So that's what's up with Dylan...

As most of you know, Dylan wont speak to anyone other than family members that he knows really well. He was in pre-k for a year and barely spoke a word to the teachers and had never once spoken to another child. There were rare occasions where his teachers would get a nod or whisper, but that was pretty much it and that didn't even happen very often. He would usually just point to what he wanted. It was beyond "shy". It's not just at school, it's pretty much anywhere except with close family. The strange thing is that when he comes home he is perfectly fine and the flood gates open: he's loud, talkative, playful, imaginative, bossy, silly - he sings and dances and jokes around and acts goofy just like any other 5 year old. But when he goes into public or meets someone he doesn't know he just shuts down. He wont talk and often wont make eye contact or smile or anything. We're like "what's going on???" It's like two different kids.

Anyway, I totally hate "labeling" kids, but we wanted to know what was going on so that we know how to handle it - otherwise he's going to have a very hard time in kindergarten. I mentioned it to his pediatrician and she said it sounds like "Selective Mutism". I didn't know what it was and so I looked online and realized that she hit the nail on the head! We're pretty positive that she's right. The good thing is that when we met with staff from his new school we found out that there are several kids in the school with SM (Selective Mutism) and they are very knowledgeable about it and how to help kids who have it. Basically it's a type of severe social anxiety. They say it's genetic and being that I was shy and Chan was introverted, it's no wonder that Dylan has social anxiety. :) There are other family members too who have different levels of social anxiety.

Here's some info on it. I know it's a lot of info, but I actually sifted through it and just selected the areas that got right to the point. Those of you who know Dylan, will see how much this describes him. I made a few comments which I put in red. Even if you've already read the paper that I printed out, read what I have below because I made some comments:

What Is Selective Mutism?

Selective Mutism is a childhood anxiety disorder characterized by a child's inability to speak in select social settings, such as school. These children understand language and are able to talk normally in settings where they are comfortable, secure and relaxed.

They may also be unable to communicate nonverbally, may be unable to make eye contact and may stand motionless with fear as they are confronted with specific social settings. (yep, that's Dylan!) This can be quite heart wrenching to watch, and is often very debilitating for the child as well as frustrating for parents and teachers.

What are the diagnostic criteria for Selective Mutism?

A child meets the criteria for Selective Mutism if the following are true:

1. The child does not speak in "select" places such as school or other social events. Yes

2. But, he or she can speak normally in at least one environment; usually this is in the home environment. Yes

3. The child's inability to speak interferes with his or her ability to function in educational and/or social settings. Yes

4. The mutism has persisted for at least one month. Yes

5. The mutism is not caused by a communication disorder (such as stuttering) and does not occur as part of other mental disorders (such as autism). Yes

Why does a child develop Selective Mutism?

The majority of children that have SM have a genetic predisposition to anxiety. In other words, they have inherited the tendency to be anxious from various family members and may be vulnerable to the development of an anxiety disorder. Very often, these children show signs of anxiety, such as: difficulty separating from parents, moodiness, clinging behavior, inflexibility, sleep problems, frequent tantrums and crying, and extreme shyness from infancy on (yes to all). When they reach the age when they begin to interact socially outside the family environment, their persistent fear of speaking or communicating begins to manifest in symptoms like freezing, lack of response, stiff posture, blank facial expression, lack of smiling, and mutism (yes to all again!).

What behavioral characteristics does a child with SM portray in social settings?

It is important to realize that the majority of children with SM are as normal and appropriate as any other child when in a comfortable environment. (yep!) Parents will often comment how boisterous, social, funny, inquisitive, talkative, and even bossy and assertive these children are at home! (Sounds exactly like Dylan) However, what differentiates children with SM is their severe behavioral inhibition and inability to speak in certain social settings. When in these settings, children with SM feel as though they are constantly "on stage", and experience the same symptoms as many people have with stage fright.

When in school or other anxiety provoking settings, behavioral characteristics may vary, with some children being much more withdrawn than others. Some children with SM stand motionless and expressionless, and may demonstrate awkward or stiff body language. Some may turn their heads, avoid eye contact, chew or twirl their hair, or withdraw into a corner. Over time, some children learn to cope and participate in certain social settings by performing nonverbally or by talking quietly to a select few. There are also variations in the degree of outward anxiety or nervousness; some children display facial expressions and body language that are obviously due to fear or nervousness. Others may appear outwardly calm and may be able to communicate nonverbally; it is these children that are most often misinterpreted as being defiant or oppositional, since they do not show visible signs of being nervous.

Children with SM tend to have difficulty initiating and may be slow to respond even when it comes to nonverbal communication. (This same issue was specifically noted by Dylan's teachers. They said that he would need prompted several times before he'd follow-through even with nonverbal tasks. Not because he's uncooperative, but because he would just need time to think about it.) This can be quite frustrating to the child and may lead to falsely low test scores and misinterpretation of the child's cognitive abilities. (Yep. His teachers kept saying that he wasn't learning what he was taught when indeed he really was learning it, he just wasn't able to express it to the teachers - which can be a big problem in school.)

Are there other associated behaviors or personality traits?

The following characteristics have been found to be common in children with SM:

• Heightened sensitivity to noise/crowds/touch (Dylan will freak out if a stranger touches him - even though they are being very polite)
  

• Difficulty separating from parents and difficulty sleeping alone (yes. and yes.)
  

• Introspective and sensitive - seems to understand the world around them more thoroughly than other children the same age, and displays an increased sensitivity to feelings and thoughts. (That's Dylan!)
  

• Behavioral manifestations at home, such as: moodiness, inflexibility, procrastination, crying easily, temper tantrums, need for control, bossiness, domination, extreme talkativeness, creativity and expressivity (Definitely! All of them!)
  

• Intelligent, perceptive and inquisitive (Of course)
  

• Tendency to be creative and artistic

• Anxiety over using public restrooms (He has very odd bathroom rules that we never understood.)
  

• Excessive tendency to worry and have fears (often manifested in children older than 6 years of age)
  

Doctors, teachers and other professionals will often tell a parent that the child is just shy or that he/she will outgrow this behavior. Other professionals incorrectly interpret mutism as oppositional or defiant behavior; where mutism is a means of manipulating and controlling other people. (we thought that!) Some professionals view Selective Mutism as a variant of autism or an indication of severe learning disabilities. (others thought that) For the true Selectively Mute child, these views are completely wrong and do not lead to appropriate therapy.

Waiting to see if a child will "outgrow" SM or overcome it on his/her own is not advised. Studies indicate that the earlier a child is treated for Selective Mutism, the quicker the response to treatment, and the better the overall prognosis. If a child remains mute for many years, his/her behavior can become a conditioned response where the child begins to believe that he/she will never be able to speak in certain settings or to certain individuals. The children also begin to fear more and more that people will "make a big deal over it" if they begin speaking. (YES! I think Dylan 'wanted' to speak after awhile when he was in pre-k, but he feared that it would be seen as a big deal. He actually spoke up once in school and his teacher made a big hoop-la about it in front of the whole class and I think she scared him back into not speaking.) In other words, Selective Mutism can become a difficult habit to break!

Some children may speak to the therapist right away; this definitely does not rule out a diagnosis of SM, as the "selective" nature of the disorder varies from child to child. Some children are comfortable speaking to adults but not other children; (Dylan does prefer adults to children) others only experience mutism in the school setting, and many other combinations and variations exist.

Cognitive strategies for the selectively mute child aim to reduce the social anxiety that is often part of the disorder. The child may think, for example, "If I ask the teacher for extra help, she'll get angry with me" or "If I talk it might sound funny and the kids will laugh at me".