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Frequently Asked Questions

Is SM heritable?

Anxiety and other mental health conditions, just like medical conditions, tend to be highly genetic and run through families. Consistent with this finding, studies show that 75% of children with SM have at least one close relative that suffers from some form of anxiety. Parents of children participating in MMKC -OKC often report that upon reflection they realize they met criteria for SM as a child and now recognize the impact early diagnosis and treatment would have made in the trajectory of their lives. Many of these parents continue to experience ongoing difficulties associated with mental health issues that have persisted into adulthood. Research indicates that generally at least one parent of a child with SM reports having problems coping with anxiety as a child. Thus, children with SM have an inherited disposition to anxiety and often have inhibited temperaments which researchers believe are caused by an “over-excitability” of the amygdala of the brain. The amygdala is the area in the brain that receives indications of possible threats and triggers the “flight-or-fight” response. Children with SM are reported to manifest high levels of social anxiety without a corresponding psychopathology condition – for this reason, SM is considered a type of social phobia

Is SM just shyness? Will my child grow out of it?

SM is a type of social anxiety that is much more extreme than ordinary shyness; it's a paralyzing inability to speak which interferes with a child's life and development. While some children do eventually overcome SM without treatment, they may endure years of suffering and miss out on age appropriate activities and development. Not all children manifest their anxiety in the same way. Some may be completely mute and unable to speak or communicate to anyone in a social setting, others may be able to speak to a select few or perhaps whisper. Some children may stand motionless with fear as they are confronted with specific social settings. They may freeze, be expressionless, unemotional and may be socially isolated. Less severely affected children may look relaxed and carefree, and are able to socialize with one or a few children but are unable to speak and effectively communicate to teachers or most/all peers.

If adults make their demands clearer will a child with SM speak?

Pressure to speak is precisely what children with SM find most paralyzing. What they need are interventions to reduce anxiety and encourage efforts to speak with positive reinforcement. Being careful to give a child extra time (5 whole seconds) to respond to a question can also increase the chance that they will be able to use their voice.

Are children with SM just being oppositional or manipulative?

The idea that children "choose" selective mutism was such a popular idea that for a while SM was known as "elective mutism," and it was attributed to poor parenting. The truth is that SM stems from social anxiety and inhibition, not anger or a desire to control; the children experience it as an inability to speak.

For more information regarding managing challenging behaviors contact OUHSC’s Child Study Center.

Is SM a form of Autism?

Children with SM, when they are feeling anxious, often react with lack of eye contact, a blank expression, and other behaviors that may look like an autism spectrum disorder. However, SM is fundamentally different from autism; while children with autism lack social and communication skills, children with SM are severely inhibited in speaking in certain situations.

For services and consultation for children from birth to 7 years with or suspected of having developmental delays contact OUHSC’s Jump Start Developmental Clinic.

Do children with SM have speech problems?

While some children with SM do have a speech delay, the two conditions are unrelated and many selectively mute children have no speech or language learning problems. When children cannot speak to unfamiliar adults, their verbal skills may be underestimated. Speech therapy however is a great opportunity for these children to practice controlled exposures.

Have children with SM been traumatized or abused?

There is no evidence linking selective mutism to trauma; children who are selectively mute are comfortable speaking at home but overcome by anxiety in social situations.

For more information regarding trauma concerns contact OUHSC’s Child Trauma Services.

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