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Selective mutism is a social anxiety disorder in which a person who is normally capable of speech is unable to speak in given situations.
Additional recommended knowledge
In the Diagnostic and Statistical Manual of Mental Disorders selective mutism is described as a rare psychological disorder in children. Children (and adults) with the disorder are fully capable of speech and understanding language, but fail to speak in certain social situations when it is expected of them. They function normally in other areas of behavior and learning, though appear severely withdrawn and some are unable to participate in group activities due to their extreme anxiety. It is like an extreme form of shyness, but the intensity and duration distinguish it. As an example, a child may be completely silent at school, for years at a time, but speak quite freely or even excessively at home.
Particularly in young children, selective mutism can sometimes be confused with an autism spectrum disorder, especially if the child acts particularly withdrawn around his or her diagnostician. Unfortunately, this can lead to incorrect treatment.
Selective mutism is usually characterised by the following:
The former name elective mutism indicates a widespread misconception even among psychologists that selective mute people choose to be silent in certain situations, while the truth is that they are forced by their extreme anxiety to remain silent; despite their will to speak, they just cannot make any voice. To reflect the involuntary nature of this disorder, its name had been changed to selective mutism in 1994. However, misconceptions still prevail; for instance, the ABC News erroneously attributed the cause of selective mutism to trauma and described it as willful in a report dated May 26, 2005.
The incidence of selective mutism is not certain. Due to the poor understanding of the general public on this condition, many cases are undiagnosed. Based on the number of reported cases, the figure is commonly estimated to be 1 in 1000. However, in a 2002 study in The Journal of the American Academy of Child and Adolescent Psychiatry, the figure has increased to 7 in 1000.
No single cause has been established, but there is some evidence that there is a hereditary component. Typical sufferers have some of the following traits when anxious, some of which are often perceived as rudeness:
Contrary to popular belief, people suffering from selective mutism don't necessarily improve with age, or just "grow out of it." Consequently, treatment at an early age is important. If not addressed, selective mutism tends to be self-reinforcing; those around such a person may eventually expect him or her not to speak and stop attempting to initiate verbal contact, making the prospect of talking seem even more difficult or foreign. Sometimes in this situation, a change of environment (such as changing schools) to a place where the condition is not proven make the difference. In some cases, with psychological help, the sufferer's condition can improve.
Occasionally, treatment in teenage years becomes more difficult, though not necessarily.
Forceful attempts to make the child talk are not productive, usually resulting in higher anxiety levels and so reinforcing the condition. The behaviour is often viewed externally as willful, or controlling, as the child usually shuts down all communication and body language in such situations, which is perceived as rudeness.
The exact treatment depends a lot on the subject, their age and other factors. Typically, stimulus fading is used with younger children.
Some in the psychiatric community believe that anxiety medication may be effective in extremely low dosages and that higher doses may just make the problem worse. Others in the field believe that the side-effects of psychiatric medications — in any dose and on any child — are so dangerous as to negate any temporary benefit, preferring behavioral and psychological interventions.
In this technique the sufferer is brought into a controlled environment with someone who they are at ease with and can communicate. Gradually another person is introduced into the situation involving a number of small steps.
These steps are often done in separate stages in which case it is called the sliding-in technique, where a new person is slid into the talking group. This can take a relatively long time for the first one or two faded in people.
The subject is allowed to communicate via non-direct means to prepare them mentally for the next step. This might include email, instant messaging, or online chat, until they are in a position to try more direct communication.
Some practitioners believe that there is evidence indicating that antidepressants such as fluoxetine (Prozac) may be effective in treating children with selective mutism. Though many in the medical community believe that psychiatric medications decrease the anxiety levels enough to allow communication to take place in cases of selective mutism, other practitioners and activists (see articles on Peter Breggin and David Healy (psychiatrist)) stringently decry any use of psychiatric medications on children and note the lack of medical proof of genetic links to behavioral disorders. The denunciation of psychotropic intervention on children with behavioral anxiety disorders has intensified particularly since lawsuits against several drug companies — current to 2005 — have exposed previously unseen internal research documents linking fluoxetine and other SSRI antidepressants with increased risk of suicide, psychosis and — ironically enough — damage to areas of the brain which could affect language production and normal social development.
List of well-known people with selective mutism
|This article is licensed under the GNU Free Documentation License. It uses material from the Wikipedia article "Selective_mutism". A list of authors is available in Wikipedia.|