Let’s Talk Anxiety: Selective Mutism – by David H. Rosmarin, Ph.D., ABPP, & Sara Berlin, LMSW

Question: My nine-year-old son has just started fourth grade. While he’s always been shy and has had difficulty interacting with friends and teachers in school since he was quite young, he’s been able to communicate well enough to avoid serious difficulty in school. Just this year, however, he started at a new school and stopped talking altogether when at school. While his teachers were able to help him get his schoolwork done, we are very concerned that he’s not been able to make any new friends. He also refuses to join groups at shul on Shabbos and he clams up every time we are out in public. We are already nearly two months into school and he is still not improving. When he’s home, he presents as a very different child and has no problem interacting with his siblings. At what point do I know that his shyness is…”too shy?” And how can I help him overcome his fear? I find myself concerned that his fear of talking will become debilitating.


Concerned Parent

Dear Concerned Parent,

It sounds like your child may be experiencing Selective Mutism, which is a childhood anxiety disorder. While Selective Mutism affects a small percentage of the population, anxiety disorders in children are relatively common, and can affect between 10 to 30 percent of kids. While anxiety on its own is a normal (and – yes – even adaptive!) part of life, anxiety disorders are characterized by persistent and excessive fear, which causes notable distress or impairment in everyday life. To help your child, it’s important to understand these concerns so that you can help your son develop coping skills to effectively manage his anxiety. Below are some tips to understand and help your child learn to cope:

Be Informed Know that your child is not intentionally choosing to ignore friends and teachers. Children with Selective Mutism are rarely (if ever) trying to be “troublesome” kids. Instead, almost all of these children would do anything to stop being so anxious and “difficult!”

Give Praise! Give your child praise when they try to speak to others (verbally or even non-verbally). Any baby steps your son takes towards overcoming his anxiety should be noticed and reinforced. So when you see your child struggling to speak in spite of their fear, make sure to praise them right away! In addition, it is very important to verbally describe your child’s behavior as you praise them (we call this “specific praise”). For example, if you see your child struggling to speak, you can say something like “I can see how hard it is to speak to these unfamiliar people in your class, and I’m proud of how you made sure to ask the entire question.” When you praise your child, (1) try to say it immediately after he does something that’s really hard, (2) be as behaviorally specific as possible when praising, and (3) do it often.

Don’t Ask Too Many Questions, but Validate It’s natural to ask your child questions about their fears when you start noticing them getting tense in certain social settings. Believe it or not, though, asking questions to help alleviate their anxiety can actually have the opposite effect, and direct their thoughts even deeper into their anxiety. Instead of probing, try and focus on praising positive behavior. However, it is important to validate your child’s anxiety, especially when he feels overwhelmed, by noting how difficult their experiences are, while incorporating praise. For example, you can say, “I know that speaking with your classmate was really hard for you today and I am proud that you are practicing your bravery.”

Resist the Urge to speak For Your Child  When you see your child is uncomfortable and anxious, it’s natural to want to intervene and speak on his behalf. After all, what parent wants to see their child in distress?! However, this will make it hard for your child to learn how to speak – if you communicate for him when he’s anxious he will never learn to manage his anxiety! Instead, try and encourage him to speak or, if he is really struggling, you can tell guests that your child is working on brave talking and he’ll try again in a minute or two. Just make sure you do in fact come back to it a minute or two later, though! If you don’t and you simply “save” your child from speaking, it will reinforce his silence by preventing him from ever having to learn to speak for himself.

Make Talking Fun!  Some games that you can play with your child when they are ready to talk to encourage continued speech are: Go Fish, Battleship, Surveys of “Favorites,” Hangman, Spot It, and Tell Tale. Relatedly, secure attachment and strong social support are huge protective factors for all children, especially those experiencing anxiety disorders. Be patient and positive as your child finds new ways to cope. Continue to provide a warm, safe, loving, and fun environment for your child!

Know When to Seek Help Finally, though perhaps most important, childhood anxiety disorders are easily treated and it often makes sense to consult with a mental health professional. A therapist can help assess, diagnose, and treat the anxiety disorder and help you create a plan to help your child cope. Cognitive-behavior therapy (CBT) is often used to treat childhood anxiety disorders and helps children learn new ways to think and behave in anxiety provoking situations, and can help them learn techniques to manage and tolerate their anxiety. If you are concerned about your child’s anxiety, know when to seek help from a trained professional who can help you and your child.

All our best,

Center for Anxiety

David H. Rosmarin, Ph.D., ABPP, is an Assistant Professor in the Department of Psychiatry at Harvard Medical School, part-time, and a board certified clinical psychologist. He also directs the Center for Anxiety, which has offices in Manhattan, Brooklyn, Monsey, and Boston. Sara Berlin, LMSW is a staff clinician at the Center for Anxiety’s Monsey office. She is a skilled clinician who helps individuals across the lifespan, but specializes in working with children experiencing anxiety, selective mutism, oppositional behavior and social skills difficulties.

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  1. From a parent with a child that suffered (but healed) from selective mute-
    DO NOT coax your child to talk in settings where he is avoiding to talk. This is a dangerous approach and will surely back fire and excasperate the problem.

    Your child needs help coping with his emotions. You need to get your child help ASAP!

    If you’re smart you could help your child by having them talk to YOU and getting his emotions off his chest and clarified in his mind. Some emotional situation(s) (perhaps trauma) is overloading your child causing him to shut down when he feels threatened by his own emotions.

    He is lost and swimming in what I coined “murky emotions”. You need to uncover what’s hurting him, give him tools to cope emotionally and the selevtive mute will go away by itself!

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