Suffering in Silence

Excerpt from Suffering in Silence; Breaking Through Selective Mutism Parent visitor day at school- I woke up feeling excited for a day off of work and a day to see my twins in their respective preschool classrooms! I walked in to Katie’s classroom, waved to Katie and said, “Hi!” but she looked at me like a deer in headlights. “She’s nervous,” I thought to myself. “It’s okay,” I reassured myself. “I will calm her down,” I thought. I took her over to her favorite area of the classroom, the dramatic play area, to help her feel comfortable. Nobody else was around, and I tried again. I whispered this time: “Hi, Katie.” Instead of acknowledging me, she looked like she was scared to death- of me. Her mommy. Her protector. She looked like a child after being with an abusive captor: blank, expressionless, and dead on the inside. I wanted to shake her, let her know it was me, and let her know that she was safe. A few minutes later, the children sat down for circle time. Katie was seated in the circle next to the teacher’s left side. The teacher started the circle-time question on her other side, so Katie would go last. (This was a great intervention, so Katie could hear the other children and mimic them if her mind went blank from anxiety when her turn came around.) The question was, “What animal do you like best?” Every child answered the question. When it was Katie’s turn, she looked at the ground. I couldn’t even tell if she was breathing. “Dogs,” I thought. “You like dogs. Just say it. It’s okay. It’s safe here. You Like Dogs. Please Talk! PLEASE,” I pleaded in my head, and my anxiety spiked. The teacher gave Katie ample wait-time and then offered her a forced-choice question: “Katie, do you like cats or dogs better?” This was her chance. She was going to say it. I could feel it….She could do it…Instead, she nodded. I let out my breath that I didn’t even know I was holding. I smiled at Katie for reassurance that she did a “good job,” and then I excused myself to go to the bathroom- where I sobbed more intensely than I had ever cried before. As a clinician, I knew what I was seeing. I knew it was selective mutism and social anxiety disorder comorbidly together. The teachers had described it to me on the phone, but I didn’t comprehend the full extent until this very moment… and I had never in my life been more scared as I was in that moment. Believe me, I had seen her frozen expression, the mute behaviors in other environments, but this…this was worse than I had ever imagined. Selective mutism is an anxiety disorder, and currently, it is one of the most misunderstood, under-diagnosed, and undertreated mental health conditions. When children with selective mutism feel expected or pressured to speak in social situations, they become terrified. Therefore, their level of anxiety significantly increases, but by remaining silent, their anxiety level slightly decreases, obtaining some relief for themselves. For these children, remaining silent is actually an ineffective coping mechanism, or a maladapted solution, to create a sense of safety within themselves. Hence, their mouths freeze, and they remain silent. Due to the fact that many children will display shy behavior or even socially anxious behavior at times, it can be challenging to discern if the child’s behavior falls within normal limits or if the child actually demonstrates clinically significant behavior, signifying a selective mutism diagnosis. This can be confusing for parents, teachers, and even clinicians. Suffering in Silence; Breaking Through Selective Mutism is meant to help clarify this distinction. This manual will also assist you in figuring out how to seek help, the right questions to ask, and what you can expect from Early Intervention services, school-based services, and holistic, therapeutic, and psychiatric services. You will understand why your child suffers from this disorder and what you can do with specific parenting strategies to help him break out of his silence. This guide is also helpful for teachers and clinicians, giving examples of why these children are sometimes mistaken for “shy children,” “defiant children,” “intellectually delayed children,” or “autistic children.” Differential diagnosis between selective mutism and other diagnoses are explored: normative shyness, social anxiety disorder, separation anxiety disorder, specific phobia, autism spectrum disorders, intellectual disabilities, learning disabilities, and oppositional defiant disorder. In addition, it is discussed why there are possibilities of different comorbid diagnoses. My twin daughters have several mental health diagnoses, which can complicate matters, but no matter what, as a parent of a child with SM, you know that each small step provides an abundance of hope: As a parent, you never think that it would make you cry happy tears to see your child say “hi” to another child. This really puts life in perspective. A rather large step for my daughter occurred in kindergarten. During the second quarter of kindergarten, I got an email from Makenzie’s teacher. Attached to the email was a video of Makenzie signing a song in the presence of her class! By herself! Alone! Singing alone! (I actually also have a college degree in music, and I don’t even want to sing alone in front of others!) When I forwarded the video to my daughter’s former preschool teacher, she said, “I cried happy tears.” It was more words than Makenzie had spoken in an entire year of preschool. This concludes that the combination of my twins’ therapeutic treatment, medication, school-based strategies, and parenting strategies continue to show efficacy as the girls both continue to break out of their silence. This manual is meant to offer practical strategies and hope for other children with SM, in addition to offering a sense of universality to the SM community.