Complete Wikipedia Article on Selective Mustism
Selective mutism (SM) is an anxiety
disorder in which a person who is normally capable of speech is unable to speak
in given situations, or to specific people. Selective mutism usually co-exists
with shyness or social anxiety.
Children and adults with selective mutism are fully capable of speech and
understanding language but fail to speak in certain situations, though speech is
expected of them. The behaviour may be perceived as shyness or rudeness by
others. A child with selective mutism may be completely silent at school for
years but speak quite freely or even excessively at home. There is a
hierarchical variation among those suffering from this disorder: some people
participate fully in activities and appear social but don't speak, others will
speak only to peers but not to adults, others will speak to adults when asked
questions requiring short answers but never to peers, and still others speak to
no one and participate in few, if any, activities presented to them. In a severe
form known as "progressive mutism", the disorder progresses until the sufferer
no longer speaks to anyone in any situation, even close family members.
Selective mutism is by definition characterized by the following:
Particularly in young children, SM can sometimes be confused with an autism
spectrum disorder, especially if the child acts particularly withdrawn around
his or her diagnostician, which can lead to incorrect treatment. Although
autistic people may also be selectively mute, they display other behaviors—hand
flapping, repetitive behaviors, social isolation even among family members (not
always answering to name, for example)—that set them apart from a child with
selective mutism. People with higher-functioning autism may be selectively mute
due to anxiety in social situations that they do not fully understand. If mutism
is entirely due to autism spectrum disorder, it cannot be diagnosed as selective
mutism as stated in the last item on the list above.
Selective mutism may co-exist with or cause the child to appear to have
Attention Deficit Disorder. Many people with the inattentive form of ADHD show
little or no interest in other people primarily. People with inattentive ADHD
may appear to be "space cadets" or "out in their own world", and may be slower
to respond to social stimuli. Children with selective mutism, especially when
they have severe social anxiety, may also look like this. Also, they might be
distracted by their anxiety or by sensory input, if they are highly sensitive,
or from the task at hand.
Most people with selective mutism have social phobiæ, and many have other
anxiety disorders such as obsessive compulsive disorder or panic disorder.
The former name elective mutism indicates a widespread misconception
among psychologists that selective mute people choose to be silent in certain
situations, while the truth is that they often wish to speak but cannot. To
reflect the involuntary nature of this disorder, the name was changed to
selective mutism in 1994.
The incidence of selective mutism is not certain. Due to the poor
understanding of this condition by the general public, many cases are likely
undiagnosed. Based on the number of reported cases, the figure is commonly
estimated to be 1 in 1000. However, a 2002 study in The Journal of the
American Academy of Child and Adolescent Psychiatry estimated the incidence
to be 7 in 1000, 0.7%.
Other Symptoms:
Besides lack of speech, other common behaviors and characteristics displayed
by selectively mute people include:
On the positive side, many sufferers have:
Causes
Most children with selective mutism are believed to have an inherited
predisposition to anxiety. They often have inhibited temperaments, which is
hypothesized to be the result of over-excitability of the area of the brain
called the amygdala. This area receives indications of possible threats and sets
off the fight-or-flight response.
Some children with selective mutism may have sensory integration dysfunction
(trouble processing some sensory information). This would cause anxiety and a
sense of being overwhelmed in unfamiliar situations, which may cause the child
to "shut down" and not be able to speak (something that some autistic people
also experience). Many children with SM have some auditory processing
difficulties.
About 20–30% of children with SM have speech or language disorders that add
stress to situations in which the child is expected to speak.
Despite the change of name from "elective" to "selective", a common
misconception remains that a selectively mute child is defiant or stubborn. In
fact, children with SM have a lower rate of oppositional behavior than their
peers in a school setting. Another common belief is that selectively mute
children have experienced abuse or trauma. A study of six adults who were
selectively mute as children suggests that those with selective mutism are more
likely to have suffered abuse, which may contribute to the onset of their
mutism. The interviewees also said that there was a conscious determination not
to speak and that they were afraid of speaking, indicating that both choice and
fear may be involved in selective mutism. Only two of the interviewees
specifically reported childhood social anxiety, and those were twins. Other
anxiety and emotional problems seemed to have appeared after the onset of the
disorder. This study shows that selective mutism may be more complex than
currently believed, with both past and current understandings of the disorder
both being partly true.
