Too Scared to Talk: Managing Selective Mutism in an Abandoned Girl

Abstract

Selective mutism (SM) is a complex anxiety-related disorder, primarily prevalent in girls, and usually diagnosed in early childhood. The main diagnostic features include persistent failure to speak in some social situations, where there is an expectation for speaking, despite normal or near-normal speech in other social settings. AD, an abandoned girl, about 3-year-old, from a child care institute was referred for a medical examination to a tertiary care pediatric hospital. The major complaints were poor appetite, failure to speak to others, and excessive aloofness. She had no major behavioral difficulties, was cooperative, and complied with all verbal instructions. She would use gestures to communicate. The child was diagnosed with SM and a comprehensive individualized therapeutic plan was implemented. The management plan focused on enhancing attachment, cognitive stimulation, and language skills. As a first step, AD was enrolled in a day care center. An enabling and enriching environment was provided with plentiful opportunities for play and interaction with peers. Defocused communication that involved sitting alongside the child rather than face to face, creating joint attention using tasks that the child enjoyed, not asking direct questions, giving the child adequate time to reply, and continuing with the conversation even if she did not respond verbally was used as the primary treatment strategy. Collaborative teams including pediatricians and mental health professionals can play an integral role in early diagnosis and in overseeing the challenging path of overcoming SM in young children from adverse circumstances.