Case Study of Selective Mutism Part 1.

Selective mutism (or selective muteness) is an anxiety disorder of childhood, where the child can speak normally in familiar environments (e.g., at home with the family), but struggles or refuses to speak in other social situations, such as at school or with strangers.

What drives a child to stop speaking for no apparent reason? What's to blame?

In many children, we'll never know. In some, perhaps an event that deeply frightened them, like an accident or anger towards someone, which leads them to withdraw into themselves. In a primary school in London, when I worked with my first child with selective mutism, the trigger was quite clear to the parents at the time. She got burned by an iron-it was an accident, while her mum was ironing clothes. The little girl, who was in first grade at the time, hadn't spoken in class for almost 2 years. All she managed was to nod her head yes or no to indicate what she wanted, only when spoken to directly. She didn't speak to classmates, nor obviously to any teacher, but she could play in the yard with 2-3 friends.

We started play therapy sessions. Slowly but steadily, without any pressure to speak. As the child felt safe, after 6 sessions, she began whispering in my ear. With one-word answers like yes or no. In a subsequent session, I managed to convince her to let me record her voice on my mobile saying simple sentences in a whisper, and then louder. We listened to the recording again and again, and it was as if she felt proud-and so did I-for the great achievement. In our next session, the girl spoke and asked me to record her again.

After another 12 sessions, the child initially transferred what she wanted to say in whispers to a friend, and later managed to speak in the ear of one of the classroom's support assistants. Without pressure, without outbursts, this continued with other children in the class with whom she felt comfortable, until the whisper turned into clear speech.

She was a very shy and reserved child by nature. A traumatic event happened to her, and she decided within herself not to speak to anyone again. Through play therapy, she felt safe again, protected, received acceptance, encouragement, and took her time to experiment with what it would be like for her voice to be heard by others again.

I thank her for the trust and the unique experience she gave me by working with her; now she must be around 20 with her own children somewhere in East London.