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- Hey everybody.
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Today I'm gonna talk with
you about selective mutism.
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How do we diagnose it?
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And what treatment options are out there?
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(soft music)
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Now I put a video out about
this quite awhile ago,
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and I actually got a lot
of negative comments,
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and hate about some missteps
that I took in the video
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and things that I said
that were incorrect.
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And I want to apologize whole-heartedly.
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I would never create a video
or content that I thought would
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be harmful, hurtful, or in any
way upsetting to any of you.
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My goal is actually to put
out positive helpful content
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and so I'm here to kind of make amends
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and create another video that is correct.
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And I've done a lot more research
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and hopefully this is much more helpful.
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And I have since turned
that video private,
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so if you go searching
for it you won't find it.
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Because I'm hoping that this'll replace it
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and I'm hoping that you'll forgive me.
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And that's the great
thing about our community
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is that I do my best to research.
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You always are asking and challenging me
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to find new information
about other disorders
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and issues that you're struggling with
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and together we will make
things better, right?
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So thank you for keeping me in line
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and thank you for letting me know
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and hopefully this sounds
and feels much better to you.
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So to start off, selective
mutism is a diagnosis.
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And as always, if I can
get it off the table,
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I'm reading from my handy dandy DSM.
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Now, selective mutism
has a set of criteria.
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The first being consistent
failure to speak in specific
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social situations in which
there's an expectation
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for speaking, like at school.
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Selective mutism usually presents itself
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before the age of five
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so usually we run into it
and recognize it's happening
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when they enter school because
there's pressure to talk.
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Like "Oh, the teacher called on me" or
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"Oh I have to stand up and I
have to tell kids about this"
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or "I have to present my
project" and there are a lot of
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things that where we're pushed
and there's pressure to talk.
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And those with selective
mutism will not be able to.
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The second is the disturbance
interferes with educational
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or occupational achievement
or with social communication.
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And you can see why that would happen.
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'Cause if I can't talk in school or work,
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and I can't express or show my project,
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or talk to friends or talk
to my teacher or my boss
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or coworkers, it's gonna
effect the way that
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we're able to function in those tasks.
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The third is the duration of
the disturbance is at least
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one month, not limited
the first month of school.
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And they say that because
school can be really
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anxiety-provoking and we're
starting a new school year.
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And it can take us a little
while to get adjusted,
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to feel okay, to know
what our teacher's wanting
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and to feel like we can speak up.
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A lot of people are shy from the get-go
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and selective mutism is not shyness, okay.
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Also, selective mutism,
just so that you understand
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where it comes from, is that
it's an anxiety disorder.
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So that kind of tells you
the root of where this
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difficulty speaking, and
inability to speak is coming from.
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It usually stems from a
really intense feeling of
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social anxiety or generalized anxiety.
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So we'll get so anxious
that we're unable to speak
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in school, at work, with
friends, at home, etc.
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Now the next criteria, the
4th, is that they failure
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to speak is not attributable to a lack of
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knowledge or comfort
with the spoken language
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required in a social situation.
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In one of the articles I
was reading it talked about
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children coming from other countries.
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Let's say my native language is Mandarin,
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and then I'm thrown into
a school in Florida,
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and I don't speak
English that well and I'm
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really anxious about it
already and it makes me nervous
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and I'm just not comfortable.
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So I don't know the language well
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enough to actually speak it.
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It cannot be attributed to that.
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That's not what selective mutism is.
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The last criteria is that
the disturbance is not better
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explained by a communication disorder.
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It could be childhood onset
fluency disorder, or any other.
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I have some videos,
I'll actually link here,
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where I talk about my
friend Katherine who's
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a speech pathologist and
there are a lot of different
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things that can go along
with reasons children don't
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speak, but that again
is not selective mutism.
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Selective mutism comes from
an intense internal anxiety
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which leads us to feeling
like we actually cannot speak.
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We'll want to, we'll have so much to say
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and we literally physically cannot.
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That like I said, the
onset selective mutism
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is usually before the age of five,
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or around the age of five.
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And a lot of the research
that they've done
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shows that the majority of
people do grow out of it
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but from what I've heard from you,
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and from what I've been
reading on other really
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not actually supportive research studies
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that doesn't mean they're not valid,
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that some people don't, and many don't.
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And some people have onset later in life.
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So like I said, the DSM is
not the end all, be all.
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Everyone's experience
is gonna be different,
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however the majority,
just meaning 50% or more,
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find that it usually
starts at a very young age
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at the age of five or a little younger.
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So now we know what selective mutism is.
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It's an inability to speak due
to intense internal anxiety.
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So we have it, or our child has it.
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What are our treatment options?
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And know that they're are a lot out there.
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I'm gonna offer up four to you today,
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however you can do your own research,
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talk to your own speech pathologist.
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Maybe someone at the
school, maybe the therapist
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that your child or yourself is seeing.
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And ask for other options or referrals
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because they're always
more options out there.
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But these are the four
that they talk about
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the most frequently when we
talk about treating this.
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Now the first is actually
something that I don't know myself
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I've never done it in
my own private practice,
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but they talk it about it
like it's the golden rule
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for treatment of this and it's the best.
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It shows the best outcomes.
