What is selective mutism? How to treat selective speech?


Selective mutism can be explained as a state of silence even though the person can speak. With this disease, the child himself chooses people to talk to and prefers to talk only next to them. Mutism is actually a rare problem and often occurs during childhood. Selective mutism is observed especially at the age of 4-8 years. Although this disorder mostly occurs during the preschool years, it can be noticed especially during this period, as the number of anxiety-provoking areas increases during the school period. So what does selective mutism mean? What does selective mutism mean? What is selective mutism? What should be the role of the family in the detection of selective mutism? How are the treatments progressing? Details below!

What is selective mutism?

“Selective mutism” is when a child prefers to speak only in the presence of home, family or relatives, that is, in an environment where he feels comfortable and safe. During the course of this disorder, the child prefers not to speak in social settings where he is expected to speak, such as at school, with friends, and during play. Children with this disorder typically do not maintain eye contact in social environments where they “prefer not to talk,” and when asked to contact them, they may pretend they have never heard and remain completely still. Less than 1% selective speechlessness can be explained as a very rare condition. On the other hand, this problem that parents face with their children can last from several months to several years.

In children with this disorder, instead of verbal speech, the use of facial expressions, shaking the head, stretching, pushing and pronouncing one-syllable words or whispering is observed. On the other hand, there is excessive shyness, fear of incorrect self-expression in the social environment, social isolation, withdrawal into oneself, non-separation from the mother, compulsive traits, negative emotions, malaise, tantrums. In addition, keeping people at home under control and oppositional behavior can be called among the most basic features of this disorder.

How does it arise?

what is selective mutism

What is selective mutism? We have explained this above. So how does it show up? Early diagnostic studies for selective mutism revealed low self-esteem, insecure home environments, emotional problems, and past traumatic experiences. Specialists with psychoanalytic inclinations explain selective mutism as a product of physical and emotional trauma. According to this definition; mutism is the result of psychic conflicts and unresolved developmental conflicts. For example, a child who has experienced past traumas may not speak in order to punish their parents. Children who keep family secrets regress to the previous period of development. In addition, they prefer to reflect their anger and anger on their parents without speaking.

On the other hand, behavioral theories treat mutism as a learning pattern shaped by long-term negative reinforcement. According to this understanding, mutism results from the interaction of the child with the environment and is based on learned responses that the child uses to manipulate the environment. According to supporters of the family system; Overly controlling and oppressive family dynamics, interdependence, and family problems can also lead to indiscriminate speech.

Are environmental factors effective in selective mutism?

So, are environmental factors effective in the process of selective mutism? First of all, the concept of mutism can be assessed as a kind of anxiety disorder that occurs when exposed to environmental factors with a shy temperament, and not a language or speech disorder. From this point of view, the biological causes of this situation are assessed and the stages of treatment are planned. Treatment should take into account many factors in the relationship with the child. Speech therapist, teachers, school orientation and family play a very important role in the treatment team, which is centered on child psychiatrists. As a result, environmental factors can have both positive and negative effects on the process of selective mutism.

How are the treatments progressing?

Because children with mutism are resistant to treatment, treatment can sometimes be slow. However, many treatments have been proposed during the illness. Behavioral, group, family therapy and multiple therapies can be listed among successful therapies. Behavioral approaches are among the most commonly used intervention methods with a strong scientific focus. When we look at successful methods, behavioral techniques such as stimulus extinction, systematic desensitization, reinforcement, and reciprocal arousal are mentioned. Methods at the stage of treatment of selective mutism can be listed as follows:

1. Step by step approach

With this method, which is at the top of the list, positive reinforcement is given for verbal behavior, while a method without reward or suppression is preferred for non-verbal behavior. It is also claimed that this method produces very successful results over time.

2. Self-simulation

This method is a method that demonstrates appropriate behavior and has a positive effect on the child’s attitude and behavior. On the other hand, viewing video images recorded and edited later by the child himself explains this technique.

3. Mysterious motivator

This method focuses on a covert form of reward aimed at increasing the expectation and strength of the reinforcement in the child. An envelope with a question mark and the name of the child written on it is left in a conspicuous place in the classroom. Inside the envelope is a prize that the child may like. Later, when the child speaks loudly enough for everyone in the class to hear, the award is given.

4. Reward yourself

This technique is defined as a person’s self-reward for appropriate behavior. This method provides continuity if the child himself initiates communication and began to speak voluntarily in the social environment.

5. Awakening Responsiveness

In this technique, the child is told what to say. Then a meeting is planned where the child will spend the whole day with the therapist. If the child says one or more words, he is rewarded and allowed to move away from the therapist. Otherwise, he will have to stay in the therapist’s room all day. In such cases, it has been observed that most children talk within the first hour or two. After this technique, the child plans new goals: to talk with the teacher and friends in the classroom or in other environments where he does not prefer to talk.

Bonus: What should be the role of the family?

selective mutism

The first role of the family in the process of selective mutism may be early treatment planning. Early referral is very important in the treatment of selective mutism. The reason for this is that the state of the child’s taciturnity is increasing every day, and the treatment becomes more complicated. For this reason, the first duty of the family is to seek treatment as soon as possible and start treatment properly. On the other hand, the family should try to strengthen the child’s sense of security in the process of mutism. Given that selective mutism occurs when children experience anxiety, the main goal is to reduce anxiety.

At this stage, methods for coping with anxiety can be developed. Most often, children feel safe next to their parents. The expansion and strengthening of this trusting environment is very important in this period. Only in this way will it be possible to maintain the child’s trust in the cat and speed up the treatment process.

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