Two weeks ago, I was asked to step into one of the four-year-old nursery classrooms to screen a child who has not uttered a single word out loud since the start of the school year. It was already the middle of April, eight months into the year, and way past the amount of time that a typical child might take to adjust to a new environment, peers and teachers. I observed an adorable little boy who was standing by a shelving unit, holding one toy in his hand, while watching the other children play. He never engaged in the play with the other children, though he was passively enjoying it. While he stood there, he evidenced some odd oral movements, with tongue protrusion and lip rounding behaviors noted. I watched the ongoing play for several minutes before attempting to “coax” this child into play with my silliness. I made some progress, as he began to smile at me and giggle, and communicated to me by nodding his head. I felt sure that he would eventually interact with me.
Is this child simply shy, or is there more going on? To answer this question, I spoke with both the teacher and his parent. The teacher told me that this child is bilingual, and is stronger in his native tongue than in English. She informed me that he does appear to have two friends whom he speaks to, but always in a whispered voice, and never directly in front of other peers. In fact, while I was observing the class, several of the other children came up to me and told me that he “doesn’t talk.” He has never spoken aloud in the classroom during circle time, or to his teachers. His parent told me that he speaks at home all the time, and is fluent in both his native tongue and in English. His parent continued, noting that he speaks during play dates at his house, and that his older sister had the same issue, but was much improved after her mainstream teacher began using a program specifically designed for children with selective mutism in the classroom. All this additional information confirmed for me that this child is not suffering from extreme shyness, but is in fact, a selective mute.
Selective mutism is an anxiety disorder in which one cannot speak in certain environments or to specific people. This little boy has made a list of rules for himself, dictating when, where, and to whom, he will speak. He withholds language to alleviate extreme anxiety. In this way, he can exert some control over his environment, and ease his stress.
The problems that a child such as this one faces, are numerous. Firstly, as it is an anxiety disorder, he is extremely anxious. Anxiety permeates all aspects of his life. In addition, withholding language in the classroom causes him to experience even more anxiety, and results in his inability to fully engage with his peers in the classroom. He would probably like to engage with some of these peers, but is too anxious to try and likely has not learned how to enter ongoing play. He is missing out on crucial psychosocial and emotional development, because he is not interacting with his peers. He probably has very few classroom peer playdates; in fact, his parent reported that most of his play dates are with his cousins.
Helping a child with selective mutism begins with removing the pressure to speak from him/her. I advised the teacher to no longer call on him for responses during circle time, removing the stress of having everyone staring at him while he squirms in silence. In addition, I told her that when she is engaging with him, one on one, she should ask only yes/no questions, so that he is able to respond to her with gesturing. In addition, I told her to assure him that while he isn’t able to speak to his teachers now, one day he will be able to do so. It is important to provide this type of child with hope for the future. When I spoke with the parent, I advised him that this child should begin speech and language therapy, with a therapist who specializes in selective mutism, and/or be enrolled in a therapeutic program, such as the one at the JCC Therapeutic Nursery, where the results of treatment for selective mutism are outstanding. This child needs to be surrounded by therapeutic intervention, to relieve his anxiety and encourage and slowly coax expressive language in new environments. As he ages, he can begin to receive psychological counseling, to help him to develop coping strategies when faced with extreme anxiety.
Hopefully, this child’s future will be bright and full of social interactions and ongoing cognitive, psychosocial and emotional development. If he receives the help he needs, he should be good to go.
Written by Lisa H. Bernholz-Balsam MS, CCC-SLP/A
Speech and Language Therapist, Therapeutic Nursery
Kaplen JCC on the Palisades