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It's called SCAT, or Social
Communication Anxiety Treatment.
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And that would make sense,
it sounds very specific.
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It sounds perfect for selective mutism.
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So if you can find someone
who specializes in this
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I would encourage you to give em a call.
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And what it really
focuses on is addressing
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the answers to these three questions.
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The first is why did they
develop selective mutism?
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In many cases they find that
children, if it starts in,
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if the onset is in childhood, that there's
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usually a triggering event.
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Not always, but usually.
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And that could be parents got divorced,
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maybe they witnessed something traumatic.
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It could be a number
of things, but there is
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a triggering event and then they just
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completely lose the ability to speak.
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And so finding out what caused it,
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can usually help us figure
out how to help them.
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The second questions is why does it
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persist despite past treatment?
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If we've tried things,
why is it still lingering?
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If we've had them at a speech pathologist
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or we've had them in therapy,
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how come it's still hanging around?
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And that can obviously show us what
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work still needs to be
done, and that would be,
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I could apply that to my
patients with eating disorders
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who've already been in treatment.
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How come it's still around,
what's still going on?
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Did we not really fix
that root of the root
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and the reason that it exists?
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The answer's probably yes.
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And the third question
that they work to answer is
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what can be done at home, school,
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or in the real world to help them?
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And that could be anything from do they
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have a really close
friend that can help them?
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That they feel okay
communicating with them
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to get their needs met in school?
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Maybe they have a teacher
that they really like
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and they feel comfortable
with and they actually
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talk a little bit in that class because
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their anxiety is lowered.
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Maybe they can get that
teacher all day long.
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Or we can increase the number of classes
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that they have with that teacher.
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There may be a lot that we can
do, especially through IEP's.
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I do this for clients all the time.
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I'm going to schools, and working on
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different education plans
with the child to make sure
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that we're getting them
the help that they need.
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The second treatment option
is psychodynamic therapy.
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And when it comes to children
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that really means play therapy.
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And this can be really healing
and helpful for children
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who struggle with selective mutism
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because they can speak through play
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without actually having
to use their voice.
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And this can often lead them
to feeling more comfortable
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and more understood, and
maybe speaking a little
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bit with a therapist over time.
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But at the very least it gives them a way
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to communicate what they're
feeling and thinking
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without having to say it.
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The third treatment option, and the one I
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think should be attached to everyone of
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these options, is family therapy.
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Because this happens
most often in children,
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if we go right back into
our family household
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and whatever chaotic or
triggering event that
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happened is still happening there,
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it's gonna be really hard for us to keep
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fighting against it, using our tools.
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It's really difficult for
children to, essentially speak up.
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Not just verbally, but even physically.
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Letting people know that they're upset.
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And if they've already
struggled with that,
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we wanna make sure that
we're working as a family
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to create a healthy
happy environment where
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they can work on lowering
their anxiety, dealing with
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whatever caused it, and
being able to finally feel
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comfortable and at ease enough to speak.
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And the fourth and final treatment option
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is behavioral therapy.
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And the way that this kind of works,
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and I'm on the fence about this.
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I do this a lot in my
practice, but like I said
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I don't specialize in selective mutism.
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But the way that behavioral
therapy work is that we,
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in a way, reward like positive behaviors.
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So if they are speaking, or
they do express themselves
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in some way we reward that behavior.
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It could be in golden stars on a board,
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it could be in treats or benefits at home
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like oh, I get to go out
and walk the dog by myself
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or I get to spend extra
time on the computer
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or whatever it may be, they
use those to help guide
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the child to doing more
of the positive behavior.
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And like I said, I
don't know how well this
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would work necessarily
for selective mutism.
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The others sound better personally to me.
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But we have to find what works best for us
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and in our own scenarios.
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So that's another treatment option.
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And the last thing that
I'll mention is medication.
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I know this happens most
commonly in children
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and a lot of us don't
want to put our children
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on medication and I totally
hear you out on that.
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And that's why there's
all those other options.
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And like I said there's
probably more out there,
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so do some research, find
something that works for you.
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But if we're doing all those
things and it's still not
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getting better and we worry
about how our child is feeling.
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Or we ourselves are struggling
and we're feeling worse,
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medication is an option,
and they always talk about
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SSRI's or SNRI's, helping with anxiety.
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And since we know selective
mutism is an anxiety disorder,
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there is some evidence to
show that medication does
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help alleviate that and
maybe get us to the level
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like we've talked about in other videos,
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where the anxiety is low enough
that we can start actually
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doing the work and challenging
ourselves and feeling better.
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And so that's another
thing to keep in mind.
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Again, I wanna thank you
all for letting me know
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when I've messed up and
when I've been misspoken
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and said something that wasn't correct.
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It's together, we're
working together, right,
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towards a healthy mind and a healthy body.
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And I want you to know
I always hear you out,
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I always read your comments,
and it really, really helps
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that we have a wonderful
working community behind us.
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And it always helps to share videos.
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If you are upset by the last video,
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please share this video
if you feel it's correct.
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I've done as much research as I can,
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I'm doing the best I can, it
would really help to share it
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on Facebook so that those
out there who are struggling
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can hopefully get the treatment
that they need and deserve.
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And if you wanna follow me
on any other social medias
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and I will see you next time.
