By: Dr.Elisa Shipon-Blum
President and Director Selective Mutism Anxiety Research and Treatment Center (SMART-Center)
Founder and Director Emeritus  Selective Mutism Group Childhood Anxiety Network (SMG~ CAN)
Clinical Assistant Professor Family Medicine and Psychology PCOM
SMartCenter@selectivemutism.org  ~  215-887-5748
www.selectivemutismcenter.org ~ www.selectivemutism.org
 

UNDERSTANDING SELECTIVE MUTISM AS A SOCIAL-COMMUNICATION ANXIETY DISORDER

The name, SELECTIVE MUTISM, implies that the main and only issue with ‘silent’ children is their ‘inability to speak.’ As a result, so many focus treatment and understanding on ‘ways to get the child to speak.’

 Unfortunately, this method is inappropriate and only causes more anxiety and frustration for the child.

 When one starts to decipher the characteristics of the child with SM and determines his/her ability to socially engage and communicate it will become clear that many of our children are unable to communicate nonverbally as well as verbally when anxious and uncomfortable. As a result, appropriate socialization  and communication is compromised.

Therefore, in order to truly help the anxious SM child who may stand motionless with fear, one must determine the degree of ‘communication anxiety’ that the child demonstrates in various social situations.

With this understanding, referring to the following SM-STAGES of Social COMMUNICATION COMFORT SCALE © is KEY in working with the SM child and understanding the stages of social communication that children with SM often struggle with. 

The SM-SCCS © illustrates that communication is broken down into RESPONDING and INITIATING and the three different stages of communication.
Stage 0- Noncommunicative; Stage1- Nonverbal responding (1a) & Nonverbal initiating (1b); Stage 2- Transitional Stage and Stage 3; Verbal responding (3a) & Verbal initiating (3b)

Children with SM demonstrate DIFFERENT levels of anxiety and are therefore in DIFFERENT stages of social communication comfort with different people within different settings.

Examples are:

-                 The child who speaks normally (responds and initiates) with his/her friend at home or out of school (Stage 3) but can only communicate nonverbally (nodding, pointing) in response to her friends in school (Stage 1a and possibly 1B)

-                 The child who can respond to his friends via ‘quiet talking’ to friends in class (Stage 3a) but is mute, frozen-looking/expressionless & cannot even respond when their teacher asks a question (Stage 0) in any size group setting

-                 The child who stands motionless with fear or simply avoids interaction with a store clerk, but can verbalize in an articulate manner to his/her close friends and family members.

-          The child who can whisper to a friend during recess (stage 2) and/or make sounds to his teacher (stage 2) via one on one interaction, but remains nonverbal (stage 1) with this same friend and teacher during class instruction.
 

What is often confusing to many is the SM child’s ability to SPEAK in one setting, but their inability to speak in another setting. To an outsider, and to someone who does not understand the selectively mute child, this can be interpreted as defiance on the child’s part and interpreted as the child’s “REFUSAL” to speak.

In reality, the child’s anxiety level changes from one scenario to the next.  His/her ability to engage socially and communicate comfortably determines his/her ability or lack of ability to function appropriately.  In other words, a child who’s social communication inability interferes with his or her ability to function socially, academically or impinges on his/her emotional well being has a dysfunctional or maladaptive way of interacting and communicating. This child needs professional help to overcome this social communication anxiety.  He/she is not being oppositional or ‘difficult’ but truly has a disability that enables for appropriate social interaction and communication.

The most overlooked stage is the transitional stage. (Stage 2). Most believe, 'lower anxiety' and the child will become verbal. For the YOUNG child, 'setting up scenarios' or silent goals may be enough, but as the child ages, more active goals or child-directive goals are critical. These active goals are the specific interventions needed to BRIDGE from NV-->V communication!

An example is the child who can talk to his friends, but cannot answer the teacher when questioned.  Many educators get frustrated and upset and consider the SM child as oppositional and defiant.  Understanding that the child’s communication anxiety rises dramatically when the teacher asks a question is KEY to being able to help the child overcome his or her fears.  What is happening in this scenario is that the child is in STAGE 3 of communication with  peers, but in STAGE 1 with their teacher.  Working to help gradually progress the child from stage 2àstage 3 using strategies and interventions is the goal of treatment in this case. GOALS centering on developing the strategies that focus on using a verbal intermediary (person whom child speaks to or object (stuffed animal, finger puppet, ‘fist’) who can help transfer verbalization into setting or to another person); shaping sounds into words and/or perhaps using an augmentative device (tape recorder) to begin the transition. Therefore although finding means of lowering anxiety is important, it will be the specific interventions that will help the child progress from nonverbal to verbal communication.  

When one starts to VIEW Selective Mutism from a social communication anxiety standpoint, it becomes clear that expecting a silent, ‘frozen-looking,’ noninteractive child to speak is only causing MORE anxiety for the child.  Social-Communication Anxiety Therapy (SCAT) enables for small, purposeful steps to be taken (under the guidance of a competent treating professional) to help a child progress from one stage to the next until a child is able to engage socially as well as communicate effectively.

Therefore, using the SM - Social Communication Comfort Scale © as a GUIDE in determining the child’s baseline level of social communication anxiety is CRITICAL in the assessment, evaluation and treatment process.

Please contact the Selective Mutism Group Childhood Anxiety Network SMG-CAN)
For further information contact www.SelectiveMutism.org and www,childhoodanxietynetwork.org
215-887-5748   ~   SMinfo@selectivemutism.org

Please visit the 501( c )3, nonprofit organization the Childhood Anxiety Network, Inc.

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