Dr. Zelinger’s successful treatment of children with selective mutism, has prompted her to share her information at professional conferences and in a newly released book, School Based Play Therapy: second edition, 2010. Chapter 17 (pages 359-377) has been written by Dr. Zelinger and is entitled, “Understanding and Generalizing Communication Patterns in Children with Selective Mutism”, intended for individuals who treat youngsters with selective mutism in the school setting. Brief excerpts from her chapter are provided below:
Selective mutism is a disorder of contrast, characterized by use of appropriate verbal and non-verbal communication in particular situations, contrasted with a persistent reduction or absence of language in other settings. It is influenced by specific conditions that determine how a child will behave and whether or not he will be able to speak. The term “selective” is not meant to indicate that an individual makes voluntary choices about his conduct in certain situations. Rather, the environment and the people in it become the resolute factors in identifying the extent of the child’s capacity to communicate. According to Ford, Sladeczek, Carlson, and Kratochwill, (1998), “Situations that most affected how often a person with SM talked were strangers (76.7%), school (72.7%), new settings (67.3%), family gatherings (60.7%) and stress/anxiety (53.3%). This concept of labile language is difficult for others to understand, given the tendency to view selective mutism as willful or oppositional based on its changing position upon a sliding continuum. In truth, the determinants of the inability to communicate are likely found in environmental triggers that induce unmanageable levels of anxiety or tension which literally shut down the psychological apparatus necessary for communication.
Selective mutism can be one of the more intractable conditions of childhood, harboring the potential to create significant negative effects in many aspects of the child’s life. It is often responsible for causing reduced social interaction, delayed acquisition of pragmatics and speech/language skill development, restricted involvement in daily school activities and interference with the building of friendships and academic skills. It is conceivable that the inability to communicate could present serious consequences for a child who may require immediate assistance but is unable to alert someone to help. Children with selective mutism withdraw from interactive experiences, enveloping themselves in a metaphorical cocoon where their insulation keeps them safe and separate from the demands of the outside world. Understandably, it is then difficult to step outside of this protective retreat and relinquish their silence, since the silence is functionally adaptive. It successfully allows the child to escape the discomfort and anxiety caused by interpersonal contact and to avoid public opportunities for exposure. The silence is further maintained by the child’s awareness that if he started to speak, it would draw immediate and increased attention from others.
Children with selective mutism are often terrified of being the center of attention, making mistakes and being teased or ridiculed in public. They also avoid making decisions, for fear of being wrong. Rather than taking that risk, it is safer for them to be non-verbal and non-committal, allowing them to fly under the radar. When the pattern persists, teachers and classmates learn not to expect a response from the student, and the mutism becomes reinforced, eliminating opportunities for the child to say or do anything that could be criticized. A teacher might refrain from placing demands upon the child or referring him for treatment, assuming that he needs a period of adjustment. These students are only too happy when teachers refocus their attention on disruptive students, allowing them to unintentionally but successfully recede in the classroom.