Shy, Quiet Or Something More?

I meet new kids every day and very few of them want to talk to me. I’m a speech language pathologist, so you can understand how this complicates my job.

I have a few tricks up my sleeve: fun toys, silly pictures, asking them about something they brought in or something they are wearing. When I’m asked to evaluate a child who isn’t talking, I begin with some easy tasks like pointing to things or naming familiar items. Most kids begin to warm up in a short amount of time and I frequently have to steer them back toward our speech activities because there is so much more they want to talk about.

But sometimes a child won’t talk to me. Week after week, they won’t talk to me.

Parents tell me that he talks a lot at home, A LOT, but rarely to other people or away from home. This is more than being shy. When the parent describes what the child says at home, I learn that they use a variety of words and usually talks in full sentences. Sometimes, I’m able to determine that the child doesn’t even have a speech problem. They may have an anxiety disorder called Selective Mutism.

Selective Mutism is a childhood social communication anxiety disorder. It occurs when children do not speak for at least 1 month in certain social settings, but are able to speak in other settings. (Important note: this does not include kids that refuse to speak during the first month of school or children learning a new language.) The inability to speak is not related to a speech delay or disorder and is not the result of other medical or psychological problems that interfere with speech.

When it comes to talking or engaging with people, some kids experience an extreme level of fear and anxiety causing them to be silent, or mute. Maybe they are afraid to engage with other people or afraid they will embarrass themselves when they speak. In the moment, no amount of reassurance or pressure will help them bring words out. They are frozen.

Some studies estimate that this happens to 1 in 1,000 children*. However, several researchers have stated they believe this is largely underestimated. Selective Mutism is slightly more common in girls than boys. Most kids are diagnosed around the age of 5, but parents report difficulty starting years earlier. Selective Mutism may last for months or years. It may even extend into adulthood if left untreated.

What should parents do?

Never try to force or bribe a child to speak.

Talk to your doctor or a psychologist. They will likely gather a team to help diagnose your child’s difficulty and develop a plan of care:

• Are there hearing problems?
• Does she have difficulty speaking or being understood?
• Has there been a recent traumatic event?
• Does she express fear about talking or other things?

Frequently there are other underlying issues that have led to the anxiety disorder.

A psychologist or counselor can help your child understand their fears and work through them using play therapy, family counseling and behavioral or cognitive strategies.

Many times a speech language pathologist is called in to help. I know this seems unusual as we have just said there is not a speech problem, but an anxiety disorder. However, speech language pathologists  are able to set up activities in a nonstressful manner with low expectations for talking.

Let’s start with playing with a train set. The therapist helps the child build the train track and continues to make comments about the activity, train sounds and try to engage in taking turns with the child creating a fun shared activity.

The next level may include asking the child to point to a picture of the train car they want to put on the track first. Recently, a child I was seeing began saying the color as they were touching the picture. I smiled and continued playing, not making a big deal about them speaking.

Slowly, week after week, the therapist helps the child build success and confidence.

We set up activities that include more people and work with parents to design practice activities they can do between therapy visits. As we provide more challenging activities, we always have a backup plan ready if the child begins to feel unsure.

With older children, once we build trust, we can help them identify challenges in speaking or socializing. We can build on skills they already have and gain confidence in communicating with others. We will also help them problem solve specific situations that cause stress.

If you suspect your child has difficulty speaking, whether it be due to anxiety or other speech skills, please talk to your pediatrician to seek help.

* Estimate from Diagnostic and Statistical Manual of Mental Disorders (DSM-IV)