The third installment in Myth Management-- a series addressing misconceptions that surround children struggling with Selective Mutism and Social Phobia

By: Hannah Hunter, ATS Intern 2017

      My hairdresser stood behind me, clumps of my wet hair falling quietly to the floor with each pass of the scissors, as I explained to her the Advanced Therapeutic Solutions (ATS) internship. We had exhausted the usual topics of my love life and the weather, so I moved on to work.
     “I think selective mutism is when a child has the physical ability to speak, but doesn’t for some reason,” I stated hesitantly, suddenly aware of my limited information on the topic.
     My hairdresser froze and rested her hands on my plastic cape-covered shoulders. “From abuse?” She didn’t even pause to let me respond before continuing, “I’ve heard of kids that have been abused and stopped speaking. I wonder if you’ll be working with these kids that have gone through terrible things.” Her words were emphasized by her thick Greek accent.
     I didn’t know how to respond. I hadn’t actually started the internship yet, and I definitely was not expecting someone to ask me such a specific question. I scanned my limited knowledge of the condition, and I came up with nothing. Was selective mutism caused by trauma?
     I would soon find out that this question was a common one--and the answer is pretty much, unequivocally, no.
     What I learned is this: selective mutism (SM) is clinically defined as the inability to speak in situations where speech is expected, despite a normal ability to speak at home or in other comfortable situations. Selective mutism is not trauma-based, but so many people (my hairdresser included) believe that it is. Early literature that dates back to the 1950s did consider trauma as a possible cause, as stated in a 1997 article by Dummit et al. This article sought to provide diagnostic clarification of selective mutism (shortly after selective mutism replaced the name of elective mutism). Of the 50 children that Dummit et al. assessed, none had a history of trauma. Dummit et al. go on to state that other authors (e.g., Black and Uhde in 1995 and Steinhausen and Juzi in 1996) did not find trauma in the history of their patients either. Instead, the common thread found across research has been anxiety. My experiences at ATS reflect the same association between selective mutism and anxiety, not trauma. When looking at this unfortunate misconception, a quote from Dummit et al. really strikes a chord:
     “Unfortunately, all too often our families reported that school and clinical

     personnel considered the possibility of abuse in mute children before

     considering anxiety disorders, resulting in friction and exasperation from

     parents where a cooperative and understanding approach to overcoming

     impairing anxiety and avoidance was needed.”
I hear from therapists at Advanced Therapeutic Solutions that sadly, 20 years later, this still happens at times.
     Just because SM is not based in trauma does not mean that some individuals don’t go mute after traumatic events. However, if a person goes mute after a trauma, it is more than likely not SM. This type of mutism is a symptom of trauma. In her literature review of causes and treatment for selective mutism, Priscilla Wong discusses Posttraumatic Stress Theory, among other theories, in relation to SM. She points out that traumatized individuals and individuals with selective mutism may present similarly, such as withholding speech, but that this does not mean trauma causes selective mutism. In a traumatized child, “the cessation of speech with the outside world may be a child's internal coping mechanism for the traumatic event.” She goes on to state that “most often, the connection between selective mutism and PTSD is descriptive and literary rather than linked to actual trauma and highlights the common dissociative characteristics in both disorders.” The distinction between SM and trauma may be hard to discern if a child has indeed experienced a trauma, but the production of speech itself may help. With SM, children frequently are “chatterboxes” at home or in other comfortable situations. Once the child goes to school or has to interact with strangers, then the child may be mute. In trauma-based mutism, the child may suddenly cease speaking to everyone, even in the home with close family.