The story of Seung-Hui Cho, who killed 32 people and wounded 25 others at Virginia Tech in April 2007, is sad and terrifying. Along with schizophrenia and depression, Cho suffered from selective mutism.He was treated with medication and therapy, but apparently was never cured. On his dormitory wall, he had written telling lyrics from the song Shine by the band Collective Soul: "Teach me how to speak, teach me how to share." He ultimately made his voice known in the most gruesome way possible.Selective mutism (SM) is a rare anxiety disorder in which people speak comfortably in some places or with some people, and are struck utterly mute in other situations.
For parents, it is a sad, confounding, and frustrating condition. For children, SM can be painfully debilitating and can hinder their ability to advance in school, make friends, and participate in activities. If left untreated, it can lead to adult anxiety and depression.SM is recognised by the American Psychiatric Association as a real mental disorder often associated with social phobia. Despite this fact, teachers, pediatricians, and other people too often dismiss this affliction as mere shyness.
"He'll grow out of it, my kid was shy too and he's fine," are among the more common words of advice some parents of children with SM are offered.But according to Dr Elisa Shipon-Blum, a recognised expert on SM, the disorder is "the most misdiagnosed, mismanaged, and mistreated anxiety disorder of childhood.Children with selective mutism truly suffer in silence, and yet most people completely misunderstand the child's silence." This patronising attitude can deprive mute children of the therapy or medication-and even just the empathy-that SM requires.
SM is usually diagnosed during the preschool years, when children face the first real performance pressure of their lives. The psychiatric profession changed the name in 1994 to reflect its current understanding that mutism is actually an involuntary anxious response.While SM is not on the autism spectrum, the one is often confused with the other, and behaviors and treatments can be similar
Five signs your child might have SM
• The child talks comfortably in certain places, such as home, but routinely does not speak in another social situation, such as school.
• The duration of the mutism lasts at least one month and is not limited to the first month of school.
• The inability to speak is not related to a lack of fluency in the primary language used in a particular social situation.
• The mutism does not appear to be related to a communication disorder, such as stuttering, or another mental disorder.
• The mutism interferes with social relationships or educational achievement.
Diagnosing selectivemutism
A child with selective mutism should be seen by a speech-language pathologist (SLP), in addition to a pediatrician and a psychologist or psychiatrist. These professionals will work as a team with teachers, family, and the individual.It is important that a complete background history is gathered, as well as an educational history review, hearing screening, oral-motor examination, parent/caregiver interview, and a speech and language evaluation.
Treating selectivemutism
The type of intervention offered by an SLP will differ depending on the needs of the child and his or her family.The child's treatment may use a combination of strategies, again depending on individual needs. The SLP may create a behavioral treatment program, focus on specific speech and language problems, and/or work in the child's classroom with teachers.
How to talk whenyour child's not talking
• Do not address the mutism directly.
• Do not ask open-ended questions that require a verbal response.
Yes-or-no questions work best.
• Instead of questions, do make comments that could invite a verbal response if the child so desires.
• Allow for nonverbal communication, such as pointing, sounds.
• If the child does begin speaking, act completely normal.
Mute children often will continue the mutism out of a fear that people will make a fuss once they speak.