With growing awareness, it become increasingly common for the word ?anxiety? to be used in our daily conversations as well, and is not restricted to the clinical settings. While such increasing awareness is clearly reflective of our progressing society, it is equally important to ensure that the understanding of such conditions is accurate, especially within the field of mental health which has been shrouded by myths and stigmas. Therefore, it is necessary for us to recognize that anxiety could be manifested in various forms, both in children as well as adults.
Understanding Selective Mutism
One such manifestation, most commonly occurring in young children, is Selective Mutism, (with the onset usually being before the age of 5 years), which is characterised by a consistent failure of the child to speak in specific social situations. The child is able to speak otherwise, and knows the language, however becomes selectively mute only in those specific situations. For example, such a child would typically become quiet or may not speak at all during social outings or in school, being interactive at other times at home or with a select few people. Selective Mutism is a relatively rare disorder, with a prevalence of 0.03% to 1% depending on the setting, for example in the clinic, school, or general population (APA, 2013).
Identifying Signs and Symptoms
In fact, these children might appear to be shy, running to hide behind their parents, and therefore could also be mistaken as simply a variant of introversion. Therefore, it is important for us to be able to recognize the signs and symptoms of Selective Mutism, which typically lasts for several months, but if left untreated, may sometimes persist for longer and may continue for several years. Some of the warning signs could include:
* Does not initiate conversations in specific social situations
* Speaks spontaneously in other situations
* Unwilling or hesitant to reply despite repeated attempts or cajoling
* Avoids social situations or situations in which a performance is likely to be expected
* Appears to be excessively shy or clingy
* Tendency to throw frequent temper tantrums
* Significant interference in academic performance
* Discomfort in the presence of unfamiliar others
* Few or no friends
* Crying or displays of anger if forced to speak
As is the case in other anxiety disorders, multiple theories and contributing factors have been suggested for the etiology of Selective Mutism as well. However, no single causative factor has been fully implicated. An interaction between genetic, biological, and psychosocial factors has been implicated, including the role of neurotransmitters like serotonin, psychological and social stressors like trauma, loss of a dear one, difficulties in relationships, work-stress, change in environment, and other life-challenges can be a trigger for symptoms of anxiety. Moreover, over-protective, controlling or detached parenting could also increase the chances of children developing Selective Mutism.
Seeking Help and Treatment
At the outset, it is important to eradicate myths, and understand that a selectively mute child would not simply ?outgrow? his or her anxiety. Selective Mutism is an anxiety disorder that requires adequate psychiatric as well as psychological interventions. In addition, a child displaying Selective Mutism is likely to find it challenging to communicate with people and in social situations through the use of verbal mediums. Therefore, the application of various forms of Expressive Arts-Based Therapy can help provide a selectively mute child with alternate mediums like art, play, music, etc. which can serve as means of catharsis. However, it is important to reiterate that Selective Mutism in children requires adequate medical and psychological interventions, clearly indicating that the professional help of a psychiatrist and a psychologist is irreplaceable.