Selective mutism: symptoms, causes and treatment

When at home, Javi is a very busy and cheerful child, who always asks his parents how things are going and tells them about his thoughts and dreams. However, one day his teachers tell his parents to tell them that the child does not talk to his classmates or teachers, remaining silent in the face of attempts by others to interact with him, although he responds. usually by force of gesture.

While at first they thought it was shyness, the truth is he hasn’t said a word since class started two months earlier. After arranging and performing a medical and psychological examination of the child, it is diagnosed that Javi suffers the disorder known as selective mutism.

    Selective mutism: definition and characteristic symptoms

    The aforementioned disorder, selective mutism, it is a form of childhood anxiety disorder in which the individual suffering from it is unable to speak in certain contexts.

    Symptoms of selective mutism they are the decrease and disappearance of the ability to speak in certain circumstances or in front of certain people, generally in front of people outside the circle closest to the child. This apparent lack of capacity only occurs in these circumstances or situations, so that in other contexts or with close circles in which the child feels safe, he communicates normally. It’s not about not having communication skills or deteriorating for some reason, the child just can’t start them.

    These symptoms occur for at least a month without any significant change having occurred that would justify the onset of possible shyness. Nor is it a difficulty caused by a medical illness that can justify a lack of oral communication.

    While the term selective may give the impression that the lack of speech is intentional, in many cases it is not. In fact, it is common for the child to really want to express himself despite being unable to do so, and sometimes resorting to strategies such as the use of gestures. However, in some cases it is given intentionally, as an attempt to show opposition to a situation or a person.

    Such a selective mutism this assumes a high level of anguish and suffering, In addition to which it produces a significant alteration in the social and academic life of the minor.

      Causes of this disorder

      The diagnosis of selective mutism requires that the presence of medical diseases is excluded or that the lack of speech is due to insufficient development of this ability to allow oral communication.

      The causes of this problem are mainly psychological, More precisely in the presence of anxiety. It is an affectation similar to social phobia (in many cases comorbid with selective mutism), in which there is also a fear of being judged and evaluated. Risk and pressure when they are the center of attention cause the subject not to act, which has been understood to be a learned response through conditioning.

      It has also been observed that there is some hereditary family influenceAs it is a more common disorder in families with anxiety or mood problems.

      By the absence of speech, selective mutism can make the victim capable claiming rudeness and lack of interest in communication, So that social contact decreases and rejection may appear towards the child in question. This fact feeds the situation of silence by producing great tension and anxiety about being judged negatively by others.

      Coping with selective mutism

      While sometimes the disorder goes away after several months, in other cases it can last for years, making social adjustment difficult for the child in question. Involvement of the family and the environment is essential. It is especially important not to criticize the child’s lack of speech, which can lower their self-esteem and worsen the image. Teaching forms of socialization, highlighting their strengths and supporting their efforts is very useful.

      One of the most common types of psychological treatment for selective mutism is the use of different therapies for exposure to the phobic stimulus at the same time as the management of contingencies likely to affect the transmission or non-broadcasting of the speech.

      Forms of psychological intervention

      Exposure to situations should be gradual and cautious. Performing a gradual dive is also useful, for example moving people with whom the child is don’t be afraid to communicate in environments where you have more problems. Over time, it will become a mild stimulus of the stimulus release, in which stimuli and people will be gradually suppressed and provide security for the child so that over time he begins to communicate in other contexts.

      Self-molding filmed and called it is also a fairly common technique: it records the child interacting with his relatives in situations where he communicates verbally and then modifies the recording so that he seems to be communicating with others. In the video, he will advance in a hierarchical fashion, having him respond monosyllabically first and gradually increasing the level until he speaks spontaneously.

      It also appears to be effective the use of modeling and theatrical activities, In which the child can see how others interact and at the same time can gradually begin to express words that are not his own but those that come in the script, so that its content can not be judged. Gradually, the child will be able to integrate his own ideas into the conversation. This can increase the level of complexity if you change the location where the videos are made, first creating videos in very safe environments and gradually moving away from them.

      There are also programs social skills training which can help the child to move forward slowly by letting go and speaking. Cognitive behavioral therapy has also been shown to be effective in allowing children to restructure their thoughts and beliefs about how they are viewed by others.

        Bibliographical references:

        • American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders. Fifth edition. DSM-V. Masson, Barcelona.
        • Thief, A. (2012). Clinical child psychology. CEDE PIR preparation manual, 03. CEDE: Madrid.
        • Rosenberg, DR; Ciriboga, JA (2016). Anxiety disorders. A: Kliegman RM, Stanton BF, St Geme JW, Schor NF, eds. Nelson Handbook of Pediatrics. 20th ed. Philadelphia, PA: Elsevier.

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