In their book Adoption Detective: Memoir of an Adopted Child, Judith
and Martin Land mention how selective mutism, extreme shyness, and other social
anxiety disorders can be evidence of trauma frequently associated with adoption,
especially in children under three years old. Selective mutism might be highly
functional for a child by reducing anxiety and protecting the child from
perceived challenges of social interaction, particularly in situations with high
performance expectations, such as school. Adoptees with this anxiety might be
highly talkative at home with family and friends, but avoid speaking altogether
in classrooms, large groups, and social functions. Adoptees with selective
mutism likely have difficulty verbalizing personal thoughts when they are
excessively revealing and painful or of a subconscious nature.
History
In 1877, a German physician named a disorder aphasia voluntaria to
describe children who were able to speak normally but often refused to.
In 1980, a study by Torey Hayden identified four "subtypes" of Selective
Mutism. First, and most common, she described "symbiotic mutism" characterized
by a vocal and dominating mother and absent father and the use of mutism as
controlling behavior around other adults. Second, the least common, was "speech
phobic mutism" in which the child showed distinct fear at hearing a recording of
his or her voice. This also involved ritualistic behaviors and was thought to be
caused by having been told to keep a family secret. Third was "reactive mutism"
thought to be caused by trauma or abuse, though not all children put in this
category were known to have been abused. These children all showed symptoms of
depression and were notably withdrawn, usually showing no facial expressions.
Finally, Hayden described "passive-aggressive mutism" in which silence is used
as a display of hostility, connected to antisocial behavior. Some of the
children in this group had not been mute until age 9–12. These subtypes are no
longer recognized, though "speech phobia" is sometimes used to describe a
selectively mute person who appears not to have any symptoms of social
anxiety.
The Diagnostic and Statistical Manual of Mental Disorders (DSM), first
published in 1952, first included Elective Mutism in its third edition,
published in 1980. Elective Mutism was described as "a continuous refusal to
speak in almost all social situations" despite normal ability to speak. While
"excessive shyness" and other anxiety-related traits were listed as associated
features, predisposing factors included "maternal overprotection", mental
retardation, and trauma. Elective Mutism in the third edition revised (DSM
III-R) is described similarly to the third edition except for specifying that
the disorder is not related to Social Phobia.
In 1994, Sue Newman, co-founder of the Selective Mutism Foundation, requested
that the fourth edition of the DSM reflect the name change to selective mutism
and described the disorder as a failure to speak. The relation to
anxiety disorders was emphasized, particularly in the revised version (DSM
IV-TR).
There are no changes to the definition of selective mutism planned for the
DSM V.
Treatment
Contrary to popular belief, people suffering from selective mutism do not
necessarily improve with age. Effective treatment is necessary for a child to
develop properly. Without treatment, selective mutism can contribute to chronic
depression, further anxiety, and other social and emotional problems.
Consequently, treatment at an early age is important. If not addressed,
selective mutism tends to be self-reinforcing. Those around such a person may
eventually expect him or her not to speak and therefore stop attempting to
initiate verbal contact with the sufferer. Alternately, they may pressure the
child to talk, making him or her have even higher anxiety levels in situations
where speech is expected. Because of these problems, a change of environment
(such as changing schools) may make a difference, and treatment in teenage or
adult years can be more difficult because the sufferer has become accustomed to
being mute.
The exact treatment depends on the sufferer's age, other mental illnesses he
or she may have, and a number of other factors. For instance, stimulus fading is
typically used with younger children, because older children and teenagers
recognize the situation as an attempt to make them speak, and older sufferers
and people with depression are more likely to need medication.
