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Is Your Child Shy, or Could It Be Something More?

Blog Is Your Child Shy, or Could It Be Something More?

“There’s absolutely nothing wrong with being a quiet kid,” Dr. Curtin says. “However, if your child is normally talkative at home but doesn’t speak in social situations or at school, that can be a sign selective mutism.”


If your normally chatty child always clams up around anyone who isn’t immediate family, it could be a sign of selective mutism. Michelle Curtin, DO, a developmental-behavioral pediatrician at Riley Hospital for Children at Indiana University Health, shares what parents should know about this unusual condition and what doctors can do to help.

If your child is the quiet, introverted type, it’s generally nothing to worry about; many kids are simply shy or slow to warm up. But in rare cases, kids who go silent when they’re around anyone who isn’t a close family member or friend may have selective mutism, a type of anxiety disorder that typically emerges before the age of 5.

“There’s absolutely nothing wrong with being a quiet kid,” Dr. Curtin says. “However, if your child is normally talkative at home but doesn’t speak in social situations or at school, that can be a sign selective mutism.”

The disorder can be tricky to identify, and some parents assume their child is just shy or being defiant. However, selective mutism isn’t a matter of temperament or bad behavior. “When these children are around strangers or people they don’t know well, they genuinely believe they can’t speak,” Dr. Curtin explains.

In fact, their anxiety can be so paralyzing that they can’t even communicate urgent needs, like asking to use the bathroom. Some kids with selective mutism will rely on facial expressions and hand gestures to interact with people, while others may be able to whisper a few words. Other signs of the disorder include avoiding eye contact; clinginess; appearing sulky, disinterested, tense, or withdrawn around others; and temper tantrums (past the age when your child should have outgrown them.)

It’s unclear why some kids develop selective mutism, but it’s likely that both genetics and environment play a role, says Dr. Curtin: “Children who are temperamentally more inhibited are at greater risk of selective mutism, as are those who have a parent with an anxiety disorder.” Boys and girls are affected in equal numbers and often have other types of anxiety problems, such as social anxiety disorder.

If your child has exhibited the symptoms of selective mutism for more than a month (but not during the first month of the school year, when many children are anxious), it’s time to visit your pediatrician. Prompt diagnosis and treatment is important, says Dr. Curtin, because selective mutism can interfere with your child’s social development. “Children with the disorder have such a small comfort zone that they can become very isolated,” she explains. “The extent to which their symptoms interfere with their daily life is key to making the diagnosis.”

The good news is that selective mutism, like many anxiety disorders, is treatable, according to Dr. Curtin. Treatment typically involves behavior therapy, in which your child is given small goals (saying hi to the teacher when you drop him off at school, for example) to help build his confidence and prepare him to take on increasingly challenging social interactions. Your support is key in the process, says Dr. Curtin: “Parents often want to swoop in and rescue their kids when they see them become distressed, but what children really need to hear during these exposures is that you’ll be there by their side and that you know they can do this.” Medication usually isn’t necessary for mild to moderate cases.

While treatment is often successful, children with selective mutism should be monitored in case other anxiety symptoms emerge. “There’s always a chance that their symptoms could come back during times of stress, especially when they’re becoming teenagers,” Dr. Curtin says.

-- By Jessica Brown

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