometimes resorts to strategies such as the use of gestures. Despite this, in some cases it does occur intentionally, as an attempt to show opposition to a situation or person.
Thus, selective mutism involves a high level of anguish and suffering in addition to producing a significant alteration in the social and academic life of the minor.
Causes of this disorder
The diagnosis of selective mutism requires that the presence of medical diseases is ruled out or that the lack of speech is due to insufficient development of this capacity to allow oral communication.
The causes of this problem are mainly psychological, specifically to the presence of anxiety. This is an affectation similar to social phobia (in many cases comorbid with selective mutism), in which there is also a fear of being judged and evaluated. Risk and pressure when they are the center of attention cause the subject not to act, which has been understood as a response learned through conditioning.
It has also been observed that there is some hereditary family influence since it is a more common disorder in families with anxiety or mood problems.
Due to the absence of speech, selective mutism can cause the sufferer to appear surly and lack interest in communication, with which social contact decreases and rejection towards the minor in question may appear. This fact feeds back on the situation of mutism by producing greater tension and anxiety when being judged negatively by others.
Treating selective mutism
Although in some cases the disorder subsides after several months, in other cases it can last for years, which makes the social adaptation of the child in question difficult. The participation of the family and the environment is essential. It is especially important not to criticize the child’s lack of speech, which can reduce his self-esteem and worsen the condition. Teaching ways of socialization, highlighting their strengths and supporting their efforts are very useful.
One of the most common types of psychological treatment in case of selective mutism is the use of different exposure therapies to the phobic stimulus along with the management of contingencies that may affect the emission or non-emission of speech.
Forms of psychological intervention
Exposure to situations must be gradual and careful. Progressive immersion is also useful, for example by transferring people with whom the child Don’t be afraid to communicate to environments that are more problematic for you. Over time, there will be a stimulating fading of the stimulating fading, in which stimuli and people who provide security to the child are gradually removed so that over time they begin to communicate in other contexts.
Self-shaping filmed and tricked It is also a fairly common technique: in it the child is recorded interacting with those close to him in situations in which he does communicate verbally and later modify the recording so that it appears that he is communicating with others. In the video we will advance hierarchically, first making him respond in a monosyllabic manner and little by little increasing the level until he speaks spontaneously.
It also seems to be effective the use of modeling and theatrical activities, in which the minor can see how others interact and at the same time can gradually begin to express words that are not their own but those that are in the script, so their content cannot be judged. Little by little the infant will be able to incorporate his own ideas into the conversation. He can increase the level of complexity if he changes the place where the videos are made, first making videos in very safe environments and gradually moving away from them.
There are also some programs social skills training that can help the child to gradually let go and express themselves. Cognitive behavioral therapy has also been shown to be effective in helping the child restructure his thoughts and beliefs regarding how he is seen by others.
Bibliographic references:
Rosenberg, D.R.; Ciriboga, J. A. (2016). Anxiety disorders. In: Kliegman RM, Stanton BF, St Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics. 20th ed. Philadelphia, PA: Elsevier.