Self-modeling
The child is brought into the classroom or the environment where s/he will
not speak and is videotaped answering a series of questions. First, his/her
teacher, or adult representative of those to which the child will not speak asks
the child questions. The child likely does not answer the questions at this
time. A parent or someone to whom the child will converse verbally then comes in
the room and the teacher goes out. The comfortable adult asks the child the same
questions, this time eliciting a verbal response. This video is then edited so
that the it looks like the child is answering the questions posed by the
teacher. This video is then shown the child over a series of several weeks. The
child is asked to view the tape and every time s/he sees him/herself answering
the teacher verbally, stop the tape to receive a positive reinforcement.
The video can also be shown to the child’s classroom in order to set an
expectation in the classroom by his/her peers that s/he speaks. The classmates
now know the sound of the child’s voice and believe they have seen the child
conversing with the teacher.
Mystery motivators
Mystery motivation is often seen paired with the self-modeling technique. An
envelope is placed in the child’s classroom in a visible place. On the envelope,
the child’s name is written along with a question mark. Inside is a prize
determined with the child’s parent in order for it to be something the child
would want to have. The child is told that when s/he asks for the envelope
appropriately and loudly enough for the teacher and his/her peers to hear, s/he
may then receive the mystery motivator. The classroom is also told in this case
about the expectation that the child ask for the envelope loudly enough that the
class can hear.
Stimulus fading
The subject is brought into a controlled environment with someone with whom
they are at ease and can communicate. Gradually, another person is introduced
into the situation. One example of stimulus fading is the sliding-in
technique, where a new person is slowly brought into the talking group. This can
take a long time for the first one or two faded-in people but may become faster
as the patient gets more comfortable with the technique.
An example of this would be a child playing a board game with a family member
in his/her classroom at school. Gradually, the teacher is brought in to play as
well. When the child adjusts to his/her presence, then a peer is brought in to
be a part of the game. Each person is only brought in if the child continues to
engage verbally and positively.
Desensitization
The subject communicates indirectly with a person he or she is afraid to
speak to through such means as email, instant messaging (text, audio, and/or
video), online chat, voice or video recordings, and speaking or whispering to an
intermediary in the presence of the target person. This can make the subject
more comfortable with the idea of communicating with this person.
Shaping
The subject is slowly encouraged to speak. He or she is reinforced first for
interacting nonverbally, then for saying certain sounds (such as the sound that
each letter of the alphabet makes) rather than words, then for whispering, and
finally saying a word or more.
Spacing
Spacing is important to integrate, especially with self-modeling. Repeated
and spaced out use of interventions is shown to be the most helpful long-term
for learning. Viewing videotapes of self-modeling should be shown over a spaced
out period of time of approximately 6 weeks.
Drug treatments
Many practitioners believe that there is evidence indicating that
antidepressants such as SSRIs may be helpful in treating children and adults
with selective mutism and even that medicine is essential to effective
treatment.[citation needed]The medication is used to decrease anxiety
levels to speed the process of therapy. Use of medication may end after nine to
twelve months, once the person has learned skills to cope with anxiety and has
become more comfortable in social situations. Medication is more often used for
older children, teenagers, and adults whose anxiety has led to depression and
other problems.
Medication, when used, should never be considered the entire treatment for a
person with selective mutism. While on medication, the person should be in
therapy to help him or her to know how to handle anxiety and prepare him or her
for life without medication.
Anti-depressants have been used in addition to self-modeling and mystery
motivation in order to aid in the learning process.
In popular culture
Children's books with a selectively mute protagonist include The Secret
Voice of Gina Zhang by Dori Jones Yang and Alvin Ho: Allergic to Girls,
School, and Other Scary Things by Lenore Look. Both of these books are set
in elementary school and specifically mention selective mutism. In addition,
several children's picture books have been written with the specific purpose of
educating readers about selective mutism, such as Understanding Katie
by selective mutism expert Elisa Shipon-Blum.
