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Jessie Hewitson reports on the rarely understood condition of selective mutism.


By Jessie Hewitson
Published: 8:00AM BST 16 Apr 2010


From the moment Megan Coleman started school, it was obvious something was wrong. She would happily chat to her parents and siblings at breakfast but once she had been dropped off at the school gates would fall silent. Her brother reported that she spent her break times alone – a far cry from the sociable girl her family knew at home.


At first, her parents, Karen, 48, and Wayne, 46, put it down to shyness. When Megan also stopped talking to her grandparents, however, they realised there was more to it.


“Sometimes she would come home desperate for the lavatory because she couldn’t ask to go in school,” says Karen, who lives in Kent. “We spoke to the teachers, who confirmed she wasn’t talking to them at all. One day, I was speaking to a customer at work about Megan and she asked if she might have selective mutism. When I got home I read up about it on the internet, and realised it was quite possible.”


Karen alerted the school nurse, who arranged for Megan to see a speech therapist, who made the official diagnosis. Megan had a fairly typical case of selective mutism (SM), where a child can speak but in certain situations chooses not to. Often they will be chatterboxes at home but completely silent at school. When asked a question by a teacher, children with SM will freeze out of fear that others will hear their voice, hyper-aware of the potential of saying the wrong thing.


There are several causes but the most common is anxiety, according to Lindsay Whittington of SMIRA (selectivemutism.co.uk) the country’s only support group for parents. She established the group when her own child was diagnosed with SM.


“Sometimes there may be some form of trauma involved, but for children trauma can be triggered by something relatively small,” she says. “Starting school can in itself be traumatic.”


Karen Coleman believes her daughter’s selective mutism may have been triggered by an incident on a family holiday at the age of four – Megan was playing and turned to speak to a person she thought was her mother, only to find out it wasn’t.


There is no reliable figure for the number of children affected by SM. It is thought to be roughly one in 150, according to a study carried out by the American Academy of Child and Adolescent Psychiatry in 2002, making it twice as common as autism. Girls are more likely to suffer, and the problem usually manifests itself between the ages of three and five, when a child goes to nursery or school. Early detection is key: SM is curable but gets more serious as the child gets older.


Generally, the first step to treatment is to involve an educational psychologist and/or a speech therapist. Parents and teachers also need to understand that the child is not just being stubborn or wilful, says Maggie Johnson, a speech and language therapist and co-author of the Selective Mutism Resource Manual.


“In one school where I worked, a girl with SM had broken her arm and still was unable to raise help. Despite being in a lot of pain, she did not say a word to pupils or teachers. It wasn’t until she got home that her mother realised what had happened and took her to hospital,” she says.


Another key issue is not to put too much pressure on the child to speak. “Pressuring or cajoling a child to speak does not work,” Johnson advises. “In fact, the more you back off, the more the child is likely to be able to speak.”


Gradual exposure to conversation with new people has proven to be effective, allowing children to face their fears in small, manageable steps. A technique known as “sliding in” – where a speech therapist will slowly involve another person in a conversation between child and parent – has worked wonders for Megan. Now 11, she is able to speak to her teacher. It is a small but significant step and a promising sign that, with patience, she will one day be talking freely. “Allowing children to get there at their own pace is key,” Johnson says. “Smaller steps will mean quicker progress.”


  • *Megan and Karen Coleman appeared in a Landmark Films documentary called My Child Won’t Speak, made for the BBC and broadcast in February

SPOTTING THE SIGNS OF SM


  • *Children with SM are likely to be emotionally sensitive, and have a tendency to worry about other people’s reactions
  • *They may be more sensitive to crowds, being touched and loud noises
  • *They may also be slow to respond to a question, or look anxious when a stranger speaks to them

Source: http://www.telegraph.co.uk/family/7589677/Selective-mutism-Speaking-up-for-silent-treatment.html



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