Quiet time
The worrying rise of selective mutism
Like many girls her age, Isla loves drawing, swimming and arguing with her sister. She is a boisterous, spirited sixyear-old who, at home, is forever being asked to quieten down by her mother, Charlotte Maddams, 35. But at school or in front of strangers, Isla is a very different child: her voice disappears, her mouth locks shut and she is unable to articulate even the shortest of words. For the past four years, Isla has suffered with selective mutism, a growing and devastating anxiety-based mental health disorder.
The condition – which affects 1 in 150 children in the UK – means that, while able to speak fluently and freely at times, those affected remain consistently silent at others. It can be debilitating, humiliating and interfere with educational development. Early intervention from therapists, sympathy and time solve most cases, but others progress throughout adult life. Experts blame the latter on a lack of awareness for a disorder that is frequently misunderstood, often as shyness or even extreme surliness.
Alison Wintgens, the Royal College of Speech and Language Therapists’ adviser on selective mutism, says: “The name is difficult, because people still think of the word ‘selective’ in connection with choice. But it has nothing to do with choice. Situational mutism would be a better name.”
Isla, who is asthmatic, has been unable to ask for her inhaler or antihistamines at school. “Once,” recalls her mother Charlotte, a childminder from Buckinghamshire, “her asthma had got bad that she was coughing and coughing. She had to wait two hours in awful discomfort until I arrived at school to collect her.”
Now Charlotte gives her daughter cue cards with written pointers such as “I need my inhaler” or “I need the toilet”. It has still taken a while for Isla to feel confident enough to use them, and during her first year at nursery she would return home with the cards anxiously chewed to pieces, rather than show them to the teacher.
This October is selective mutism awareness month, and experts are hoping to boost knowledge of the condition, which is thought to be more common than autism. There is no single cause, although emotional, psychological, genetic and social factors are believed to influence its development. It’s more common in girls and multilingual children, although there is little research into why, and it usually affects children in early childhood, when they start to interact with those outside the family.
Instances of selective mutism in this country are on the rise, says Alison Wintgens: “There are more stresses and pressures around. Schooling has become more verbal because of changes to the curriculum. You can’t be a silent achiever any more; you have to work in groups or give speeches. This puts pressure on those who struggle with social interaction.”
Charlotte Maddams believes Isla is a naturally anxious child, and that her early experiences may have contributed to her disorder. “She was poorly, with asthma and chest and ear infections, so saw people in white coats around her a lot. It may have had an impact, because it was the doctors she stopped talking to first.”
Charlotte googled her daughter’s symptoms, stumbled upon selective mutism and arranged for her to see a speech and language therapist and child psychologist, who have helped. Where previously Isla would only speak to her 11-year-old sister Phoebe at school, she now whispers with a teaching assistant and a dinner lady.
In terms of treatment, speech and language therapist Libby Hill believes animal therapy holds the answer. She uses a Labrador called Ralph to encourage children to talk. “He can perform commands such as sit, wait and stay, but to give him those instructions you have to speak. Some [children] are able to overcome their condition to give him the commands; sometimes you just need something to boost the confidence and break the spell.”
While most children overcome selective mutism over time, or with help from triggers such as moving school, for others, it can cast a shadow over their adult lives, leading to other mental health difficulties, depression and suicidal thoughts.
Danielle Fitt, 21, a maths student at Cardiff University, had selective mutism until the age of 14. She endured panic attacks, bullying from pupils and teachers, and was diagnosed with depression aged 13, after seeing 12 psychiatrists. Thankfully, she is able to speak to strangers now, although she still has panic attacks and social phobia. She says: “It feels as though your throat is physically closing up and you can’t get the words out. In my head I always knew what I wanted to say, but the anxiety took over.”
Danielle thinks school accelerated the disorder, as did one or two moments when teachers attempted to force her to overcome her “shyness”. “If I’m in a controlled environment I’m calmer, but if someone approaches me who I am not expecting, it makes me really uncomfortable. I believe that if the awareness of selective mutism had been greater, I wouldn’t have had to deal with some of those experiences. I don’t want others to have to go through what I did.”