In young adult literature and films, there are several instances of
protagonists who do not speak despite having the ability to do so. They usually
are mute in all situations, and trauma is a common cause for the mutism, though
some make the choice to stop speaking. In one well-known book, Cut by
Patricia McCormick, features a main character who is entirely silent after
facing problems at home and being sent to a mental hospital. These two books
have most likely done a great deal to spread the conception of selective mutism
as a response to trauma. There are various lesser-known books in both young
adult and adult fiction, as well as films that follow the same idea, such as in
the 2004 made-for-TV movie Samantha: An American Girl Holiday, wherein
one of the three orphans that the protagonist befriended with never said a word
for the majority of the story, likely out of emotional trauma due to the death
of their parents. In the children's film Jumanji, after the death of
their parents the character Peter speaks only to his sister, and only when they
are alone.
Possibly the most well-known instance of selective (as opposed to total)
mutism in popular culture is the character of Rajesh Koothrappali in the
television sitcom The Big Bang Theory. Due to social anxiety, he is
unable to talk to women who are not family members. Drinking alcohol suppresses
his anxiety, allowing him to speak; however, this is a placebo effect, as seen
in "The Terminator Decoupling", in which he speaks to the actress Summer Glau
while drinking beer that was, unbeknownst to him, non-alcoholic.[31] In other
episodes, Raj has also treated his condition with medications, suffering of
realistic, if somewhat parodically enhanced, aftereffects (nervous tics, mood
swings, decreased cognitive abilities...), forcing him to suspend his therapy.
The joke was later added upon in "The Wiggly Finger Catalyst", in which Raj
dates a deaf woman, whereupon, though initially needing his friend Howard for an
interpreter, he realized that he could talk normally around her, knowing that
she could neither hear him nor read his lips.
The film Little Voice centers upon a selectively mute singer.
To view entire content of original Wikipedia article click the link
below:
http://en.wikipedia.org/wiki/Selective_mutism
disorder in which a person who is normally capable of speech is unable to speak
in given situations, or to specific people. Selective mutism usually co-exists
with shyness or social anxiety.
Children and adults with selective mutism are fully capable of speech and
understanding language but fail to speak in certain situations, though speech is
expected of them. The behaviour may be perceived as shyness or rudeness by
others. A child with selective mutism may be completely silent at school for
years but speak quite freely or even excessively at home. There is a
hierarchical variation among those suffering from this disorder: some people
participate fully in activities and appear social but don't speak, others will
speak only to peers but not to adults, others will speak to adults when asked
questions requiring short answers but never to peers, and still others speak to
no one and participate in few, if any, activities presented to them. In a severe
form known as "progressive mutism", the disorder progresses until the sufferer
no longer speaks to anyone in any situation, even close family members.
Selective mutism is by definition characterized by the following:
- Consistent failure to speak in specific social situations (in which there is
an expectation for speaking, e.g., at school) despite speaking in other
situations. - The disturbance interferes with educational or occupational achievement or
with social communication. - The duration of the disturbance is at least 1 month (not limited to the
first month of school). - The failure to speak is not due to a lack of knowledge of, or comfort with,
the spoken language required in the social situation. - The disturbance is not better accounted for by a communication disorder
(e.g., stuttering) and does not occur exclusively during the course of a
pervasive developmental disorder, schizophrenia, or other psychotic
disorder.
Particularly in young children, SM can sometimes be confused with an autism
spectrum disorder, especially if the child acts particularly withdrawn around
his or her diagnostician, which can lead to incorrect treatment. Although
autistic people may also be selectively mute, they display other behaviors—hand
flapping, repetitive behaviors, social isolation even among family members (not
always answering to name, for example)—that set them apart from a child with
selective mutism. People with higher-functioning autism may be selectively mute
due to anxiety in social situations that they do not fully understand. If mutism
is entirely due to autism spectrum disorder, it cannot be diagnosed as selective
mutism as stated in the last item on the list above.
Selective mutism may co-exist with or cause the child to appear to have
Attention Deficit Disorder. Many people with the inattentive form of ADHD show
little or no interest in other people primarily. People with inattentive ADHD
may appear to be "space cadets" or "out in their own world", and may be slower
to respond to social stimuli. Children with selective mutism, especially when
they have severe social anxiety, may also look like this. Also, they might be
distracted by their anxiety or by sensory input, if they are highly sensitive,
or from the task at hand.
