Ask Dr. Marla: Selective Mutism in Children

By Dr. Marla Shapiro on May 19, 2011

Question:

My four-year-old does not talk to other children his age. At home he is an energizer bunny and quite bossy to his older siblings, ages eight and 10, but at preschool he only plays alone and will not mingle with the other children. He doesn’t even speak to his teachers like the others do. Any advice?

Answer:

My first question is how long has this  been happening? Is this a new environment he is in? Do you notice the same behaviour in other social situations or with other family members or does it only happen in the preschool setting?

A first step would be to review the normal developmental and speech milestones with your doctor. It is reassuring that in the home setting your child is energetic, social and verbal. There does not seem to be any speech or language delay.

It is possible that your son’s refusal to speak in this social situation is a manifestation of anxiety. Both separation anxiety disorder and selective mutism can present and be first diagnosed in infancy, childhood or adolescence. Children can suffer from the same kinds of anxiety disorders adults do.

According to medical literature, selective mutism is a disorder where the child cannot or will not speak in specific situations when there is an expectation of conversational speech. You have told us that your child clearly has the ability to talk and be entirely social in a setting where he is comfortable.

Selective mutism is often seen with both shyness and anxiety. It would seem possible that this is the case with your son. You have not indicated that there is any kind of language delay. Another question to ask is if there has been any other stressor, or is it the introduction of preschool that is the social stressor?  Potential approaches to help your son include the support of his educational setting to ensure that there are no other stressors.

Speak to your child’s teachers to see if they can implement a slow and progressive program to have your son socialize with the other children. If there is pressure to speak by the teachers, it would be helpful to reduce the pressure as it might just further intimidate your son. There is a difference between encouragement and pressure.

Make sure that you have close collaboration and a team approach with your health care provider and educators. I would encourage you to speak with your physician rather than waiting to see if the situation improves over time. A consultation with a speech pathologist may also help.

Published in June, 2011.


By Dr. Marla Shapiro| May 19, 2011

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