1. http://nyti.ms/1NAkOp0
HEALTH
Coaxing Children With Selective Mutism to
Find Their Voices
By CATHERINE SAINT LOUIS AUG. 17, 2015
DORAL, Fla. — Talking is a skill most children take for granted. But not in this
classroom.
A dozen young children sit in a circle, dressed for pajama day. Some clutch their
knees or a stuffed animal. A boy in Spiderman sleepwear looks worried but eager as
he musters the courage to speak aloud.
“Who can be the first person to tell me what day it is?” asks Alejandra Golik, a
student therapist leading the session. All the children, ages 6 to 10, know the answer.
After an achingly long pause, a 10-year-old girl mouths, “Thursday.” Her
response is barely audible.
Still, it’s progress, and here the faintest whisper is applauded. It has been
months, sometimes years, since these children have talked to anyone apart from
family.
The children have selective mutism, an anxiety disorder, and they are terrified
of talking in social situations. They may be chatterboxes at home, but at school or
around unfamiliar faces, they are stone-faced and silent.
Experts estimate that roughly one in 140 children are selectively mute; most
elementary schools have at least one student with the condition. Selective mutism
can impede academic achievement and socialization, and lead to isolation and
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2. withdrawal from rituals like birthday parties and playground friendships.
The problem usually begins before age 5, and early intervention can help.
Treatment usually involves cognitive behavioral therapy, with modifications for
children who don’t talk to unknown adults — therapists included. If C.B.T. fails,
drugs like Prozac may be prescribed in low doses.
But now researchers are taking a different tack: intensive, weeklong immersion
programs, like this one run by Florida International University, in which selectively
mute children are put through a variety of exercises to practice what frightens them
most.
Classroom immersion may work more quickly than standard therapy, some
experts say. And it exposes children to the need to speak in front of and with their
peers.
“With six-hour days, they have time to process, adjust and practice multiple
situations with repeated exposure,” said Jami Furr, director of the selective mutism
program at Florida International’s Center for Children and Families. “The idea is to
translate gains to a real school setting, where they have the most limited speech.”
Last month’s program run by Florida International enrolled 26 children who
were split into two classrooms, one for elementary school patients and one for those
younger than age 6. Out-of-town families arrived days before the classroom
immersion for several three-hour sessions.
Each child was assigned an adult counselor called a “brave buddy,” and the first
task was to try to speak to him or her. A parent was present until the listening
therapist could slowly be brought closer. Later, during immersion sessions without
the parents, counselors helped each child to navigate days of board games, scavenger
hunts and other exercises gradually requiring them to answer questions and speak
up. The classes culminated with a trip to a diner for hamburgers.
“We think of it as a bravery ladder where each rung represents a step of
increasing difficulty, say, speaking to a new person, speaking in a louder voice, or
maybe speaking in full sentences instead of one-word replies,” said Rachel Merson, a
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3. psychologist at the Center for Anxiety and Related Disorders at Boston University,
which runs a similar program to treat selective mutism.
Dr. Yulia Perch, a psychiatrist from Long Beach, Calif., brought her son Leo, 9,
to the Florida program. From the first through third grades, she said, he never spoke
to his teacher or classmates.
“When he interacted with other children, he couldn’t share himself,” she added.
“He couldn’t make jokes. He couldn’t reciprocate. It was just limited intimacy.” After
his first individual session, Dr. Perch took Leo to a beach, where he and another boy
discovered a raccoon and ended up talking about the bandit-masked animal and
eventually Minecraft.
After the conversation on the beach, his mother said, “he understood the human
reward.”
During the second session, Dr. Perch was astounded when Leo managed a
whisper to his counselor. On his fourth day of the immersion program, he was asked
the date in front of the group.
“The 30th,” he said distinctly, abandoning the modest whisper he had used just
three days ago.
“He’s had this so long that I wasn’t sure he would talk at all,” Dr. Perch said
afterward.
Children with selective mutism are often misdiagnosed; pediatricians, parents
and teachers sometimes mistake mutism for shyness. But there are important
distinctions.
A shy child is always reserved, even at home, but may warm up to a new person
after a few minutes. A child with selective mutism may be outgoing at home and
never warm to strangers.
Delayed treatment can exacerbate the problem, experts say. “Every day you are
not better you are getting worse and getting better at being an avoider,” said Steven
Kurtz, a psychologist in Manhattan who treats selective mutism.
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4. Melissa Shattuck, of Huntsville, Ala., was shocked to discover that her chatty
6-year-old, Lily, hadn’t spoken a word to classmates at a holiday party. The girl’s
teacher had assumed Lily was withdrawn at home, too, Ms. Shattuck learned.
“We saw two different Lilys,” she said. Only after the party did Ms. Shattuck
realize that her daughter needed treatment for selective mutism.
Immersive programs now exist in several states. Dr. Kurtz helped start one at
NYU Langone Medical Center and another at the Child Mind Institute in New York.
Richard Gallagher, a director of the selective mutism program at NYU Langone’s
Child Study Center, said weekend sessions would be held this fall at a campus in
Hackensack, N.J.
In October, Dr. Kurtz plans to post free online educational videos for parents,
teachers and caregivers who wish to help children with selective mutism.
Even after intensive help in the Florida program, some children weren’t able to
speak audibly. By week’s end, four of the 26 were still struggling to speak aloud.
“Some take it and run with it, and for others, it’s baby steps,” Dr. Furr said.
On the last day, many of the children were able to order burgers and fries on
their own at the diner. But Elizabeth, a 6-year-old redhead from Texas, only
whispered her order to her counselor, who relayed it to the waitress.
When the food arrived, Elizabeth was unable to tell another counselor that the
chicken nuggets were hers. Given an iPhone that held recordings of her saying “yes”
and “no” captured by her parents, Elizabeth pressed the yes button, then dug in.
“It’s definitely frustrating that we didn’t see more progress,” said Jonathan, the
girl’s father, who asked that the family’s last name be withheld for privacy’s sake.
“On the other hand, with just four lead-in sessions and a week of school, she’s
talking to someone she had never met,” he added, brightening a bit. “It’s huge.”
A version of this article appears in print on August 18, 2015, on page D1 of the New York edition with the
headline: Scared Into Silence, Little Voices Learn to Speak.
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