Is selective mutism affecting you or someone you care about? Selective mutism is a relatively uncommon disorder that causes inability to speak in certain situations (e.g., the classroom) where speaking is expected, despite the ability to speak normally in other situations. Selective mutism is estimated to affect 0.1-0.7 percent of the population, but the condition is likely under-reported due to the general public’s lack of understanding of the condition. Symptoms usually appear between the ages of 2.7 and 4.2. This article will provide some suggestions for overcoming selective mutism and minimising its negative effects on the affected individual’s social functioning.
1. Check to see if you, a friend, or a loved one meets the following criteria for selective mutism:
Inability to speak consistently in specific social situations (e.g., at school) where speaking is expected.
Ability to converse and interact normally in other situations.
Inability to communicate in certain situations has a negative impact on social and academic functions.
Except for the first month of school, the symptoms last for more than a month (it takes time to adjust to a new environment).
The symptoms cannot be explained by unfamiliarity with the spoken language in the given social situation (for example, a girl fluent in another language who knows very little English and remains silent in situations where English is spoken does not have selective mutism!).
Other disabilities, such as autism/Asperger syndrome, schizophrenia, or general psychotic disorders, cannot account for the symptoms.
The inability to speak is not due to a lack of willpower, but rather to extreme anxiety that prevents the individual from speaking.
2. Recognize how much selective mutism affects your daily functioning. To overcome selective mutism, you must first understand how it affects you. Determine the specific circumstances that are preventing you from speaking. A child, for example, may be able to communicate normally with peers but unable to communicate with adults. Another child may speak and behave normally at home but is completely silent at school. You can help direct your efforts to overcome selective mutism under these conditions by identifying the specific situation in which it manifests.
3. If you can get others to help, try to gradually overcome selective mutism with the “Stimulus Fading technique”: interact with someone with whom you can communicate comfortably in a controlled environment (where help is readily available). Then gradually introduce another person to interact with in order for them to join the conversation. Begin with the most comfortable person with whom you can converse and work your way up to the most uncomfortable person with whom you can converse. The idea behind this technique is that the anxiety caused by the people with whom you are uncomfortable interacting will “fade” away when this stimulus is associated with someone with whom you are very comfortable interacting.
4. If the above technique does not work completely or is difficult to implement, try the “Systematic Desensitization Technique” to overcome selective mutism: Imagine yourself in a situation where you are unable to speak, then imagine speaking, and finally try to interact with people in that scenario indirectly, such as through a letter, e-mail, instant message, online chat, and so on. Then move on to more interactions, such as phone calls, then interactions at a distance, and finally more direct interactions. This method is also extremely effective for a wide range of other anxiety disorders, including specific phobias. The idea behind this method is to gradually expose yourself to increasing levels of the anxiety-provoking stimulus until you become desensitised enough to deal with the actual situation.
5. Practice getting attention, raising your hand, nodding/shaking your head, pointing, writing, making some eye contact, and other communication skills as needed.
Introduce speaking a little at a time, gradually increasing the amount of time you speak. Gradually increase your level of comfort. Because of the extreme anxiety, it is critical to obtain as much assistance and encouragement from others as possible.
Shaping is a technique that involves making audio recordings of one’s own voice and then replaying the speech to develop comfort with speaking. Practice whispering with a friend/parent/teacher in a public place, such as an office or classroom, and gradually increasing the volume to a talking level.
6. Use “Contingency Management,” whereby you get a simple reward for speaking under anxiety-provoking situations.
7. Focus on positive thinking to help overcome the anxiety. Instead of thinking “I can’t talk…” think “I can try to talk and make it possible if I work at it! “
8. Recognize that butterflies (nervousness or even shaking) are common in certain situations; thus, begin with smaller groups. Public speaking classes can help you learn how to give presentations and even for small venues like job interviews. Entertainers and other public speakers become accustomed to feeling stressed when speaking or singing in front of a large audience. Even experienced entertainers may turn to drugs to try to control these stressful feelings and relax on stage. Later in one’s career, when one is naturally relaxed, one may yearn for the old excitement, which is rarely felt. At the head table or on stage, people will often look at each other to offer support and to receive a smile or a nod of appreciation. There is a great deal of anxiety associated with new social situations, as well as in larger venues with large crowds.
9. For severe selective mutism, the aforementioned techniques may not be effective in overcoming the disability. In that case, you should seek professional assistance and may need to use medications to deal with selective mutism. Fluoxetine (Prozac) and other selective serotonin reuptake inhibitors are common medications prescribed to help reduce anxiety and allow for speaking and interaction (SSRIs). Medication should be used in conjunction with repeated practise of the above techniques and anxiety-reduction techniques for the best chance of overcoming selective mutism.
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