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Information on what causes selective Mutism? How could my student get more help?

Dec 2012
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General & Family Physician
Practicing since : 2012
Answered : 1704 Questions
Hi, I am giving a speech on Selective Mutism, and am doing research on it. Last school term I had a student in my class with this dis-order. I tried all year to help him feel more comfortable in class so he would talk. It never happened. His parents told me that he had the same teacher 2 years in a row at another school and he never talked to her or any other student in the class. I would like information on what causes this behavior or social disorder and, medically how it affected my student and how he could have gotten more help. He will continue on in our school to first grade. I want my speech to be accurate and complete, can you please give me the information. Thank you
Posted Fri, 12 Jul 2013 in General Health
Answered by Dr. Nsah Bernard 2 hours later

Thanks for posting on XXXXXXX

I will try to give as much information as I can (especially one that can be useful for your speech).
Selective mutism is a disorder ( a type of pediatric social phobia) in which an individual cannot or will not speak in specific situations when there is an expectation of conversational speech. Communicative language is often intact in such persons, although selective mutism can coexist with other language/communication disorders. It is usually accompanied by shyness and anxiety. It primarily affects children and in some cases adolescents and adults can continue to experience an inability to speak in public. This inability is generally most disabling in school, as the child can not be assertive and speak when called on by the teachers.
Often, selective mutism can coexist with social phobia, which can be the precursor to agoraphobia (individual fears to be in crowded places). This condition significantly impairs the individual's level of functioning, as the individual is unable to complete required educational, social and family tasks, and the emotional distress engendered in situations requiring the person to speak out loud can result in school refusal.
Social phobia is the third most common mental health disorder after depression. Selective mutism is seen in fewer than 1% of children observed in mental health settings and is reported about 2-2.5 times more often in females than in males.
The cause of selective mutism is multifactorial Some children develop selective mutism after a stressor such as illness, separation from their caregiver, or other traumatic experiences such as abuse or neglect and bullying can especially contribute risk and also occur related to the lack of large supportive peer group. This is because youth with selective mutism are not as likely as "normal" unaffected peers to be protected by peer bystanders from being targeted and victimized.
In order to medically care for them, a series of psychosocial considerations need to be put into place.
Prevention of complications of selective mutism (e.g school phobia, academic failure due to poor attendance) can be achieved by reinforcement by family, school and physician of how important attending school is despite the child's desire to stay home and to avoid social events in order to reduce anxiety.
SSRIs are effective and superio to placebo, with efficacy rates of at least 65% in the treatment of patients with social phobia and the related disorder, selective mutism. The doses used in both children and adults are frequently much higher than those used for affective disorders.
Cognitive-behavioral therapy maybe extremely helpful to improve the level of the child's autonomous functioning and should be performed by a clinician experienced in such therapy (e.g psychologist, psychiatrist, behavioral/developmental pediatrician).

So for the child you have with selective mutism, it is best you let the parents get him a doctor specialized in that domain as mentioned above.

Hope this was useful information enough.
Dr. Nsah
Above answer was peer-reviewed by
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