[Health in the 100-Year Life Era] Selective Mutism in Children: Empathy and Treatment Over Forcing Speech

Recently, a story about a child with selective mutism was featured on a broadcast. In the clinic, we sometimes meet children who do not speak a word, and some of them have selective mutism. A child who recently came to the clinic was a kindergartener who, despite several questions and showing interesting toys, just turned away and sat on the chair. When asked the father who came along, he said that although the child is like this now, at home he is very playful and talkative. However, not only at the hospital but also at kindergarten, the child suddenly becomes quiet and unable to speak.

The situations in which a child with selective mutism can speak vary greatly. Some children only speak at home with their family, while others can say simple words to one or two close friends at school. Even if they do not speak, many can communicate simply by nodding or shaking their heads. Selective mutism is often misunderstood as a symptom of 'not speaking,' but it is more accurate to describe it as a symptom of 'not being able to speak.' Being unable means that even if the desire to speak is strong, the words do not come out. Selective mutism can be seen as a form of anxiety; in unfamiliar people or places, anxiety increases, causing the child to freeze and be unable to speak. This anxiety can become more severe, especially in situations where the child has to speak in front of many people.

Although there is some variation, selective mutism is generally thought to occur in about 1 in 100 children. It is not very common. However, because it is uncommon, it is often not well understood by those around the child. The child may be mistaken for being mute or considered naturally silent. The most common mistake made by family members and others is to force the child to speak no matter what. Rather than forcing the child to do something they cannot, it is better to let them know that there is no need to speak until they feel comfortable. Children who do not speak are already well aware of their condition and are quite concerned about whether others might think poorly of them.

What should be done if selective mutism is suspected? First, it is important to recognize that this symptom is never trivial and that help is needed. Thinking that it is due to shyness, being young, or that it will improve with age can further entrench the child’s symptoms. It is necessary to visit a hospital as soon as possible and meet with a specialist for evaluation and diagnosis. To improve symptoms, non-pharmacological treatments such as play therapy and behavioral therapy are used along with medication to reduce anxiety. If there is hesitation about using medication, non-pharmacological treatments can be tried first. However, if symptoms do not improve sufficiently, medication should also be considered. Parents should avoid pressuring the child to speak and instead understand and empathize with the child’s difficulty in speaking. It is also important to recognize and praise any effort the child makes to communicate, even a little, in unfamiliar situations.

Nowadays, awareness of selective mutism has increased compared to before, and children facing difficulties tend to come to the hospital more quickly. This is fortunate. Selective mutism is one of the more severe anxiety disorders. Moreover, as children grow older, problems with peer relationships and academics caused by their inability to speak become more significant. The difficulty in speaking can lower the child’s self-esteem and may be accompanied by depressive symptoms. It would be beneficial to quickly identify the child’s difficulties and actively help reduce their anxiety.

Professor Tae-Yeop Lee, Department of Child and Adolescent Psychiatry, Asan Medical Center, Seoul