Have you ever felt shy in social settings but at ease in familiar settings? A failure to speak in a specific social environment, Selective Mutism is an anxiety disorder that usually begins in early childhood.

Rushu Katel, a psychologist and mental health trainer currently teaching at Nepal Film Campus/Nepal Music School, explains how this condition affects children's ability to communicate and engage socially.

What is selective mutism, and how does it differ from other communication disorders?

Selective Mutism is a type of mental health condition seen in children, which is characterised by constant failure to speak in a specific social environment or with unfamiliar people despite being able to communicate normally at home. It is an anxiety disorder that usually begins in early childhood, where children experience intense fear that prevents them from being socially engaged outside their home environment. This condition impairs a child's social, academic and occupational functioning.

Although selective mutism shares certain characteristics with other communication disorders, such as difficulty speaking, its underlying causes differ. In contrast to other communication disorders, such as stuttering or language impairments, the issue often stems from developmental, neurological, or physiological factors affecting speech or language production or understanding.

Selective mutism is unique because an individual's speaking ability is context-dependent. For example, a child may be quiet in class but loud and expressive at home.

In summary, other communication disorders usually include language issues that have distinct causes. In contrast, selective mutism represents an anxiety-based syndrome that impacts the capacity to speak in specific social settings.

Can you explain the psychological and environmental factors that contribute to the development of this disorder?

The development of selective mutism is often attributed to the combination of psychological factors such as social anxiety, temperamental issues and past experiences such as being bullied, receiving harsh criticism, or harassment. Similarly, environmental factors include high parental expectations, overprotective parenting and a lack of emotional support for the child.

For instance, in social settings like schools, children are often pressured to engage in activities that emphasise public speaking or group participation. Naturally, shy children may feel overwhelmed and resort to silence as a coping mechanism. This reaction often stems from a fear of being judged, embarrassed, or failing to meet social expectations, leading them to withdraw from speaking to avoid potential discomfort or scrutiny.

What are the symptoms of selective mutism?

Selective mutism manifests as a persistent inability to speak up in specific social situations, such as schools or other unfamiliar situations. Other symptoms include social withdrawal, uncommunicative, nonverbal communication, difficulty making friends, and everyday speech in safe and comfortable settings.

What are the complications associated with the disorder?

There are various complications associated with selective mutism; they are:

Difficulty in Social Interaction: Children with selective mutism often struggle to connect with other people other than their close ones. This may hamper their social skills and friendships, causing them to feel excluded and misinterpreted, which may increase their anxiety level.

Long-term Effects: Untreated selective mutism at an early age may impact adolescence or adulthood, making it difficult to socially interact, get a job, pursue education, or speak publicly in the future.

Risk of Other Anxiety Disorders: Untreated selective mutism may lead to other anxiety disorders like social phobia and generalised anxiety disorders in which the child experiences excessive worry about a variety of life events and fears of being judged by others and social situations.

Academic Challenges: Speaking is crucial for class participation, discussion, making inquiries, and even asking for help in a classroom setting, but children with selective mutism may need to speak in such settings. This makes it difficult for teachers to evaluate students' understanding or offer assistance.

Emotional Impact: The inability to speak in specific situations and ongoing fear and anxiety that arise along with mutism can cause emotional distress. Children may feel embarrassed or ashamed because they cannot even do simple tasks that others find easy, which can undermine their sense of value and confidence.

What triggers selective mutism?

Children who are naturally shy, timid, or sensitive by nature are most likely to develop selective mutism. Due to this temperament, they feel overwhelmed in social settings and stop speaking. Additionally, experiencing traumatic events in the past, like witnessing an accident, serious illness, or distressing life changes, can trigger selective mutism.

If there is anyone with a history of anxiety disorders in the family, genetic components may also act as a triggering factor. Some children with selective mutism also struggle with speech and language difficulties. These challenges might cause them to feel uncomfortable or afraid to speak in front of others, worrying they could be laughed at or misunderstood.

How can selective mutism be treated? What role do social settings play in its prevention?

Selective mutism can be treated by using different therapeutic approaches with a primary focus on reducing anxiety and helping children feel confident in social situations. Following are a few of the techniques:

Behavioural therapy: Systematic desensitisation, where a child is gradually exposed to anxiety-inducing situations, and positive reinforcement, rewarding speech, are common methods to manage selective mutism and encourage communication.

Cognitive Behavioural Therapy: This treatment helps to learn anxiety-reducing techniques, including relaxation methods, deep breathing, and encouraging self-talk. It gradually helps them face their fear of speaking through small, manageable steps.

Family Therapy: A specialist can teach parents and related caregivers how to support their child's speech in a non-pressuring approach and help them understand a child's anxiety by establishing nurturing and supportive environments in their homes.

Speech and Language Therapy: A speech therapist can work with children to address any underlying speech or language difficulties that they may be experiencing. Developing their communication skills can increase their willingness to participate in social situations and decrease their speaking anxiety.

Medication: In some special cases, where treatments alone are ineffective, medication is prescribed. However, medicine is only used as a last option.

School-Based Intervention: School counsellors and teachers can create a safe and encouraging environment to help children build confidence and develop a plan to promote communication.

Social environments fostering tolerance, acceptance, and understanding can considerably lower the likelihood of selective mutism by helping children feel at ease and secure enough to express themselves.