Question:

Hello,
I have an 8 year old with selective mutism and lately she has been angry at the drop of a hat. I ask her to do her homework or something else and she gets into this rage and hits me. I put her in her room for an hour, but what can I do to stop this behavior?

Desperate mom

Answer:

Dear Desperate Mom,

This sounds like a very unsatisfying situation for you and your daughter! Let’s start by explaining what it is you mean when you say she has “selective mutism.” My colleague at the Diagnostic Center, Virginia Sanchez-Salazar, speech and language pathologist extraordinaire, wrote the following:

“Selective Mutism (SM) is a childhood manifestation of social anxiety disorder. It is found in approximately 2% of the children in early elementary school. It typically appears between ages 2-5 years, but usually is not diagnosed until ages 6-8 years old. Children with SM are anxious to the point that they actually exhibit a physical reaction and literally cannot talk in one or more social settings, including school, despite speaking in other social situations, such as at home. These children may also lack typical facial expressions because they are overwhelmed with fear and unable to participate in any way.

Other children with this diagnosis may be able to participate in activities while remaining silent. Some anxious children may speak only when required but do not volunteer to speak and do not initiate interaction. In many cases, these children have fully developed to age expectations in all respects; they tend to be intelligent, sensitive, introspective, and perceptive. However, some children with Selective Mutism may also have receptive or expressive language disorders, articulation disorders, or learning disabilities; they may be bilingual or come from bilingual homes.

Some children who are selectively mute benefit from treatment with selective serotonin reuptake inhibitors (SSRI). These medications are monitored by knowledgeable physicians and psychologists. Other children gradually overcome Selective Mutism with step-by-step treatment plans but without the aid of medication. However, if left untreated, Selective Mutism can lead to underachievement in school, poor social skill development, low self-esteem, social withdrawal, and possibly psychiatric complications.”

From Virginia’s explanation, it is clear that working with your daughter requires a team. The first questions I would ask are:

• Has she been evaluated by a knowledgeable psychologist, familiar with this diagnosis? Has this person assessed her cognitive ability and her emotional state? Does your daughter have learning disabilities?
• Has your pediatrician/psychiatrist been made aware of the SM and has medication been considered?
• What approach is her school team using?
• Is the speech and language pathologist (SLP) actively involved and is the team following the recommended approaches? Specifically,

“The SLP, with knowledge and skills in effective communication treatments, can assume leadership to coordinate an integrated approach for the child among the school staff. Effective treatment of selective mutism requires a highly refined and consistent response among all significant adults around the child. The treatment team consists of at least five members: the child, the parents, the teacher, the psychotherapist, and the SLP.” (http://www.asha.org/about/publications/leader-online/archives/2002/q3/020924ftr.htm)

Remembering that SM is an anxiety disorder, it is likely that your daughter experiences great stress while at school, even if the best possible program is provided to her and no demands are placed on her to speak at school. It is not surprising, then, that what she gets home, the place where she feels safe, she unburdens herself of this anxiety by turning it into anger.

What can you do?

• Be sure her treating therapist knows this is happening and ask for his/her help. If she is not being seen by a therapist, see if your medical plan will cover it or if the school system has resources for therapy.

• Some of the anxiety may be alleviated by providing her with a predictable schedule that lets her know her activities for the afternoon and evening. It also puts some distance between your telling her what to do and an impartial list that she can’t argue with.

• Here is one website to help you create a schedule: http://www.dotolearn.com/. A nice example is: http://www.joeschedule.com/ . Consult with her teacher about whether to use words or photos or icons or some combination

• Have a place for her to check off each activity as she completes it.

• Start with some down time so she can relax and “come down” from her school day.

• Include some choices. For example, if she has homework from 4:00 to 4:15, allow her to choose math or reading; for chores, let her choose between clearing the table and loading the dishwasher.

• Build in some rewards for completing the schedule (she may earn a reward for progress, not for 100% ) and/or for each day of “safe behavior.” Staying up 10 minutes later or an extra story might be some immediate rewards for days when she has not hit.

• Check with her teacher that the homework is at the level that your daughter can do independently. It should be a review of learned material.

• If the schedule changes (e.g., a doctor’s appointment) or a new activity occurs, preview this change with her as you review the schedule

• It is never okay for your daughter to hit you, no matter how hard her day may be. It is good that you do not hit her back but you need some parenting assistance. There may be some parenting groups available. There are some good books that are readily available that can help you:

  Greene, Ross The explosive child

  Greenspan, Stanley The challenging child

  Nelson, Jane – any of the positive discipline books for families

A helpful website (that you probably know) is:

http://www.selectivemutism.org/