Supporting Children with Selective Mutism
Advice for Parents
(adapted from Maggie Johnson SMM)
Children with selective mutism are so anxious about talking that the muscles they need for speaking freeze (especially their vocal cords) and they cannot make a sound. Any anxiety, disapproval or uncertainty they pick up from adults will increase their own sense of guilt, failure and fear about the future – they’ll then tense up and find it even harder to speak.
Don’t ask: ‘Why don’t you talk?’ or ‘When will you have a go?’
This implies that you don’t like them the way they are, wish they were different and worst of all, have no idea what to do about it. They will worry that they are upsetting you and try to avoid situations that
are likely to highlight their difficulty. Repeatedly asking ‘Did you talk today?’ or ‘How did you get on?’ makes children dread going to school in case they let you down.
Tell children why they find it hard to speak at certain times rather than ask questions they cannot answer. Reassure them that everyone grows up with childhood fears and although they find talking difficult right now, they’ll find it gets easier as they get older. Their fear will go away because they will get used to talking, one tiny step at a time, and meanwhile there are lots of other ways to join in and have fun. Your child needs approval whether they speak or not, so be positive about their efforts and tell them how brave they are when they try new things. The calmer you are, the more relaxed your child will be and the quicker they’ll improve.
Do not put them on the spot by pushing them to talk to other people.
Allow them to warm up in their own time, help them to loosen up through physical play, join in activities yourself or give them a job to do which you know they will do well, and they are much more likely to relax sufficiently for their speech muscles to start moving again.
Educate family and friends about the nature of your child’s difficulties
This should be no different to telling other people that your child has a real fear of water or dogs and expecting them to make allowances. Never let your child hear you tell people that they can’t or won’t speak, as this reinforces their belief that talking is impossible and can make it very difficult for them to break the pattern – especially when you are present! Your message needs to be much more positive. Explain that when they are worried about talking they can’t get their words out, and that asking questions and putting pressure on just makes it worse. They will be able to speak once they conquer their fears and when they do, it’s important that no fuss is made – everyone needs to carry on as if they’ve always spoken!
Help others respect alternative forms of communication
These can be: nodding, pointing, smiling, waving, writing, talking through a friend or parent etc. e.g. Joe needs a little while to warm up, please don’t think he’s being rude.
Make sure no-one makes a big fuss when your child starts talking?
If you just talk back quietly he’ll find it easy to carry on. If your child is getting much braver about talking to grown-ups but to start with it would really help him if you could let him tell his friends what he wants to say.
Build confidence by focusing on your child’s achievements
In conversations with your child, your friends and yourself, focus on what your child CAN do, not on what they CAN’T. Support them in their interests and creative talents and find ways in which they can comfortably demonstrate their skills to others.
Keep busy and have a routine
Activity and physical exercise are good for mind, body and soul and help to keep
anxiety at bay. Sitting around doing nothing increases stress, as does uncertainty about the day’s events. Start each day with a plan that includes exercise – whether this is letting off steam after school for younger children, sweeping up leaves or walking the dog for older children.
Remember that avoidance strengthens fear
When we do things for our children or let them avoid activities, we are confirming the child’s belief that these things are too difficult or threatening for them.
Let children know what is happening
Warn children of changes to their routine and prepare them for new events by talking through what will happen. Rehearse or make a game of real-life scenarios such as going to the doctors, opticians, McDonalds or ordering a Chinese takeaway. Visit new schools as soon as possible to meet and educate key staff, take photos to show relatives, throw wet sponges at the summer fair etc.
Provide an escape route
Feared situations are a lot easier to tolerate when we have the control of knowing we can opt out if it all gets too much – the signal to the dentist, the rescue text, independent means of transport. Children have far less control over their escape routes than adults so it’s important to give them the same security. If children are anxious about a school trip or going to a friend’s house for example, arrange to pick them up at lunchtime so they only go for half the day or say you will phone at intervals to see if they need collecting. Gradually extend the time.
Don’t spring surprises on your child
Many parents don’t like to warn their children about a forthcoming event because then they see their child worrying for days or weeks and doing all they can to avoid it. They prefer to tell their child on the day and find they cope reasonably well because they haven’t had time to think about it.
This is a risky strategy that increases rather than reduces anxiety. On the surface it works well but it’s a very short term gain.
Remember that it can be just as scary talking to children as adults
Help your child play with other children rather than leaving them to get on with it. Join in with them, starting with activities or games where talking is optional, so you can all concentrate on having fun.
Establish safe boundaries with your child so they can take small steps forward
Laughing, singing, talking in unison and talking to parents will be a lot easier than talking to other people. But children are often afraid to do these things in case it draws attention to them and leads to an expectation to speak. Reassure your child:
- Grandma knows you can’t talk to her just yet, but it’s OK to talk to me and Daddy in front of her.
