What Is Selective Mutism?

What Is Selective Mutism?

选择性变态（SM）是一个童年焦虑症characterized by an inability to speak or communicate in certain settings. The condition is usually first diagnosed in childhood. Children who are selectively mute fail to speak in specific social situations, such as at school or in the community.

据估计,只有不到1%的儿童selective mutism. The first described cases date back to 1877 when German physician Adolph Kussmaul labeled children who did not speak as having "aphasia voluntaria."

Symptoms

If you believe that your child may be struggling with selective mutism, look for the following symptoms:

• 表达渴望通过焦虑，恐惧或尴尬留下来
• 在担心的情况下，躲避，眼睛接触避免，缺乏运动或缺乏表达
• 无法在学校和其他特定的社交场合中发言
• Use of nonverbal communication to express needs (e.g., nodding head, pointing)
• 羞怯，害怕人，不愿意在2到4岁之间发言
• Speaking easily in certain situations (e.g., at home or with familiar people), but not others (e.g., at school or with unfamiliar people)

虽然这些行为是自我保护的，但其他儿童和成年人可能经常将他们视为故意和挑衅。

Diagnosis

Although selective mutism is believed to have its roots in anxiety, it was not classified as an anxiety disorder until the fifth edition of the精神疾病诊断与统计手册(DSM-5)published in 2013.

在1994年采用了“选择性”术语的使用，在此之前，该疾病被称为“选修型互动”。改变是强调有选择性互感的孩子没有选择沉默，而是太害怕说话。

In addition to this primary symptom, children must also display the following:

• Symptoms of selective mutism must have been present for at least one month, and not simply the first month of school.
• Your child must understand spoken language and have the ability to speak normally in some situations (usually at home with familiar people).
• Finally, a lack of speech must interfere with your child's educational or social functioning.

在移民到国外或体验创伤事件后停止暂时停止说话的儿童将不会被诊断出具有选择性互动度。

Causes

Because the condition tends to be quite rare, risk factors for the condition are not fully understood. It was once believed that selective mutism was the result of childhood abuse, trauma, or upheaval.

Research now suggests that the disorder is related to extremesocial anxiety并且这种遗传易感性很可能。像所有精神障碍一样，它不太可能有一个原因。

发展病情的孩子：

• Tend to be very shy
• May have an anxiety disorder
• Fear embarrassing themselves in front of others

Other potential causes include temperament and the environment. Children who are behaviorally inhibited or who have language difficulties may be more prone to developing the condition. Parents who have social anxiety and model inhibited behaviors may also play a role.

经常选择性变形co-occurs with other disorders包括：

• Anxiety
• 沮丧
• Developmental delays
• 语言问题
• 强迫症（OCD）
• Panic disorder

Treatment

选择性旋转主义最早的治疗是最容易接受的治疗。如果您的孩子在学校沉默了两个月或更长时间，则重要的是，治疗迅速开始。

Treatment for selective mutism may include psychotherapy, medication, or a combination of the two.

心理治疗

选择性互感的常见处理是使用行为管理计划。这些方案涉及技术desensitizationand positive reinforcement, applied both at home and at school under the supervision of a psychologist.

药物

药物也可能是合适的，特别是在严重或慢性病例中，或当其他方法没有导致改善时。选择是否使用药物的选择应与有患有儿童焦虑药物的经验的医生进行咨询。

应对

除了寻求适当的专业待遇外，还有一些东西可以做些什么来帮助您的孩子管理其状况。

• 告知教师和与孩子合作的其他人。教师有时可能对不说话的孩子感到沮丧或生气。您可以通过确保您的孩子的老师知道行为不是故意的帮助。你需要在一起鼓励你的孩子and offer praise and rewards for positive behaviors.
• 选择适合他们目前技能的活动。不要强迫你的孩子从事随着沟通所需的社交场合或活动。相反，选择不涉及言论，诸如阅读，艺术或做谜题的活动。
• 奖励进展，但避免惩罚。Where rewarding positive steps toward speaking is a good thing, punishing silence is not. If your child is afraid to speak, they will not overcome this fear through pressure or punishment.
• 不要迫使你的孩子。Parental acceptance and family involvement are important in treatment, but you should avoid trying to force your child to speak. Putting pressure on your child will only increase their anxiety levels and make speaking all that more difficult. Focus on showing your child support and acceptance.

In general, there is a good prognosis for selective mutism. Unless there is another problem contributing to the condition, children generally function well in other areas and do not need to be placed in special education classes.