Most people with selective mutism have social phobiæ, and many have other
anxiety disorders such as obsessive compulsive disorder or panic disorder.
The former name elective mutism indicates a widespread misconception
among psychologists that selective mute people choose to be silent in certain
situations, while the truth is that they often wish to speak but cannot. To
reflect the involuntary nature of this disorder, the name was changed to
selective mutism in 1994.
The incidence of selective mutism is not certain. Due to the poor
understanding of this condition by the general public, many cases are likely
undiagnosed. Based on the number of reported cases, the figure is commonly
estimated to be 1 in 1000. However, a 2002 study in The Journal of the
American Academy of Child and Adolescent Psychiatry estimated the incidence
to be 7 in 1000, 0.7%.
Other Symptoms:
Besides lack of speech, other common behaviors and characteristics displayed
by selectively mute people include:
- Difficulty maintaining eye contact
- Blank expression and reluctance to smile
- Stiff and awkward movements
- Difficulty expressing feelings, even to family members
- Excessive shyness, fear of social embarrassment, and/or social isolation and
withdrawal - Tendency to worry more than most people of the same age
- Desire for routine and dislike of changes
- Sensitivity to noise and crowds
- Moodiness
- Sleep problems
On the positive side, many sufferers have:
- Above-average intelligence, perception, or inquisitiveness
- Creativity and a love for art or music
- Empathy and sensitivity to others' thoughts and feelings
- A strong sense of right and wrong
Causes
Most children with selective mutism are believed to have an inherited
predisposition to anxiety. They often have inhibited temperaments, which is
hypothesized to be the result of over-excitability of the area of the brain
called the amygdala. This area receives indications of possible threats and sets
off the fight-or-flight response.
Some children with selective mutism may have sensory integration dysfunction
(trouble processing some sensory information). This would cause anxiety and a
sense of being overwhelmed in unfamiliar situations, which may cause the child
to "shut down" and not be able to speak (something that some autistic people
also experience). Many children with SM have some auditory processing
difficulties.
About 20–30% of children with SM have speech or language disorders that add
stress to situations in which the child is expected to speak.
Despite the change of name from "elective" to "selective", a common
misconception remains that a selectively mute child is defiant or stubborn. In
fact, children with SM have a lower rate of oppositional behavior than their
peers in a school setting. Another common belief is that selectively mute
children have experienced abuse or trauma. A study of six adults who were
selectively mute as children suggests that those with selective mutism are more
likely to have suffered abuse, which may contribute to the onset of their
mutism. The interviewees also said that there was a conscious determination not
to speak and that they were afraid of speaking, indicating that both choice and
fear may be involved in selective mutism. Only two of the interviewees
specifically reported childhood social anxiety, and those were twins. Other
anxiety and emotional problems seemed to have appeared after the onset of the
disorder. This study shows that selective mutism may be more complex than
currently believed, with both past and current understandings of the disorder
both being partly true.
In their book Adoption Detective: Memoir of an Adopted Child, Judith
and Martin Land mention how selective mutism, extreme shyness, and other social
anxiety disorders can be evidence of trauma frequently associated with adoption,
especially in children under three years old. Selective mutism might be highly
functional for a child by reducing anxiety and protecting the child from
perceived challenges of social interaction, particularly in situations with high
performance expectations, such as school. Adoptees with this anxiety might be
highly talkative at home with family and friends, but avoid speaking altogether
in classrooms, large groups, and social functions. Adoptees with selective
mutism likely have difficulty verbalizing personal thoughts when they are
excessively revealing and painful or of a subconscious nature.
History
In 1877, a German physician named a disorder aphasia voluntaria to
describe children who were able to speak normally but often refused to.
In 1980, a study by Torey Hayden identified four "subtypes" of Selective
Mutism. First, and most common, she described "symbiotic mutism" characterized
by a vocal and dominating mother and absent father and the use of mutism as
controlling behavior around other adults. Second, the least common, was "speech
phobic mutism" in which the child showed distinct fear at hearing a recording of
his or her voice. This also involved ritualistic behaviors and was thought to be
caused by having been told to keep a family secret. Third was "reactive mutism"
thought to be caused by trauma or abuse, though not all children put in this
category were known to have been abused. These children all showed symptoms of
depression and were notably withdrawn, usually showing no facial expressions.
