Wednesday, May 19, 2010

Selective Mutism - Understanding a Child's Silence

I've been seeing a young girl in my private practice for about three months now, who I am totally fascinated with. Until recently, I had no idea she remains completely silent in class except for Spanish and Music. She is in Kindergarten and is 6. At She has a 9 year old brother, who at the first session informed me that she doesn't speak and that he will speak for her. At home it's a different story. She talks, plays, and wrestles with her brother. She is also aggressvive at times, acts out inappropriately and uses profanity.

So what's going on with this six-year old girl? That's what I've been seeking to understand and figure out since beginning to see her. I first thought I was working with a child with ODD, oppositional defiant disorder, a diagnosis from the DSM IV manual. The more I work with this young girl, the more I begin to see an intelligent, witty and athletic child, who is doing the best she can to cope with her surrounding environment. She loves animals, loves sports and loves to win. After speaking to her teacher, I realized that this kindergartner is silent throughout most of the day. Some how, she keeps it all together without speaking or uttering a word. She has pretty good peer relations, but definitely has her triggers. The clinical term given to children who do not speak is called Selective Mutism. Many will report that selective mutism is about control, but it is not. It is a social anxiety disorder that causes children to clam up for fear of being laughed at and fear of social embarrassment. It is found in less than 1% of mental health settings and can develop into other issues later in life if not treated. It usually occurs before the age of 5, but does not become recognized until a child enters school.

One of my therapeutic goals is to help my client improve her self-confidence and to decrease her social anxiety. As an art therapist, I do this by incorporating play, art and games. It has taken about 3 months for this child to feel comfortable and to begin to trust me and to not act out or miss use my art supplies or toys. Though this child does exhibit signs and symptoms of ODD, it is due in part to her underlying anxiety disorder. It makes sense that a child who remains silent for a good portion of his or her day, would at some point need to some how release all their built up feelings and emotions. I continue to learn, and try to understand how this child perceives her world. Part of my job as her therapist, is to help her develop healthy and constructive coping skills to handle her world. Becasue at six, she already sees her world as being scarey and unpredictable. I have to help her learn tools to not only cope, but to handle disappointment and unpredictability.