- Hey everybody.
Today I'm gonna talk with you about selective mutism.
How do we diagnose it?
And what treatment options are out there?
(soft music)
Now I put a video out about this quite awhile ago,
and I actually got a lot of negative comments,
and hate about some missteps that I took in the video
and things that I said that were incorrect.
And I want to apologize whole-heartedly.
I would never create a video or content that I thought would
be harmful, hurtful, or in any way upsetting to any of you.
My goal is actually to put out positive helpful content
and so I'm here to kind of make amends
and create another video that is correct.
And I've done a lot more research
and hopefully this is much more helpful.
And I have since turned that video private,
so if you go searching for it you won't find it.
Because I'm hoping that this'll replace it
and I'm hoping that you'll forgive me.
And that's the great thing about our community
is that I do my best to research.
You always are asking and challenging me
to find new information about other disorders
and issues that you're struggling with
and together we will make things better, right?
So thank you for keeping me in line
and thank you for letting me know
and hopefully this sounds and feels much better to you.
So to start off, selective mutism is a diagnosis.
And as always, if I can get it off the table,
I'm reading from my handy dandy DSM.
Now, selective mutism has a set of criteria.
The first being consistent failure to speak in specific
social situations in which there's an expectation
for speaking, like at school.
Selective mutism usually presents itself
before the age of five
so usually we run into it and recognize it's happening
when they enter school because there's pressure to talk.
Like "Oh, the teacher called on me" or
"Oh I have to stand up and I have to tell kids about this"
or "I have to present my project" and there are a lot of
things that where we're pushed and there's pressure to talk.
And those with selective mutism will not be able to.
The second is the disturbance interferes with educational
or occupational achievement or with social communication.
And you can see why that would happen.
'Cause if I can't talk in school or work,
and I can't express or show my project,
or talk to friends or talk to my teacher or my boss
or coworkers, it's gonna effect the way that
we're able to function in those tasks.
The third is the duration of the disturbance is at least
one month, not limited the first month of school.
And they say that because school can be really
anxiety-provoking and we're starting a new school year.
And it can take us a little while to get adjusted,
to feel okay, to know what our teacher's wanting
and to feel like we can speak up.
A lot of people are shy from the get-go
and selective mutism is not shyness, okay.
Also, selective mutism, just so that you understand
where it comes from, is that it's an anxiety disorder.
So that kind of tells you the root of where this
difficulty speaking, and inability to speak is coming from.
It usually stems from a really intense feeling of
social anxiety or generalized anxiety.
So we'll get so anxious that we're unable to speak
in school, at work, with friends, at home, etc.
Now the next criteria, the 4th, is that they failure
to speak is not attributable to a lack of
knowledge or comfort with the spoken language
required in a social situation.
In one of the articles I was reading it talked about
children coming from other countries.
Let's say my native language is Mandarin,
and then I'm thrown into a school in Florida,
and I don't speak English that well and I'm
really anxious about it already and it makes me nervous
and I'm just not comfortable.
So I don't know the language well
enough to actually speak it.
It cannot be attributed to that.
That's not what selective mutism is.
The last criteria is that the disturbance is not better
explained by a communication disorder.
It could be childhood onset fluency disorder, or any other.
I have some videos, I'll actually link here,
where I talk about my friend Katherine who's
a speech pathologist and there are a lot of different
things that can go along with reasons children don't
speak, but that again is not selective mutism.
Selective mutism comes from an intense internal anxiety
which leads us to feeling like we actually cannot speak.
We'll want to, we'll have so much to say
and we literally physically cannot.
That like I said, the onset selective mutism
is usually before the age of five,
or around the age of five.
And a lot of the research that they've done
shows that the majority of people do grow out of it
but from what I've heard from you,
and from what I've been reading on other really
not actually supportive research studies
that doesn't mean they're not valid,
that some people don't, and many don't.
And some people have onset later in life.
So like I said, the DSM is not the end all, be all.
Everyone's experience is gonna be different,
however the majority, just meaning 50% or more,
find that it usually starts at a very young age
at the age of five or a little younger.
So now we know what selective mutism is.
It's an inability to speak due to intense internal anxiety.
So we have it, or our child has it.
What are our treatment options?
And know that they're are a lot out there.
I'm gonna offer up four to you today,
however you can do your own research,
talk to your own speech pathologist.
Maybe someone at the school, maybe the therapist
that your child or yourself is seeing.
And ask for other options or referrals
because they're always more options out there.
But these are the four that they talk about
the most frequently when we talk about treating this.
Now the first is actually something that I don't know myself
I've never done it in my own private practice,
but they talk it about it like it's the golden rule
for treatment of this and it's the best.
