Regarding "'Shy' child? Don't overlook selective mutism" (July 2005): In my general pediatric practice, most of the children with selective mutism whom I have seen are preschoolers, ages 3 and 4.1 In most of these children, selective mutism resolved within one year without specific therapy! I suggest, therefore, that it is acceptable to manage preschoolers with selective mutism without specific therapy for at least one year.
Paul R. Joseph, MD Syosset, N.Y.
Author reply: A small percentage of children who are "quiet" and do not speak much do spontaneously progress to quiet speaking and, eventually, to speaking. These children seem to truly be nothing more than shy. But I have seen countless older elementary-school-age children, and many teenagers, whose parents waited for them to outgrow their silence-and just the contrary occurred. The child became more withdrawn and socially isolated and her (or his) behavior became more conditioned. Many of these children developed secondary depression and became severely socially phobic. They began performing poorly in school. Some of the older teens began self-medicating with drugs or alcohol.
My clinical work has taught me that when children become mute, there are reasons why, and "not speaking" is just one symptom. Many of these children have trouble with nonverbal communication. Most cannot socially engage comfortably, avoiding eye contact and ignoring others until they have a "warm up" time. Most children also have a speech-language difficulty, learning differences, sensory processing disorder (auditory processing), developmental delay, or another reason for increased anxiety.
In my professional opinion, one should not wait in the hope that a socially isolated, mute, withdrawn child-who may not be able to start or complete classroom tasks, express a need or want to his teacher, initiate play with others-will become a social communicator. The factors causing the mutism need to be determined and addressed. All parents will require education. In some cases, that may mean nothing more than educating them to stop pressuring the child (constant bribing and pressure to speak only reinforces the silence); in many families, however, a more in-depth approach is required.
A variety of information and literature on this topic can be found at http://www.selectivemutism.org/, the Web site of a nonprofit organization dedicated to individuals who have selective mutism.
Elisa Shipon-Blum, DOJenkintown, Pa.