- It’s hard to talk to your teacher at the moment but it’s OK to laugh.
- It’s OK to join in the singing, no-one will make you talk afterwards.
- It’s fine to talk to us here in a very quiet voice, no-one will make a fuss.
- You don’t need to speak on your own, you can just try joining in when everyone speaks together.
Encourage a very quiet voice rather than whispering
Accept whispering on the odd occasion if you can genuinely hear and are in a hurry but do not lower your head so that your child can whisper in your ear. This easily becomes a habit and encourages avoidance. A very quiet voice is much better than a whisper as it will gradually get louder as your child gains confidence.
So, if your child wants to talk to you but is worried about being overheard, either:
- turn so that you are blocking your child’s view of whoever they are concerned about and, maintaining eye-contact, quietly say ‘Pardon?’ (do not whisper!)
- or ‘it’s OK, X isn’t listening’.
- Or move far enough away from onlookers so that your child can speak to you face to face rather than in your ear. If you are in the middle of a conversation, ask your child to wait for you to finish and then pull away to speak to your child.
There is no need to explain what you are doing but if your child asks why they can’t whisper, explain that too much whispering will give them a sore throat so it’s better to stand where they can talk normally.
Ask friends, relatives, shop-assistants etc to speak to your child through you if you know they will not be able to respond directly. e.g.
- ‘What colour would your son like to try on first?’
- ‘Max, what colour would you like to try on first?’
- (Max points to brown shoes) ‘He’d like to try on the brown ones please.’
- ‘I love Max’s blazer. Could you ask him what school he goes to?’
- ‘Max – you like your school don’t you, what’s it called?’
- ‘St. Joseph’s’
- ‘Max says it’s called St. Joseph’s.’
- If children are relaxed with you in public and know you are not pushing them to talk directly to other people, you will find that they begin to cut out the middle man!
Help your child offload their stress safely
Being watchful, anxious and unable to speak for much of the day is a great strain. It’s common and can be challenging for the whole family to get the brunt of SM children’s pent up emotions when they come home from school, but they need you to understand that it is natural to feel this way and to provide a calm, safe place rather than more emotional upheaval. Your child may need a chance to relax completely after school before attempting homework, or a physical outlet for their frustration – trampolining, swing-ball or swimming for example. Violent computer games are NOT a good idea!
Show your child it is OK to relax and have fun
If parents have unrealistic standards and try to keep their children and house
spotless with everything in its place, their children will constantly worry about spilling or breaking something, getting food on their hands or faces, touching something unhygienic or making the room untidy. They will get extremely anxious at school or other people’s houses where they perceive a different set of standards. They will not be able to tolerate lively, unstructured behaviour or engage in normal messy play like finger-painting, papier mâché or digging for worms.
This fear of getting dirty and putting something in the wrong place can spread to a fear of using toilets outside the home and inability to take risks. It will certainly impact on children’s ability to relax around other people and make friends. It is important for all the family to enjoy mealtimes, gardening, cooking and play without fear of making a mess – put away the wet-wipes til the end of the activity!
If different languages are spoken at school and home, set a good example
Your child needs to hear you having a go at speaking the school language at school and with their new classmates. Show them learning is fun and mistakes are OK! Ask the teacher if your child can spend some time with other children who speak the same language for part of the day, teaching their vocabulary to English speaking children so everyone sees what it is like to learn something new.
Make explanations, instructions and reminders visual
Anxious children quickly feel overloaded, forget things easily and tend to take things literally or at face-value. Anxiety causes ‘brain-freeze’ so we are unable to take in all we hear and cannot think laterally or rationally. Put things on paper so that children have a checklist to follow rather than trying to remember instructions. If they repeatedly ask the same question for reassurance give them a visual reminder and respond to further questions by asking them to refer to it and tell you the answer.
Answer anxiety questions with another question so that your child becomes the problem solver
Children tend to bombard parents with questions as they try to control their anxiety,
- Who’s going to be there?
- How long will it last?
- Have they gone?
- Are you going to talk to my teacher? etc. etc.
Instead of answering (which rarely alleviates the anxiety) respond with another
question so that children start to understand their anxiety, and can think about
- Who do you hope will be there?
- How long do you think you can manage?
- Why do you want them to go?
- If I talk to your teacher, what would you like me to say?
Celebrate your child’s unique qualities
We cannot change the personality of SM children – and wouldn’t want to! They are naturally sensitive individuals who take life seriously and set themselves impossibly high standards. The downside is a tendency to be overwhelmed by novelty, change and criticism; the upside is an empathetic, loyal and conscientious nature. When treated fairly and allowed to show their true colours, SM students often display far more creativity and insight than their peers.
Maggie Johnson, is the Selective Mutism Advisory Service, Kent Community Health NHS Trust