It shows the best outcomes.
It's called SCAT, or Social Communication Anxiety Treatment.
And that would make sense, it sounds very specific.
It sounds perfect for selective mutism.
So if you can find someone who specializes in this
I would encourage you to give em a call.
And what it really focuses on is addressing
the answers to these three questions.
The first is why did they develop selective mutism?
In many cases they find that children, if it starts in,
if the onset is in childhood, that there's
usually a triggering event.
Not always, but usually.
And that could be parents got divorced,
maybe they witnessed something traumatic.
It could be a number of things, but there is
a triggering event and then they just
completely lose the ability to speak.
And so finding out what caused it,
can usually help us figure out how to help them.
The second questions is why does it
persist despite past treatment?
If we've tried things, why is it still lingering?
If we've had them at a speech pathologist
or we've had them in therapy,
how come it's still hanging around?
And that can obviously show us what
work still needs to be done, and that would be,
I could apply that to my patients with eating disorders
who've already been in treatment.
How come it's still around, what's still going on?
Did we not really fix that root of the root
and the reason that it exists?
The answer's probably yes.
And the third question that they work to answer is
what can be done at home, school,
or in the real world to help them?
And that could be anything from do they
have a really close friend that can help them?
That they feel okay communicating with them
to get their needs met in school?
Maybe they have a teacher that they really like
and they feel comfortable with and they actually
talk a little bit in that class because
their anxiety is lowered.
Maybe they can get that teacher all day long.
Or we can increase the number of classes
that they have with that teacher.
There may be a lot that we can do, especially through IEP's.
I do this for clients all the time.
I'm going to schools, and working on
different education plans with the child to make sure
that we're getting them the help that they need.
The second treatment option is psychodynamic therapy.
And when it comes to children
that really means play therapy.
And this can be really healing and helpful for children
who struggle with selective mutism
because they can speak through play
without actually having to use their voice.
And this can often lead them to feeling more comfortable
and more understood, and maybe speaking a little
bit with a therapist over time.
But at the very least it gives them a way
to communicate what they're feeling and thinking
without having to say it.
The third treatment option, and the one I
think should be attached to everyone of
these options, is family therapy.
Because this happens most often in children,
if we go right back into our family household
and whatever chaotic or triggering event that
happened is still happening there,
it's gonna be really hard for us to keep
fighting against it, using our tools.
It's really difficult for children to, essentially speak up.
Not just verbally, but even physically.
Letting people know that they're upset.
And if they've already struggled with that,
we wanna make sure that we're working as a family
to create a healthy happy environment where
they can work on lowering their anxiety, dealing with
whatever caused it, and being able to finally feel
comfortable and at ease enough to speak.
And the fourth and final treatment option
is behavioral therapy.
And the way that this kind of works,
and I'm on the fence about this.
I do this a lot in my practice, but like I said
I don't specialize in selective mutism.
But the way that behavioral therapy work is that we,
in a way, reward like positive behaviors.
So if they are speaking, or they do express themselves
in some way we reward that behavior.
It could be in golden stars on a board,
it could be in treats or benefits at home
like oh, I get to go out and walk the dog by myself
or I get to spend extra time on the computer
or whatever it may be, they use those to help guide
the child to doing more of the positive behavior.
And like I said, I don't know how well this
would work necessarily for selective mutism.
The others sound better personally to me.
But we have to find what works best for us
and in our own scenarios.
So that's another treatment option.
And the last thing that I'll mention is medication.
I know this happens most commonly in children
and a lot of us don't want to put our children
on medication and I totally hear you out on that.
And that's why there's all those other options.
And like I said there's probably more out there,
so do some research, find something that works for you.
But if we're doing all those things and it's still not
getting better and we worry about how our child is feeling.
Or we ourselves are struggling and we're feeling worse,
medication is an option, and they always talk about
SSRI's or SNRI's, helping with anxiety.
And since we know selective mutism is an anxiety disorder,
there is some evidence to show that medication does
help alleviate that and maybe get us to the level
like we've talked about in other videos,
where the anxiety is low enough that we can start actually
doing the work and challenging ourselves and feeling better.
And so that's another thing to keep in mind.
Again, I wanna thank you all for letting me know
when I've messed up and when I've been misspoken
and said something that wasn't correct.
It's together, we're working together, right,
towards a healthy mind and a healthy body.
And I want you to know I always hear you out,
I always read your comments, and it really, really helps
that we have a wonderful working community behind us.
And it always helps to share videos.
If you are upset by the last video,
please share this video if you feel it's correct.
I've done as much research as I can,
I'm doing the best I can, it would really help to share it
on Facebook so that those out there who are struggling
can hopefully get the treatment that they need and deserve.
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