Selective Mutism Essay Example

The American Psychiatric Association's DSM-IV adopted this new term, which remains in use today (APA, 1987, 1984, 2000 cited in Morris ; Mach, 2004). Selective mutism refers to a child's persistent inability to speak in certain social situations, particularly at school. They may remain silent throughout the entire setting or whisper instead of speaking aloud. Recent conceptualizations of the disorder align with theories on the origins of social anxiety.

Children diagnosed with selective mutism commonly remain silent under stressful conditions, occasionally producing single-syllable words that are inaudible. According to DSM-IV, these children are fully capable of speaking when not in social contexts. For example, a child with SM may speak fluently at home but remain completely silent at school or in unfamiliar settings (Sadock, B., Kaplan, & Sadock, V.).

Research on selective mutism has been conducted in several countries, including France, Canada, Great Britain, Germany, Israel, Japan, and the United States (Barowsky, 1999 cited in Reynolds & Fletcher-Janzen, 2007). Recent evidence suggests that this condition typically arises between ages two to four years old (Black & Uhde, 1995; Dummit et al., 1997; Kristensen, 2000; Steinhausen & Juzi, 1996; cited in Morris & March, 2004) and may persist into adolescence (Carlson Kratochwill & Johnston ,1994 cited in Reynolds & Fletcher-Janzen ,2007), although it tends to become more transient during this phase with a duration of only a few months (Kehle ,Hintze & DuPaul ,1997 cited in Reynolds & Fletcher-Janzen ,2007).

Despite the disorder beginning in early childhood, it is not until children enter school that they are typically identified and treated for it (Morris & March, 2004). As a result, the longer the disorder persists, the more severe

it becomes (Kehle et al., 1997 cited in Reynolds & Fletcher-Janzen, 2007, p. 1817).

According to various studies cited in Morris and March (2004), selective mutism is believed to be more common among girls than boys, with an estimated range of 2.6:1 to 1.5:1. The condition can be observed in all social strata, per Steinhausen and Juzi (1996) cited in Reynolds and Fletcher (2007), and can affect children regardless of their intellectual ability, according to Kehle et al.

According to Reynolds and Fletcher-Janzen (2007), selective mutism is a condition that may be more common than previously reported in studies due to cases going unnoticed or resolving with age. This view is supported by Carlson et al. (1992) and Haeberli & Kratochwill (2005). Bergman, Piacentini, & McCraken's study of a public school sample found a prevalence rate of 0.71 percent for the disorder. A comparative study of 1,000 native-born and immigrant children showed that less than 1 percent of native-born children were affected while 7.0 percent of immigrant children had the disorder.

Reynolds ; Fletcher-Janzen (2007) state that "selective mutism" is a disorder observed in a small number of immigrant-born children, around 1 per 1,000, as mentioned by Dummit et al. (1997). This suggests that the disorder is more common than previously believed, but its cause remains unknown.

There is a widespread agreement that anxiety disorder and Selective Mutism (SM) are closely associated, despite ongoing debates. SM has been defined as a type of childhood social phobia, based on similarities in symptoms between children diagnosed with SM and those with social anxiety disorders. Both groups exhibit behaviors such as social avoidance, reluctance or fear to communicate with others, and discomfort

in social situations. This conclusion is supported by research conducted by Black ; Uhde (1992), Dummit et al. (1997), Steinhausen ; Juzi (1996), cited in Evans et al. (2005); Beidel ; Turner (1998) cited in Mennuti et al. (2006).

Although some argue that selective mutism (SM) should be considered a subtype or symptom of social phobia, diagnostic studies have found many children with SM meeting the DSM-IV criteria for social phobia (Mennuti, Freeman, Christner, 2006). Research has suggested a neurobiological basis for this disorder as SM may be linked to developmental delays more frequently than anxiety disorders. However, learning theory suggests that SM is acquired through reinforcement by social factors while psychoanalytic theory posits that it relieves anxiety by causing the child to become unresponsive in anxiety-provoking situations (Kehle, 1997 as cited in Reynolds ; Fletcher-Janzen, 2007).

Various factors increase the likelihood of children developing selective mutism, including migration background, early developmental risks such as complications during pregnancy and delivery, delayed development of motor skills and toilet training, speech and language disorders, abnormalities in behavior during infancy or preschool stage like relationship issues, anxiety due to separation, sleeping and eating disorders. Comorbid symptoms like enuresis also contribute to the risk as do patterns of social interactions like withdrawal, depression and schizoid type behaviors (Steinhausen & Juzi, 1996 cited in Reynolds & Fletcher-Janzen, 2007). Moreover, family history of selective mutism, anxiety disorders and extreme shyness are identified contributing factors (Dow et al., 1995 cited in Reynolds & Fletcher-Janzen , 2007). Due to a lack of verbal language for communication assessing selective mutism is challenging.In order to conduct a thorough evaluation of children's language abilities, clinicians can begin by

assessing any comorbid conditions through a structured interview with the child's parents. A comprehensive approach, proposed in 2017, includes taking into account the child's academic, medical and familial history, conducting a formal speech and language ability evaluation, using nonverbal communication methods to interview the child, performing a physical examination, administering standardized tests for auditory and psychological function along with recording the child's speech at home on an audiotape.

In 1995, it was cited that there is a low incidence of selective mutism and successful treatment protocols have not been extensively studied. A study by Kehle et al. in 1997, cited in Reynolds ; Fletcher-Janzen (2007), observed that this disorder is difficult to treat.

Psychotherapy, focusing on the child's cognitive and cognitive-behavioral aspects, is often used as the first intervention for treating selective mutism. However, research suggests that behavioral strategies are the most effective approach. These strategies include contingency management, self-modeling, stimulus-fading, shaping, and escape-avoidance programs (Kehle et al., 1997 cited in Reynolds & Fletcher-Janzen, 2007). Additionally, clinicians may use pharmacotherapy to treat selective mutism. In fact, a placebo-controlled fluoxetine trial led to significant improvements in selectively mute children after only 12 weeks.

The researchers observed that trial medication ought to be considered solely when anxiety becomes a significant characteristic of the disorder, and all other treatments prove futile during the treatment of selective mutism. According to Reynolds & Fletcher-Janzen (2007), combining medication with learning theory approaches proved to be effective for patients with selective mutism as noted by Kehle et al. (1997). Similarly, treatment of "selective mutism" through speech intervention focusing on language training and articulation was successful, as stated by Dow et al.

Reynolds & Fletcher-Janzen (2007) reported

selective mutism as a rare childhood disorder in 1995. The data suggests that this condition can last for months or years, and is often linked to anxiety disorder caused by various factors. Nevertheless, recent research demonstrates that the outlook for this disorder varies depending on individual cases.

The fact that children with selective mutism don't necessarily refuse to speak should be highlighted. A common belief among them is that they lack the ability to speak. It remains unclear whether this condition falls under anxiety or any other diagnostic category, and more research is necessary. Despite being rare, insufficient data on its prevalence indicates a lack of awareness about it. Nonetheless, treatments and therapies are available.

Despite the promising potential of medications in treating the disorder, the effectiveness of these treatments requires continuous study, as solid evidence of their side-effects remains unclear. Therefore, early intervention may be the best preventive measure to avoid problems due to inadequate comprehension of the disorder.