Disorder takes away a child’s voice

By JEAN NASH JOHNSON The Dallas Morning News
August 29, 2006

MANSFIELD, Texas — Emily Chapline loves books and the color pink. She bosses her 5-year-old brother, Blake. She can tear into a McDonald’s Happy Meal with the best of them. The 9-year-old is typical and enigmatic.

When asked about her favorite book, Emily’s chocolate eyes dance behind her eyeglasses. She leans into her mom, and with her small hands cups Jana Chapline’s ear and whispers. There is silence.

“Nancy Drew,” mom repeats for my benefit. “I love those books!” I reply. Emily warms up a bit.

But, still, she hasn’t uttered a word to me.

I had been hanging out with Emily for a few days this spring — at school, in occupational therapy and during dinner with her family. I selfishly was hoping to hear what I imagined to be the sweet voice of innocence, curiosity and joy to match the personality of the spirited little girl before me.

But Emily doesn’t speak — not to me, not to her teacher, not to her occupational therapist, not to most of her classmates. From the time she was able to, Emily has spoken only to a select few, including her mom, dad, brother and grandparents. She also has two “talking friends,” peers she converses with.

Emily was diagnosed five years ago with an extreme form of shyness called selective mutism after her mom had fought endlessly to get help for her daughter, who had encountered medical and emotional issues since birth.

“I did not want her to go through school being labeled as a dumb child,” Jana says.

Selective mutism is a complicated childhood anxiety disorder distinguishable by a child’s inability to speak in social settings, such as school. Youngsters with the disorder speak normally in settings where they feel secure and relaxed.

The disorder still is referred to as “rare,” but the latest figures from the American Academy of Child and Adolescent Psychiatry show that about seven in 1,000 children are believed to suffer from selective mutism.

Only within the past 10 years has selective mutism attracted the attention of scientists and doctors. It is recognized by the American Psychiatric Association and listed in the psychiatric diagnostic manual.

“Child anxiety in general has just recently been recognized, and selective mutism is even lagging behind the rest of the field,” says Dr. Lindsey Bergman, associate director of the University of California, Los Angeles Child Obsessive-Compulsive Disorder and Anxiety Program.

Experts recommend treatment as early as possible, although it is unclear how untreated children function and cope as adults, Bergman says.

Selective mutism differs from mutism, which renders a person unable to speak in any situation.

Parents initially may think the child is refusing to speak, but experts say a child suffering from selective mutism has a social anxiety that prevents him or her from talking in some settings.

Selective mutism is not caused by a communication disorder such as stuttering and does not occur as part of a mental disorder such as autism. It also should not be confused with a situation in which a child is hesitant to speak because his or her native language is not used.

Treatment of children with selective mutism typically involves behavior modification, family support and school participation. A doctor may recommend medications to treat symptoms of anxiety and social phobia. If the disorder goes untreated, symptoms can become worse.

“Many times, parents will wait and hope the child outgrows their mutism, but without proper treatment most do not and end up going years without speaking, interacting normally or developing proper social skills,” says Dr. Elisa Shipon-Blum, an expert on the disorder and a clinical assistant professor of psychology and family medicine at Philadelphia College of Osteopathic Medicine.

Shipon-Blum also is executive director of the Selective Mutism Group-Childhood Anxiety Network, a national nonprofit group that has helped raise awareness. Her daughter suffers from the disorder.

SIGNS OF MUTISM
 

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