Why won’t my child speak when spoken to?

A couple years ago a mom approached me about her 4 year old twin daughters saying that she wondered why they wouldn’t speak to others outside of the family.  She explained that they were super verbal with each other and would talk to her and her husband, but as soon as they were outside in the community, at school, a playground, in a store, at a birthday party, they would never say a word.  I told her that there could be several reasons contributing to this type of concern, but more than likely given their age-appropriate speech & language skills, cognitive skills and also their apparent interest in being in social situations and not avoiding social contact with other children and family members, their silence could be connected to a fairly new disorder called Selective Mutism (SM).  Selective Mutism is defined as a disorder in which an individual cannot speak in specific situations where there is an expectation of conversational speech, according to the American Psychiatric Association, Diagnostic and Statistical manual of Mental Disorders, 4th Edition. According to Joleen Fernald, M.S., CCC/SLP and doctoral student, SM has been misconceived as being caused by trauma or abuse. “Research has found no causal link between the two, but rather concludes that family history of anxiety predisposes the child to SM, as well as the child’s individual temperament,” according to Fernald. Many children with SM having underlying challenges in the area of sensory procesing, speech and language, and executive functioning.  Fernald works at the Selective Mutism Clinic in Dover, NH.  This diagnostic and treatment clinic was founded based on the expertise of Fernald and the multidisciplinary team of professionals , including behavioral health, occupational therapy and speech-language pathology services.  Specialists working with children with SM use treatment approaches such as DIR/Floortime enables clinicians, parents and educators to construct a program tailored to the child’s unique challenges and strengths. This treatment approach incorporates problem-solving exercises and involves a multidisciplinary team of specialists.  Elisa Shipon-Blum developed the Social Communication Anxiety Therapy         (S-CAT), and implements this approach with children diagnosed with SM at the Selective Mutism Anxiety Research and Treatment Center (SMart Center) in Jenkintown, PA.  Families are finally able to find the help they need for their children whose speaking challenges fall into the diagnostic profile of SM.