Hi. I just wanted to chime in with some more information on Selective Mutism. Basically, selective mutism is a Social Anxiety Disorder. The child feels anxiety so much that his vocal cords literally become paralyzed preventing any sound from being uttered. The child will speak in some environments or with certain people but not others. It is not willful behavior on the child's part nor is it an attempt on the child's part to control others. He is not CHOOSING not to speak; he literally is unable to do so due to the anxiety. The child will be mute in settings where he feels the EXPECTATION to speak. The mutism is the only strategy the child has to deal with the anxiety about speaking. There are associated behaviours too. Some kids with SM will not participate in activities at school (i.e. doing motor movements during circle time etc.), basically anything that calls attention to themselves. Contributing factors include: genetic predisposition (severe shyness/anxiety in family history), speech and language impairment (MILD typically), sensory processing disorders and prematurity. I attended a conference on SM given by Dr. Elisa Shipon-Blum, a physician whose own daughter suffered from SM. She explained that we need to focus less on the actual lack of speech and instead focus on improving the child's communication in its entirety, including non-verbal communication, social skills etc. Dr. Shipon-Blum is one of the leading experts in the world on this condition. To educate people about SM has become her life's mission. She adamantly wants people to understand that the child does not CHOOSE this behavior, nor is it an attempt to control others etc. Many children have been kicked out of school and basically emotionally abused by teachers and therapists who have this opinion. The child actually wants desperately to speak but the anxiety shuts his vocal cords down. Only by decreasing the anxiety, removing the pressure on the child to speak, and providing the child with social and communication skills will the child eventually speak. The child needs to change his perception of himself too. If the mutism continues over a matter of years, it will be much more difficult to overcome.
My son who has SM presents like this. He will chat non-stop, sing songs, bounce around the house with extreme exuberance, but the moment we park the car near school he becomes COMPLETELY mute. He can then only gesture or possibly grunt to communicate his needs. He has been attending a special needs pre-school through our school district five mornings per week for the past 6 months for children with speech and language impairment. He has yet to say one word in the classroom. He actually wants to speak and will attempt to speak to the teacher. When he does try, only strange garbled sounds come out of his open mouth. So sad! He is making signs of progress in that he has spoken to two aides and a few classmates outside of the classroom. He has also begun to speak to children when on one to one playdates. There is usually a warm up period first where he has to make wierd animal sounds etc. before actual words start flowing. He has also relaxed enough now to start doing the special dances during circle time etc. So speech is probably on the horizon. He has always LOVED going to school though and does not look physically anxious at all. He loves to be around and interact with other kids, but he just does not speak to them. You would never know he was anxious except for the mutism. My son has age level expressive and receptive speech.
It is a frustrating problem, one that takes a long time to overcome. There are numerous behavioral plans one can put into place to help encourage speech at school (pairing him up with a child he likes, allowing people he speaks with to come into the classroom environment, giving him one on one time with the teacher alone to build a relationship etc.). If these don't work, anti-anxiety meds given on short-term basis along with behavioral intervention are available too.
In my non-speech therapist opinion, I would not readily accept the SM diagnosis given the severity of your daughter's speech delay. You may have already done this, but I would encourage you to get her evaluated through your school district. It sounds to me like she would benefit from an INTENSIVE speech pre-school to help promote her language development. If you were in our district, your daughter would definitely be put in my son's classroom. He has some kids in his class who started at age three only saying 50 words or so and who then test at age level when being advanced to kindergarten. The low ratios of the speech and language pre-school rooms really help to decrease anxiety and promote speech. IF there is anything else I can do, please let me know. Best wishes to your daughter.
John, 3 1/2 years (born at 32 wks, 3 days due to Severe Pre-E)
Katrina, 22 months (born at 36 wks, 6 days due to Mild Pre-E)