Selective Mutism

 She's given up talking
Don't say a word even in the classroom
Not a dickie bird

Ah but when she comes home
It's yap-a-yap-yap
Words are running freely like the water from a tap
Her brothers and her sisters
Can't get a word in edgeways
But when she's back at the school again
She goes into a daze

By Paul McCartney
-She's Given Up Talking-

Cursory listen to the song that contains the child's world, we would not have thought that Paul McCartney is being voiced about the inconvenience of a child.

She's Given Up Talking no ordinary song. For most parents in the world, the song representing their needs to get advocates to condition baby who suffered from Selective Mutism (SM).
 
Actually what is the Selective Mutism ?


Selective mutism was first described in the 1870s, at which time it was called "aphasia voluntaria." This name shows that the absence of speech was considered to be under the control of the child's will. In 1934 the disorder began to be called selective mutism, a name that still implied purposefulness on the part of the silent child. In the 1994 edition of the Diagnostic and Statistical Manual of Mental Disorders ( DSM-IV ) the disorder was renamed selective mutism. This name is considered preferable because it suggests that the child is mute only in certain situations, without the implication that the child remains silent on purpose.
 
Selective mutism is a psychological mental disorder affecting both mostly children but also some adults. Children and adults with the disorder are fully capable of speech and understanding language, but can fail to speak in certain social situations when it is expected of them. It is in presentation an inability to speak in certain situations. They function normally in other areas of behavior and learning, though appear withdrawn and some are unable to participate in group activities. As an example, a child may be completely silent at school for years but speak quite freely or even excessively at home. 
 
There appears to be a hierarchical variation among those suffering from this disorder in that some children participate fully in school and appear social but don't speak, others will speak only to peers but not to adults, others will speak only to adults when asked questions requiring short answers but not to peers in social situations, and still others speak to no one and participate in few, if any, activities presented to them. In its most severe form known as "progressive mutism", the disorder progresses until the child no longer speaks to anyone at all, even close family members.
 
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; this can lead to incorrect treatment. Individuals with SM can communicate normally when in a situation in which they feel comfortable, as can many individuals on the autism spectrum, especially those with Asperger syndrome.
 
Although children on the autism spectrum 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), sensory integration difficulties, poor eye contact—that set them apart from a child with selective mutism. If a child is simply not speaking in social situations, this is likely not an autism spectrum disorder, but may be SM. Children with SM are not necessarily autistic, but children with autism frequently are nonverbal. Evaluation of children with these symptoms by a developmental pediatrician is critical for early intervention. Evaluations should be accompanied by a video of the child in the home environment where he/she is the most comfortable in order to assist in making a differential diagnosis.

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.
Causes


Some children with selective mutism may have sensory integration dysfunction (trouble processing some sensory information). This would cause anxiety, which may cause the child to "shut down" and not be able to speak. Many children with SM may 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.



There is no evidence that children with SM are more likely to have suffered abuse, neglect, or trauma[citation needed], though these cannot be ruled out. Children with SM nearly always speak in some situations (though their mutism may progress to the point where they cannot speak anywhere) while children with trauma-induced mutism usually suddenly become silent in all situations.

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.



False Detection
 
In Indonesia SM does not "popular" when compared with autism, because the symptoms of SM are similar to other anxiety disorders such as acute shy, withdrawn, or anxious to separate from parents who more commonly experienced by children.

No wonder if eventually many people with BC toddlers are not properly detected.
 
Some researchers and child development experts who are members of APA agrees that SM is more or less the nature of the trigger that brought a child from birth. Children are anxious tend to experience SM. 

Barriers identified this behavior is physically associated with excessive reaction on the part of the brain called the amygdala. Physiologically amygdala works to receive and process signals of danger, which then helps one determine the reaction of self-protection.
 
In anxious children, the amygdala is very sensitive and turn on the alarm "danger" when the child feel uncomfortable in a social environment that is relatively crowded or unfamiliar. Though actually there is no real danger in this condition.
 
Should Parents ..... 
  1. Adding No Child Anxiety by forcing speech or just punish him for not speaking. Children desperately need understanding and protection of parents to make them more comfortable in dealing with anxiety.
  2. Working closely with teachers and caregivers of children. Give them information or guidance on how to appropriately handle the little guy. One source of information that should be visited is www.selectivemutism.org
  3. Find professional help. Encourage your child to child development psychologist, because these experts know the proper way to develop a sense of comfort to the child, and how to control his anxiety.
  4. Prepare the child to experience various changes in advance when you will take him to new situations or places. Give children adequate information about the place, or activity to be undertaken.
  5. Face the condition is more relaxed. You do not have to blame yourself if your children is suffering from SM. Anxiety and tension that you expressed, can be felt by the child. So, it can be increasing his anxiety and make him feel uncomfortable.
Early Intervention
 
According to Charles E. Cunningham, Ph.D., an expert who works for the advocacy agency SM sufferers in the UK said that while SM would be "abated" if the child is comfortable with the surroundings, it is recommended that this condition is still receive early intervention.

Children who experience SM at the beginning of new academic year will usually start talking at the end of the school year. This happens because he has been accustomed to the environment and friends at his school ", said Dr. Cunningham.
 
The explanation once told that SM is not a permanent condition. But it also reminded him, that this condition can be repeated if the child enters another new environment, so it is recommended that early behavioral intervention, with expert handling.
 
"If left unchecked, a child with SM will become adults who are introverted and insecure," said Dr. Cunningham.

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