Talking is a skill most children take for granted. But not in this classroom. A dozen young children sit in a circle, dressed for the pyjama day. Some clutch their knees or a stuffed animal. A boy in Spiderman sleepwear looks worried but eager as he musters the courage to speak aloud. “Who can be the first person to tell me what day it is?” asks Alejandra Golik, a student therapist leading the session. All the children, ages six to 10, know the answer. After an achingly long pause, a 10-year-old girl mouths, “Thursday.” Her response is barely audible. Still, it is progress, and here, the faintest whisper is applauded.
It has been months, sometimes years, since these children have talked to anyone apart from family. The children have selective mutism, an anxiety disorder, and they are terrified of talking in social situations. They may be chatterboxes at home, but at school or around unfamiliar faces, they are stone-faced and silent.
Experts estimate that roughly one in 140 children are selectively mute; most elementary schools have at least one student with the condition. Selective mutism can impede academic achievement and socialisation, and lead to isolation and withdrawal from rituals like birthday parties and playground friendships.
Where & how
The problem usually begins before age five, and early intervention can help. Treatment usually involves cognitive behavioural therapy (CBT), with modifications for children who don’t talk to unknown adults — therapists included. If CBT fails, drugs like Prozac may be prescribed in low doses. But now, researchers are taking a different tack: intensive, weeklong immersion programmes, like this one run by Florida International University, in which selectively mute children are put through a variety of exercises to practise what frightens them most.
Classroom immersion may work more quickly than standard therapy, some experts say. And it exposes children to the need to speak in front of and with their peers. “With six-hour days, they have time to process, adjust and practise multiple situations with repeated exposure,” said Jami Furr, director of the selective mutism programme at Florida International’s Center for Children and Families. “The idea is to translate gains to a real school setting, where they have the most limited speech.”
A ‘wordy’ experiment
Last month’s programme run by Florida International enrolled 26 children who were split into two classrooms, one for elementary school patients and one for those younger than age six. Out-of-town families arrived days before the classroom immersion for several three-hour sessions. Each child was assigned an adult counsellor called a “brave buddy,” and the first task was to try to speak to him or her. A parent was present until the listening therapist could slowly be brought closer.
Later, during immersion sessions without the parents, counsellors helped each child to navigate days of board games, scavenger hunts and other exercises gradually requiring them to answer questions and speak up. The classes culminated with a trip to a diner for hamburgers.
“We think of it as a bravery ladder where each rung represents a step of increasing difficulty, say, speaking to a new person, speaking in a louder voice, or maybe speaking in full sentences instead of one-word replies,” said Rachel Merson, a psychologist at the Center for Anxiety and Related Disorders at Boston University, which runs a similar programme to treat selective mutism.
Dr Yulia Perch, a psychiatrist from Long Beach, California, brought her son Leo, nine, to the Florida programme. From the first through third grades, she said, he never spoke to his teacher or classmates. “When he interacted with other children, he couldn’t share himself,” she added. “He couldn’t make jokes. He couldn’t reciprocate. It was just limited intimacy.” After his first individual session, Perch took Leo to a beach, where he and another boy discovered a raccoon and ended up talking about the bandit-masked animal and eventually Minecraft. After the conversation on the beach, his mother said, “he understood the human reward.”
Children with selective mutism are often misdiagnosed; paediatricians, parents and teachers sometimes mistake mutism for shyness. But there are important distinctions. A shy child is always reserved, even at home, but may warm up to a new person after a few minutes.
A child with selective mutism may be outgoing at home and never warm to strangers. Delayed treatment can exacerbate the problem, experts say. “Every day you are not better; you are getting worse and getting better at being an avoider,” said Steven Kurtz, a psychologist in Manhattan who treats selective mutism.
Different demeanors
Melissa Shattuck, of Huntsville, Alabama, was shocked to discover that her chatty six-year-old, Lily, hadn’t spoken a word to classmates at a holiday party. The girl’s teacher had assumed Lily was withdrawn at home, too, Melissa learned. “We saw two different Lilys,” she said. Only after the party did Melissa realise that her daughter needed treatment for selective mutism.
Immersive programmes now exist in several states of the United States. Steven plans to post free online educational videos for parents, teachers and caregivers who wish to help children with selective mutism. Even after intensive help in the Florida programme, some children were not able to speak audibly. By week’s end, four of the 26 were still struggling to speak aloud. “Some take it and run with it, and for others, it’s baby steps,” Jami said.