When you think of selective mutism, one of the first associations that comes to mind is likely that this is something that happens in children. While it seems to manifest most common in children, selective mutism does occur in adults.
For those of us who don’t have it, it often begs the question, “Why is there silence?” One of the most important things to keep in mind is that, whether the individual is an adult or a child, they are not silent because they wish to be antisocial. It is also important to know that there is hope in the form of behavioral therapy and cognitive behavioral therapy, which are most successful when the individual has the support of loved ones to encourage them
What Is Selective Mutism?
What exactly is selective mutism in adults? In the simplest terms, selective mutism is an anxiety-based disorder which causes an individual who is capable of producing speech to refrain from speaking in certain situations or to certain people. While anxiety does not manifest in the same way for every individual with selective mutism, it is an overarching symptom.
It is rare for children and adults with selective mutism to remain mute in every social setting they are exposed to. Total social mutism is far more characteristic in those with traumatic mutism. Those with selective mutism tend to be mute in specific social settings due to the amount of anxiety those situations evoke.
If a negative reinforcement of mutism in certain social environments develops over time, the mutism can expand to a wider variety of situations. This is referred to as progressive mutism and can manifest at home and in other private spheres, extending from childhood into adulthood.
Symptoms of Selective Mutism
Symptoms of selective mutism in adults truly center around an individual’s mutism in specific social situations. Adults with selective mutism were often selectively mute children whose condition progressed or did not improve over time. This usually results when the condition is left untreated for several years. A few of the other common indicators of selective mutism are:
- An expressionless facial appearance (especially a lack of a smile)
- Being talkative at home or at any place the person feels comfortable but is unable to speak while in public
- Exhibiting a stiff physical posture or uncomfortable attitude
- Acting avoidant of others or any social interaction
- Having very few or no friends
- Speaking in a whisper
- Difficulty initiating discussion or prefer using non-verbal communication
These symptoms can vary by severity. While some individuals might seem extremely avoidant, others might be less so. As children, those with selective mutism were likely viewed by family members as being bossy or rude at home but being shy and clammy in public. Although, those behavior are not always the best indicator of selective mutism.
Selective Mutism in Adults: Causes
Selective mutism in adults and children is generally viewed as having several potential root causes.
The first explanation is that selective mutism in adults is anxiety-based and that an anxiety disorder is responsible for triggering the mutism.
The second possible explanation is that the individual possesses a low self-esteem or sense of self-worth.
The third potential explanation for why selective mutism occurs is that the individual has a hearing, language, or speech issue that has likely gone undiagnosed. The third option is more obvious in children and less so in adults but is still considered a possibility.
Other Issues that Relate to Selective Mutism
It is important to debunk a few of the pervading myths about selective mutism in adults. First and foremost, their mutism is likely not triggered by a traumatic event, as many people tend to assume. Second, selective mutism isn’t something that everyone outgrows, which is why we see it extending into adulthood. Unfortunately, some adults think that children with selective mutism are just shy and will eventually grow out of it. Also, although speech problems can occur, those with selective mutism might be able to form perfectly normal speech patterns and don’t need speech therapy. Finally, selective mutism is not a symptom of an autism spectrum disorder or vice-versa. While the two might share some similar characteristics, these are two different diagnoses with differing criteria.
How is Selective Mutism Diagnosed?
Early diagnosis is crucial in this condition as selective mutism may lead to social anxiety disorder and even isolation if left untreated. Note that social anxiety disorder is basically a social phobia that manifests as an overwhelming fear of social interaction or any social situation– it is something that you don’t want your child to go through.
In adults, selective mutism is diagnosed by a mental health professional with the support of a speech and language therapist. The clinician may also try to determine the underlying issue which causes the selective mutism. An example would be to ask about the family’s full medical history. Remember that selective mutism is highly associated with anxiety disorder.
Generally, any person with selective mutism may be unable to speak during the assessment. This could be due to the fact that the clinician is someone unfamiliar to the patient or the situation simply triggers anxiety. As a result, patients may be asked to write down their responses or type them on a computer in order for them to communicate with their therapist effectively.
There are guidelines that need to be followed in diagnosing selective mutism. Health professionals make observations in terms of the following:
- Is the patient’s inability to speak observed only in specific situations? For example, can the patient speak in front of a public audience?
- Is the patient able to communicate normally in situations wherein they feel comfortable? For example, can the patient communicate with his or her parents at home without any difficulty?
- Is the patient’s inability to speak to certain people been going on for at least a month or two?
- Is there a presence of any behavioral, mental or communication disorder that may contribute to the patient’s inability to speak?
Selective Mutism in Adults Treatment Options
Treating selective mutism in adults is possible. Of course, starting treatment at an early age is your best bet, but behavioral therapy methods can be effective in the older population. While cognitive behavioral therapy methods have been shown to be effective, researchers at the selective mutism Research Institute (SMRI) have cultivated a specialized model called Social Communication Anxiety Treatment (S-CAT).
S-CAT is founded upon the principle that selective mutism is genuinely an anxiety-based disorder, not a speech pathology issue. This model reinforces the idea that those with selective mutism adapt their mutism to specific social situations in which social communication is hindered by feelings of anxiety. When working with children or adults, this model requires a wrap-around approach involving the support of family, school personnel, and healthcare providers. This therapy is geared toward helping those with selective mutism feel better about themselves, decrease their anxiety, and boost their communication skills over time.
Examples of Selective Mutism
One of the most publicized cases of selective mutism is that of former Miss England contender Kirsty Helsewood. Heslewood attended school in Hertfordshire and would only speak inside of her home until she was seven years of age. As time went on, she, with the support of her mother, started speaking in school and, by the time she was a teenager, Heslewood was able to communicate with confidence. She now works to bring awareness to the selective mutism community
Not everyone is able to move forward at as early of an age as Kirsty Helsewood. However, her case is one of many and is a prime example of how proper support from loved ones is required to make therapy successful. Many who experience selective mutism as children were mocked by peers and misunderstood by adults and, therefore, struggle even exponentially more with self-esteem later in life.
Summing Up
If your child exhibits shyness, it is not always the sole explanation of his or her behavior towards certain people or situations. If he or she has very little to no friends at all or if your child seems to avoid any form of social interaction, those could be signs of selective mutism. In fact, it is possible that your child is not actually the shy or quiet type as you initially thought. Instead, he or she might just be very picky.
It is important to recognize early signs of selective mutism in children to prevent it from progressing as the child grows older. Also, selective mutism is generally viewed as a severe type of anxiety disorder which should give us enough reason to be more conscious about our family’s current mental health including ours.
Finding the confidence to utter that first word is the biggest hurdle that those people with selective mutism face and it is imperative that they are given the confidence to speak up in any social situation. This can be made possible through proper treatment of selective mutism along with the support and positive reinforcement provided by their families and friends.
Images: depositphotos.com.
