Ejay was a precocious little boy who loved to talk and play at home. He liked discovering things on his own.

But things changed when the three-year-old child entered play school.

In the middle of the school year, Ejay’s mother noticed something different about her son. He became noticeably quiet at home. Although he still interacted. Ejay would unusually keep to himself. She also noticed that Ejay had not been touching his “baon’’ in school. The lunchbox would still be full and untouched whenever the boy came home from school.

Alarmed, Ejay’s mother talked to the school administrator and found out that her son, the erstwhile active and chatty Ejay, would not at all talk in school! He would not open his mouth not even to eat.

Ejay’s mother decided to consult a specialist from whom she discovered that her son had something which she had never heard before – selective mutism (SM). It is a form of childhood anxiedty disorder when a child manifests persistent failure to speak in select settings and exhibits severe shyness to the extent of not talking. Complications may also arise if this condition is not addressed early on because it will greatly affect the child’s potentials especially in school.

“A child with selective mutism can’t speak in certain settings — usually in school — but is otherwise able to speak or communicate well in other settings such as the home,” Ma. Araceli “Lala” Alcala, a consultant psychologist connected with in PsychConsult, Inc., explains.

Anxiety is the main culprit.

“Children who have been diagnosed with this condition are more likely to manifest certain behaviors. For instance, many of them are often described as shy or cautious,” Alcala adds.

School age children — around seven years old and below — are usually prone to this condition.

“They are likely to be noticed at this age because this is the time when there are more demands to speak, especially in formal settings such as the school,” she says.

However, some children may already manifest the condition as early as three or four years old.

“For some parents or caregivers though, they may not immediately see the limited or total lack of verbal communication as a problem, because they may attribute this to the child being just shy,” she adds.

Alcala stresses that it is not unusual to see a child who may have previously been communicative during one school year to suddenly lapse into complete silence the following school year.

“Often, a careful check of their background does not reveal any trauma, or adverse negative social experiences,” she says. This could be the reason why those who do notice the condition are quite perplexed when they see the sudden change in the child and may even spend more time thinking about why this happened.

She explains that in undertanding selective mutism, it would be simply helpful to acknowledge that it is an anxiety disorder that can occur despite the absence of any adverse events.

“This way, the focus will be on helping the child slowly and gradually experience less anxiety in situations where they are not speaking,” Alcala says.

BREAKING THE SILENCE

The most common indicator that a child has selective mutism is the child’s inability to speak in certain settings like the school for at least a month of regular exposure in that setting. This is even if he or she is otherwise able to speak well.

“Sometimes, but not always, there are also other indicators such as the child’s refusal to eat or to use the bathroom in school,” than that, my son was perfectly fine and was speaking normally.”

Nikki cannot recall exactly when the problem started and could not identify any triggering incident as the school seemed to provide a very nurturing environment. But her son just slowly spoke less and less.

“By the start of his second year in school, he spoke to only one teacher, which eventually disappeared and refused to eat any snack or lunch in school,” she shares. It was only in school where he exhibited the manifestations of selective mutism.

But Nikki maintains a good attitude towards their discovery. “He has it - we deal with it but the good thing with this kind of anxiety is that parents and teachers are given a warning sign, there are manifestations, and we are given the opportunity to do what is necessary,” she says.

GETTING STARTED

Alcala shares that more than anything, children with selective mutism need professional help. For some parents, going to a developmental pediatrician first for initial diagnosis is more comfortable and this can be a possible route to take as well.

Once final diagnosis has been made, the family will be needing to have a multi-disciplinary team on their side which may include a therapist — psychologist or psychiatrist — as they are more well-versed with the condition and may coach other members of the team such as teachers and other physicians working with them. “Sometimes medication is also recommended when consult is being done with a medical professional,” she says.

Alcala shares that play therapy — primarily that is child-led — to reduce anxiety and a cognitive-behavior approach would help the child gradually speak in settings where they are unable to speak, and family therapy. “Parents, teachers, and therapists need to work together in order to be able to help the child,” she shares.

The condition, says Alcala, is usually diagnosed in childhood but it can persist for years until the individual is well on their way to adulthood but by then is usually called by another name but still within the anxiety disorder framework.

“This is why it is very important for the parents to be armed with information when seeking consult with a mental health professional may include knowledge of how long the situation has been going on and situations where the child speaks and where they can’t speak,” she says.

CREATING THE IDEAL ENVIRONMENT

When it comes to schooling, a regular school can definitely help a child with selective mutism to cope with the condition.

“These children have at least average intelligence and many of them are actually able to fare well in most academic subjects especially if the loading on speech is not high,” she explains.

Nikki had to seek ways to reduce her son’s anxiety right there in school.

“This involved spending time with him playing, reading or doing activities which he enjoys in school,” she says. Slowly, she says, this progressed to playing games or engaging in activities that required him to communicate. “At first through gestures and now through mouthing of words and sounding out what he can,” she adds.

With the help of her son’s teachers and with the guidance of the child psychologist, the boy gained tremendous improvement.

“[Now,] he smiles more and looks relaxed, is no longer frozen, would volunteers in class activities as long as what is required is a non-verbal response, and would respond to his teachers and his classmates,” she quips.

At home, to assure her son of the family’s love and support, Nikki makes sure that everyone would talk about his or her feelings so that they can talk about her son’s feelings as well. Having a sibling that is close in age helps her son with selective mutism ease himself into the play setting.

“On most play dates even with some of his classmates, he is able to talk normally,” she shares.

Of course Nikki has to deal with certain painful instances sometimes, like when she sees her son confronted with pointed questions like “do you talk” or “why don’t you talk” from other kids.

“I know they mean no harm and this is a natural question to ask so I harbor no ill feelings,” she says.

Outside school, she’s glad that her son speaks effortlessly. “In fact, one time when we were abroad, someone actually approached us just to say that my children speak English beautifully!” she quips.

Nikki thought of home schooling as an alternative learning environment for her child but eventually, she nixed the idea and resorted to play therapy instead. She also found a progressive school that allows her to assist her son in assessments where verbal feedback from her son is required. She thinks that a child with selective mutism requires disproportionately more attention compared with other kids.

“On the contrary, my child is able to absorb and make use of information he learns in school although he may not always show it to his teachers,” she shares. She continues to work with a team — teachers and the child psychologist — and is seeing small but constant improvements which keeps her justifiably hopeful.

She tells parents to educate themselves, family members and the teaching staff about the condition.

“Constantly remind yourself that your child needs to make small steps at a time and that we need to live with SM one day at a time,” she says.

Being an active advocate for the child would also help a lot because there is a need to show people the other side of the child.

“Luckily, technology is on our side so take advantage of videos, i-chats and other means for your child to slowly approximate “normal” conversations,” she says.

Nikki believes that she has a very smart child in her hands.

“I think many parents of children with selective mutism feel this way. Hopefully, more kids will be understood and helped instead of being written off as slow, uncooperative or just plain oppositional,” she ends.

(For more information on selective mutism, visit PsychConsult, Inc. located at Rm. 227 Regalia Park Towers, 150 P. Tuazon cor. EDSA, Cubao Quezon City, call 4212469 and 3576427 or visit www.psychconsult.com.ph)