Be cautious with quiet children
Tuesday, December 14, 2004 8:06 AM PST
By Dr. Sue Abell
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E-mail this articleDear Dr. Sue,
My daughter, who started kindergarten this year, is loving school and having great fun riding the bus. However, her teacher is very concerned about her not speaking in class, and has even suggested speech classes for her. We told her that our daughter is very verbal at home and in places where she feels comfortable. We think she'll warm up slowly to her new environment, the way she did in preschool and other places. They basically said that's great that she speaks at home but she needs to use her voice during class and do it now vs. later.
Is it such a bad thing that a child is quiet and shy in new surroundings? She talks to her little classmates on occasion, but rarely will answer a question asked by her teacher. She comes home and tells me in detail all she has learned. After some goofy tests they gave her, they think she understands well but isn't able to answer. I feel like the school staff thinks we should push her to talk. Do you have any thoughts on this??
Dear Mom,
Your daughter's teachers probably are fearful that she has a condition called "Selective Mutism." Selective Mutism is actually an anxiety disorder, in which children are virtually unable to force themselves to speak in school or in other social situations, even though they can speak normally when they're relaxed.
To qualify for that diagnosis, your daughter's inability to speak would have to actually be interfering with her function in school, would have to have persisted for more than one month, and could not be part of a communication disorder or due to other disorders such as autism, schizophrenia or psychosis.
It is believed that Selective Mutism occurs in children who are born with a genetic predisposition for anxiety. Such children appear to have a more easily excited amygdala, which is the part of the brain that evaluates surroundings for signs of danger and then sets off the "fight or flight" reaction that might be needed to avoid that danger.
It used to be believed that family dysfunction or abuse, neglect or other trauma played an important role in the development of selective mutism; that appears to be untrue. The question that remains is whether she is just shy and slow to warm up, or whether she might have selective mutism.
Two things that you report are encouraging: that she experienced the same symptoms in preschool and in other situations, but warmed up and was able to talk just fine as time went on; and the fact that she will occasionally talk in school even now (just not to the teacher, or when the whole class has their attention on her.)
It really does sound like she is just an exquisitely shy child who will probably continue to follow the same pattern in each new setting.
There is one drawback to making that assumption, however, and that is that we may be wrong. Selective mutism responds more readily to treatment the earlier that treatment is begun. So let's look at the ways in which this childhood anxiety disorder is usually treated.
In most cases, behavioral therapies would be the treatment of choice to begin with.
1. Anxiety reduction, which involves teaching the child relaxation techniques. The child doesn't have to speak during these sessions, they simply listen and learn, and then practice the techniques at home.
2. Graduated exposure and desensitization. This involves having the child talk in a situation in which they are comfortable, and then very gradually adding stressful components to the situation. A child might be asked to talk to their parents in an empty classroom at first, and then eventually talk to her parents with the teacher working on something else nearby.
Eventually the teacher (or a counsellor) would be worked into the conversation. Finally one or two children from the child's class will be added to the session. Each successful step along the way is rewarded with praise and with goodies or privileges.
3. Tape recording the child sometimes is helpful. In one method, the child is taped answering a set of questions. The teacher is taped separately asking the questions. Then the videotape is edited so that it appears that the child is responding to the teacher. Sometimes simply watching themselves perform this feat that they thought was impossible makes a huge difference. It can also be helpful to audio- or videotape the child talking normally at home, and play it in the classroom. The child then sees that nothing harmful comes of having her voice heard at school.
If behavioral techniques don't work, or in conjunction with them, anti-anxiety medications are sometimes necessary.
The three behavioral therapies I mentioned seem very benign, as well as perhaps being useful for the child who is "just" extremely shy. The very shy child is also experiencing a fair amount of emotional discomfort every time attention is focused on her, and her life could be much easier if she became more comfortable in the world outside of home.
I recommend that you talk to the speech therapist who works with children at your daughter's school to see what therapies that person would suggest, and consider getting your daughter involved in a behavior modification plan to see how much it might help her.
There is an excellent Web site about all aspects of selective mutism at http://www.selectivismmutism.org
Dr. Sue Abell is a pediatrician at the Child and Adolescent Clinic in Longview and the mother of four children. Parents are invited to send their questions about children's health or child rearing to Dr. Abell in care of The Daily News, P.O. Box 189, Longview WA 98632, or by e-mail to zimmerman@tdn.com
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