Finally, Hayden described "passive-aggressive mutism" in which silence is used
as a display of hostility, connected to antisocial behavior. Some of the
children in this group had not been mute until age 9–12. These subtypes are no
longer recognized, though "speech phobia" is sometimes used to describe a
selectively mute person who appears not to have any symptoms of social
anxiety.
The Diagnostic and Statistical Manual of Mental Disorders (DSM), first
published in 1952, first included Elective Mutism in its third edition,
published in 1980. Elective Mutism was described as "a continuous refusal to
speak in almost all social situations" despite normal ability to speak. While
"excessive shyness" and other anxiety-related traits were listed as associated
features, predisposing factors included "maternal overprotection", mental
retardation, and trauma. Elective Mutism in the third edition revised (DSM
III-R) is described similarly to the third edition except for specifying that
the disorder is not related to Social Phobia.
In 1994, Sue Newman, co-founder of the Selective Mutism Foundation, requested
that the fourth edition of the DSM reflect the name change to selective mutism
and described the disorder as a failure to speak. The relation to
anxiety disorders was emphasized, particularly in the revised version (DSM
IV-TR).
There are no changes to the definition of selective mutism planned for the
DSM V.
Treatment
Contrary to popular belief, people suffering from selective mutism do not
necessarily improve with age. Effective treatment is necessary for a child to
develop properly. Without treatment, selective mutism can contribute to chronic
depression, further anxiety, and other social and emotional problems.
Consequently, treatment at an early age is important. If not addressed,
selective mutism tends to be self-reinforcing. Those around such a person may
eventually expect him or her not to speak and therefore stop attempting to
initiate verbal contact with the sufferer. Alternately, they may pressure the
child to talk, making him or her have even higher anxiety levels in situations
where speech is expected. Because of these problems, a change of environment
(such as changing schools) may make a difference, and treatment in teenage or
adult years can be more difficult because the sufferer has become accustomed to
being mute.
The exact treatment depends on the sufferer's age, other mental illnesses he
or she may have, and a number of other factors. For instance, stimulus fading is
typically used with younger children, because older children and teenagers
recognize the situation as an attempt to make them speak, and older sufferers
and people with depression are more likely to need medication.
Self-modeling
The child is brought into the classroom or the environment where s/he will
not speak and is videotaped answering a series of questions. First, his/her
teacher, or adult representative of those to which the child will not speak asks
the child questions. The child likely does not answer the questions at this
time. A parent or someone to whom the child will converse verbally then comes in
the room and the teacher goes out. The comfortable adult asks the child the same
questions, this time eliciting a verbal response. This video is then edited so
that the it looks like the child is answering the questions posed by the
teacher. This video is then shown the child over a series of several weeks. The
child is asked to view the tape and every time s/he sees him/herself answering
the teacher verbally, stop the tape to receive a positive reinforcement.
The video can also be shown to the child’s classroom in order to set an
expectation in the classroom by his/her peers that s/he speaks. The classmates
now know the sound of the child’s voice and believe they have seen the child
conversing with the teacher.
Mystery motivators
Mystery motivation is often seen paired with the self-modeling technique. An
envelope is placed in the child’s classroom in a visible place. On the envelope,
the child’s name is written along with a question mark. Inside is a prize
determined with the child’s parent in order for it to be something the child
would want to have. The child is told that when s/he asks for the envelope
appropriately and loudly enough for the teacher and his/her peers to hear, s/he
may then receive the mystery motivator. The classroom is also told in this case
about the expectation that the child ask for the envelope loudly enough that the
class can hear.
Stimulus fading
The subject is brought into a controlled environment with someone with whom
they are at ease and can communicate. Gradually, another person is introduced
into the situation. One example of stimulus fading is the sliding-in
technique, where a new person is slowly brought into the talking group. This can
take a long time for the first one or two faded-in people but may become faster
as the patient gets more comfortable with the technique.
