| Selective Mutism
Definition Selective mutism is not well understood but it is believed to be primarily a behaviour manifestation of social anxiety disorder. It typically starts before age 5 but it may not be noticed until the child starts school. According to the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV), the following criteria must be met for a diagnosis of selective mutism:
1. Consistent failure to speak in specific social situations (in which there is an expectation for speaking, e.g., at school) despite speaking other situations.
2. The disturbance interferes with educational or occupational achievement or with social communication.
3. The duration of the disturbance is at least 1 month (not limited to the first month of school).
4. The failure to speak is not due to a lack of knowledge of, or comfort with, the spoken language required in the social situation.
5. The disturbance is not better accounted for by a Communication Disorder (e.g., stuttering) and does not occur exclusively during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic disorder.
Children with selective mutism have been reported to show oppositional, stubborn, and negative personality traits and to have a history of delayed speech and language development and a high incidence of enuresis (bed-wetting), encopresis (fecal incontinence), depression and separation anxiety. Anxiety in the form of shyness, timidity, and social withdrawal has been reported as a common characteristic of children with selective mutism, and a history of social anxiety symptoms or of childhood selective mutism has been reported in parents of children with selective mutism (1) . Usually selective mutism lasts for only a few months (transient selective mutism), but sometimes it can continue for years (persistent selective mutism).
There a many differing theories as to what causes selective mutism.
1. A response to a neurotic family life, with overprotective or domineering mothers or strict or remote fathers.
2. Unresolved psychological conflict.
3. A response to some trauma such as hospitalisation at a young age or any kind of abuse. Potentially any kind of traumatic that gives a sense of incredible loss is believed to be a cause, such as divorce or the death of someone very close.
As there is very little research done on this condition it is difficult to discount any of these theories.
(1) Black, B., and Uhde, T.W. (1995) Psychiatric characteristics of children with selective mutism: A pilot study. Journal of the American Academy of Child and Adolescent Psychiatry, 34(7), 847-856. Taken from: Diagnosis characteristics and Selected Treatments for Selective Mutism, by Margaret E. Slowikowski, Furman University, Behaviour Disorders.
Treatment There is no immediate cure for selective mutism. Depending on the individual treated there is a choice of behaviour modification therapy and drugs. As it is believed that selective mutism is a result of anxiety, drug therapy is the same as for anxiety (i.e., serotonin reuptake inhibitors). Sometimes a mixture of both drugs and behaviour modification therapy is employed with a selective emphasis. This joint approach seems to be showing a better treatment outcome which to date has been poor.
Paxil (brand name) - Paroxetine Hydrochloride
This is used to treat mental depression, obsessive-compulsive disorder, panic disorder, and social anxiety disorder (also known as social phobia). It is a serotonin reuptake inhibitor a class of drugs thought to work by increasing the activity of the chemical serotonin in the brain.
The safety and effectiveness of the use of paroxetine in children has not been established as studies on this medicine have been done only in adult patients, and there is no specific information comparing use of paroxetine in children with use in other age groups. When giving paxil to children your doctor must determine the dose.
Resources
Books
These are some of the references that have been passed to us; the list is not exhaustive. We have not necessarily read the books, and cannot say how easy it will be to get them.
- It's Not All In Your Head. Susan Swedo & Henrietta Leonard, Harper/Collins, 1996
- It's Nobody's Fault: New Hope and Help for Difficult Children and their Parents. Harold S. Koplewicz, M.D, Random House/Times Books, 1996
- Selective Mutism in Children. Tone Cline & Sylvia Baldwin, Singular Publishing Group, 1994
- The Child Therapy News. A monthly magazine published by the Center for Applied Psychology. The December 1996 issue was devoted to Selective Mutism.
- Social Phobia: Diagnosis, Assessment, and Treatment. R. Geunberg, M Liebowitz, D Hope & F. Schneier
- Selective Mutism. H. Leonard & S. Dow in Anxiety Disorders in Children and Adolescents. Edited by J. March.
- The Hidden Face of Shyness: Understanding and Overcoming Social Anxiety. F.
Schneier and L. Welkowitz.
- http://nothernlight.com/
opening this site and searching for "selective mutism" brought up hundreds of sites to explore. You can narrow the search by clicking on the folders on the left side of the screen.
- http://www.rxlist.com and
http://www.intelihealth.com/IH/
both gave access to information about Paxil.
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