Selective mutism in children

Dr Ancy George  

ABSTRACT
Selective Mutism is a complex childhood anxiety disorder characterized by a child’s inability to speak and communicate effectively in select social settings, such as school. Most children are diagnosed between 3 and 8 years old. The homoeopathic perspective looks at behavioural disorders from a bird’s eye view. The approach includes understanding the child in an evolutionary pattern i.e. the way in which the child has been brought up, its surroundings, its interpersonal interactions and evolving coping mechanisms.

Selective mutism is a childhood anxiety disorder, which makes the child anxious when he/ she communicates in social situations. Children with selective mutism do not involve with others or communicates, sometimes they get limited to social circumstances or it can even enter into family, that affects the parent child relation.

Selective mutism usually begins before a child is five year old, but may not come to clinical attention until the child enters school, where there is increase in social interactions and performance tasks. In some cases they may present after some underlying psychological incidence or even it can be due to learning disabilities in speaking, writing or finding a proper word makes the child uncomfortable to intearact with others. initially these traits show only in certain circumstances or towards certain people, but if not taken care properly it can lead to complete mutism. Most of these children have problems in academic functioning.

Selective mutism (SM) is relatively a rare disorder. According to DSM-5, the occurrence of this condition ranges between 0.3 % – 1% among children and it is slightly common in girls with an onset between the ages of 3 and 5 years. Most of the times parents or teachers interpret this as shyness. But it is not a form of shyness, though it may be thought as extreme timidity.

 Although there is no clear consensus to explain  the cause(s) of the disorder,social phobia abd anxiety are certainly involved. Presenting symptoms will be aversion to go into public or interaction with people, doesn’t answer when questioned, sticking on to one or few people to communicate their basic needs, sleep disorders, poor school performance, disinterest in participating cultural activities. data  regarding the long- term outcomes is scarce but there are indications that with early intervention improvements are made but often children are still left feeling uncomfortable in some speaking situations.

AETIOLOGY:
Causes of selective mutism can be multifactorial. The most difficult task in selective mutism is finding the causative stimuli to initiate this kind of response from a child. There can be positive family history of anxiety disorder. Child hailed from overprotective parents or broken family can present with selective mutism. Loss of loved ones or separation anxiety or social phobia can precipitate mutism.

The most difficult task is to identify if there was any history of child abuse which usually a child wont share to parents, due to fear or guilt feelings. Children with selective mutism may have a variety of co-existing disorders, such as obsessive compulsive disorder (OCD), Autism spectrum disorder ( ASD) or developmental delay. They try to be in their own world, it can lead to social isolation and low self esteem.

TREATMENT:
It is difficult for the physician to treat them without finding out the cause. Parents and teachers have to be educated to give proper attention to those children and not to neglect them, thinking of it just as their constitution because they are the helping hands of children.

While managing such children first check that there are no speech and language difficulties that may be contributing to the mutism. For some children, although early speech and language difficulties may have resolved the child may still feel under confident on their talking. One to one settings are most comfortable and try and include the family person, who the child communicates regularly with in your interventions to start with. After a while the child may be able to manage this setting without the familiar person. this process may have to be repeated to encourage the child to talk in another setting. encourage and accept non verbal communication such as head nods, writing, drawing and gestures as well as verbal communication.

In most of the cases family therapy, cognitive behavioural therapy improves the child’s anxiety. When it comes to homoeopathy, physician’s main aim should be to know the cause as well as the presenting symptom.

In Repertory Murphy gives mutism in children under the chapter CHILDREN with few remedies; agraph, lyco. But it is important to know the other causes also, such as child abuse and defiant nature.

• DEFIANT:  CAUST, CINA, TUB, arn, calc-p, cham, ign, lyco
• Sexual, abuse from: ACON, ARN, CARC, IGN, STAPHY, OPIUM, SEP
• DOMINATION, by others from : CARC, LYCO, anac

Early treatment can help kids with selective mutism to learn to speak up more frequently and improve their academic performance.

Dr Ancy George, PG scholar Department of Paediatrics, under the guidance of Dr Jyoshna Shivaprasad (M.D Hom, H.O.D Department of paediatrics), Father Muller Homoeopathic Medical College, Mangalore