An example of this would be a child playing a board game with a family member
in his/her classroom at school. Gradually, the teacher is brought in to play as
well. When the child adjusts to his/her presence, then a peer is brought in to
be a part of the game. Each person is only brought in if the child continues to
engage verbally and positively.
Desensitization
The subject communicates indirectly with a person he or she is afraid to
speak to through such means as email, instant messaging (text, audio, and/or
video), online chat, voice or video recordings, and speaking or whispering to an
intermediary in the presence of the target person. This can make the subject
more comfortable with the idea of communicating with this person.
Shaping
The subject is slowly encouraged to speak. He or she is reinforced first for
interacting nonverbally, then for saying certain sounds (such as the sound that
each letter of the alphabet makes) rather than words, then for whispering, and
finally saying a word or more.
Spacing
Spacing is important to integrate, especially with self-modeling. Repeated
and spaced out use of interventions is shown to be the most helpful long-term
for learning. Viewing videotapes of self-modeling should be shown over a spaced
out period of time of approximately 6 weeks.
Drug treatments
Many practitioners believe that there is evidence indicating that
antidepressants such as SSRIs may be helpful in treating children and adults
with selective mutism and even that medicine is essential to effective
treatment.[citation needed]The medication is used to decrease anxiety
levels to speed the process of therapy. Use of medication may end after nine to
twelve months, once the person has learned skills to cope with anxiety and has
become more comfortable in social situations. Medication is more often used for
older children, teenagers, and adults whose anxiety has led to depression and
other problems.
Medication, when used, should never be considered the entire treatment for a
person with selective mutism. While on medication, the person should be in
therapy to help him or her to know how to handle anxiety and prepare him or her
for life without medication.
Anti-depressants have been used in addition to self-modeling and mystery
motivation in order to aid in the learning process.
In popular culture
Children's books with a selectively mute protagonist include The Secret
Voice of Gina Zhang by Dori Jones Yang and Alvin Ho: Allergic to Girls,
School, and Other Scary Things by Lenore Look. Both of these books are set
in elementary school and specifically mention selective mutism. In addition,
several children's picture books have been written with the specific purpose of
educating readers about selective mutism, such as Understanding Katie
by selective mutism expert Elisa Shipon-Blum.
In young adult literature and films, there are several instances of
protagonists who do not speak despite having the ability to do so. They usually
are mute in all situations, and trauma is a common cause for the mutism, though
some make the choice to stop speaking. In one well-known book, Cut by
Patricia McCormick, features a main character who is entirely silent after
facing problems at home and being sent to a mental hospital. These two books
have most likely done a great deal to spread the conception of selective mutism
as a response to trauma. There are various lesser-known books in both young
adult and adult fiction, as well as films that follow the same idea, such as in
the 2004 made-for-TV movie Samantha: An American Girl Holiday, wherein
one of the three orphans that the protagonist befriended with never said a word
for the majority of the story, likely out of emotional trauma due to the death
of their parents. In the children's film Jumanji, after the death of
their parents the character Peter speaks only to his sister, and only when they
are alone.
Possibly the most well-known instance of selective (as opposed to total)
mutism in popular culture is the character of Rajesh Koothrappali in the
television sitcom The Big Bang Theory. Due to social anxiety, he is
unable to talk to women who are not family members. Drinking alcohol suppresses
his anxiety, allowing him to speak; however, this is a placebo effect, as seen
in "The Terminator Decoupling", in which he speaks to the actress Summer Glau
while drinking beer that was, unbeknownst to him, non-alcoholic.[31] In other
episodes, Raj has also treated his condition with medications, suffering of
realistic, if somewhat parodically enhanced, aftereffects (nervous tics, mood
swings, decreased cognitive abilities...), forcing him to suspend his therapy.
The joke was later added upon in "The Wiggly Finger Catalyst", in which Raj
dates a deaf woman, whereupon, though initially needing his friend Howard for an
interpreter, he realized that he could talk normally around her, knowing that
she could neither hear him nor read his lips.
The film Little Voice centers upon a selectively mute singer.
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