World Voice Day

Published on: 14 April 2015 Author: Alex Strick

16 April is World Voice Day, which set me thinking about children who experience serious challenges finding a voice due to disorders such as selective mutism (SM).

Selective mutism is an umbrella term covering anxiety disorders where a child is unable to speak in certain settings. People can wrongly assume that such a child is 'choosing' not to speak, perhaps just seeking attention or being insolent. In fact it is rather more like an extreme phobia, entirely preventing speech. Onset tends to be before four years of age and the causes can vary, but the disorder certainly appears to be more common amongst children who have inherited a tendency towards extreme anxiety and inhibition.

Selective mutism affects as many as one in 150 children

You will probably be surprised to hear that selective mutism affects as many as one in 150 children. This makes it almost as common as autism, yet it remains largely unheard of and widely misunderstood. For example, people might assume that it's specific to school settings or that only children can experience it. So, like with many disorders, there are clearly many myths which need to be busted.

I must confess that it is a condition that only really started to appear on my radar a few years back, when I was approached by a woman named Susmita Roy asking if I knew of any children's books featuring the subject. After a bit of research I had to admit almost total defeat.

Books can promote understanding and challenge stereotypes

Children's books, as ever, represent a great way of 'casually' acknowledging the existence of different disorders but also challenging stereotypes and helping other children to develop their understanding. According to Susmita, there is a real need for greater awareness of selective mutism and support for children experiencing it:

'Children (and adults) with the SM anxiety need the understanding, support and reassurance of the people around to help them overcome the phobia and speak up within their situations of difficulties. We need to be more aware of this disorder to help and encourage children with SM anxiety in their social settings.'

Susmita feels so strongly that she has in fact written a story herself, which she hopes will made available online by the SMIRA (the Selective Mutism Information and Research Association) later this year.

Book of the month: Unspeakable

In the meantime, several mainstream titles have emerged which feature characters who are either selectively mute or do not speak at all. One such example is this month's Bookmark book of the month, Unspeakable by Abbie Rushton. The author tells me how she developed the idea:

'Unspeakable started with a simple idea about someone having a secret and not being able to tell anyone. I took it one step further and made my character mute so she absolutely couldn't tell anyone the truth. My character, Megan, isn't a selective mute. She doesn't speak at all because she's suffering from some kind of post-traumatic stress.'

'As some of my research, I read an excellent book called Helping Children with Selective Mutism and Their Parents: A Guide for School-Based Professionals (OUP) to try to figure out how an educational psychologist might treat Megan.'

'I also YouTubed some videos created by mute teenagers. As their words scrolled across the screen, it was clear to me that, although they don't speak, they have incredibly powerful voices and what they had to say was heartbreaking and affecting.'

Children's books about selective mutism

Time, space, understanding, support and friendship prove to be some of the key factors in helping Megan eventually find her voice again. This is echoed in the short but powerful Ethan's Voice, in which a boy has ceased talking since witnessing a traumatic event which he has then blanked from his memory.

In a French book I read recently - Muette by A Cortey and A Pichard (Editions Autrement, 2011), a small child is overwhelmed quite simply by the excessive noise and bustle in her chaotic family home.

I was really pleased to learn from author Susie Day that her forthcoming title The Secrets of Sam and Sam will also feature a character who is a selective mute:

'The twins come home from school one day to find a silent little boy called Rohan in their house. They assume he's waiting for his dad; Mum K is a therapist who works from home, and Mr Grover comes to talk to her every week. It's only later they find out that he's asking for help with Rohan's condition. Sammie assumes Rohan is rude, or shy; Sam's wild imagination convinces him that Rohan's hiding a sinister secret, all to do with the spooky Bad House across the road. The reality is quite different.'

Susie tells me she was inspired by a boy she taught briefly while training to be a teacher:

'At the time his condition was called 'elective mutism', which has now changed to reflect that it is not a chosen or voluntary behaviour. The school was using various strategies to support him, and I did some research into best practice, and worked closely with classroom support staff. When it came to writing the book, I used the internet to look into case studies, and more recent thinking on both causes and treatment.'

How to write authentic characters with a disability or disorder

It's this kind of research which is surely key to ensuring an authentic depiction of a character with any kind of disability and disorder, but especially in the case of one which can be so easily misunderstood. And whether or not you are researching the subject, I'd urge everyone to read the blog at the top of the list of resources below, created by Carl Sutton, of iSpeak, who I've had the pleasure of communicating with over the past week or two. His dissertation (link on the iSpeak website) also offers a fascinating insight into selective mutism and the experiences of adults with the disorder.

It's pleasing to see the children's book landscape starting to include children with this lesser-known condition and we hope the list (short as it is!) will be of use. We'll continue to add to it and would welcome any further ideas and recommendations.

What is Selective Mutism?

(Exerpt from the iSpeak website)

Selective Mutism (SM) is a severe situational anxiety disorder which affects both children and adults. The condition generally starts in early childhood but can, if not treated early enough, continue into adulthood. Children and adults with SM are often fully capable of speaking (though many have masked speech problems/delays), but cannot speak in certain situations because they are phobic of initiating speech.

As a phobia of communication, a child or adult with SM will be mute (it is an instinctual response which can feel inexplicable even to himself/herself) in the presence of a given collection of people or indeed an individual person. The pattern of speech-related anxiety varies depending upon the person's life-experience. The pattern can be quite general - encompassing the whole school environment. Or it can be more specific - for instance with a grandparent, parent or step-parent. As such, role can, sometimes, be involved. Or it can be a complex mixture of both.

Age of onset

The mean age of onset of Selective Mutism is between 2.7 and 4.1 years of age, which is long before the mean age of onset of Social Anxiety Disorder, which generally develops during adolescence. SM often first becomes apparent when a child enters a communal environment outside the family home for the first time - for instance when a child begins playgroup or school.

While SM has a very early mean age of onset, sometimes SM (either absolute silence or extreme reticence) can last for a child's entire time at school - until the day they leave at 16 or 18. Generally, but not always, it contributes to academic underachievement, school refusal, and a torrid school life, etc. despite children with SM often being of 'above-average intelligence'.

Situations where SM can occur

School is not the only situation in which muteness can occur, however. SM being an education-only issue is a stereotype, thus incorrect. Many children (including those primarily mute at school) may also not be able to talk to certain relatives (e.g. grandparents or aunties or uncles etc.) In rarer cases, some children with SM may not be able to talk to their parents or step-parents either. This was the case for me.

Children and adults with SM do not choose to be silent in the situations in which they cannot speak. They genuinely cannot speak because attempting speech rouses too much anxiety. Almost all children and adults with Selective Mutism would love to be able to speak in every situation they cannot. They are not making their difficulties up, being difficult, rude, antisocial, or anything else.