Most people will not have heard of this disorder of
childhood, yet it affects about 1% of the childhood
population, more commonly girls than boys. It used to be
called `elective mutism' but doctors changed it to
`selective' because the former term implies a sort of willful
conscious decision on the part of the child, which is not the
case at all. Whatever its name, it is a most distressing
behavioral problem when a parent or teacher comes into
contact with it.
A child who has this problem will have no language
difficulty. S/he will have a persistent lack of speech in
some places, e.g. in school, but not in others (at home or in
the street). This disturbance cannot be accounted for by a
communication disorder like stammering, for instance. The
main feature which all selective mutes have in common is the
inability to communicate in one particular kind of
situation.
When parents take the child to a professional speech and
language therapist, the clinician will have to gain most of
his information from the parents, as the child will not
usually talk to him. Does the child understand what people
say to him/her? Does s/he understand questions and follow
instructions? The parent will be asked to describe how the
child pronounces words, the extent of his/her vocabulary, the
tone/pitch/quality of the voice and the general fluency of
speech. This is to rule out any other speech and language
disability which might be aggravating the mutism.
There is often a family history of obsessive compulsive
disorder, or extreme shyness on the part of the mother. One
or both parents might suffer from some form of social
disorder. In fact, quite frequently, one of the parents had
this same problem as a child.
Some children with selective mutism are afraid to speak,
because they feel they might say the wrong thing. Others feel
that their voice `sounds funny' if they do not have clear
diction or if they are excessively shy. Whatever the reason,
and mostly there is no obvious reason, it is a difficult
situation which is frustrating to all who try unsuccessfully
to elicit some sounds.
The child will have a very clear set of `rules.' S/he might
never speak inside the school, nor in front of any friends
from school, but will chat merrily to other outsiders. One
way of treating selective mutism, is to force the child to
break these `rules.' It will have to be done with great care,
and in very slow degrees. For instance, if Mother comes
through the school gates into the playground, the `rule' will
be in jeopardy. "I don't talk in school, but I do talk to
Mommy." If this ploy succeeds, Mother can come and sit with
the child in the classroom. Once again, the child will be in
a dilemma. Putting the child into situations which will make
the `rules' too complicated, will help break the self imposed
silence. S/he may want a way out, which Mother or Father can
give by saying, e.g., "After Pesach, when you go back to
school, you will speak like everyone else."
There are numerous other ways in which a therapist might
approach the problem, and in some cases, he might even
suggest drug therapy. Behavior therapy is one successful way
of treating mutism. The therapy is based on the premise that
the child is selectively mute because of anxiety in social
situations or to gain attention. The therapist may use a
combination of treatments, depending on the circumstances at
home and at school.
Although statistics put the incidence at around one in one
hundred children, I personally have encountered only one such
non-Jewish child and one Jewish child, in forty years of
teaching experience. During those years, I have come into
contact with well over one thousand children. However, if
parents read about this particular disorder, they will come
to appreciate their child about whom the teacher complains
that s/he never stops talking. We cannot take anything for
granted.
