Shyness can mask anxiety disorder

Doctors are increasingly finding that extreme shyness in children may actually be a symptom of a treatable anxiety disorder known as selective mutism.

Elisa Shipon-Blum, D.O., executive director and medical director for the Selective Mutism Group—Childhood Anxiety Network, answers some of the common questions about the condition:

What is selective mutism?

Selective mutism is a complex childhood anxiety disorder characterized by a child’s inability to speak in select social settings, such as school.

These children are able to talk normally in settings where they’re comfortable, secure and relaxed. Although the etiology of selective mutism is varied, the majority of cases are due to severe anxiety, specifically social phobia.

Why does the child develop selective mutism?

The majority of children have a genetic predisposition to anxiety. Very often, these children show signs of severe anxiety, such as separation anxiety, frequent tantrums and crying, moodiness, inflexibility, sleep problems and extreme shyness from infancy on. Because most of these children have a persistent fear of performance or social interaction, they have developed a "mutism" as a means of controlling their inner anxiety.

When are most children diagnosed as having selective mutism?

The average age of diagnosis is between 4 and 8 years old.

These children were probably mute before school age, but just seemed "very shy." It’s not until children enter school that selective mutism becomes blatantly obvious.

If a parent suspects his/her child has selective mutism, what should be done?

Speak to your physician and/or seek out a psychiatrist or psychologist who has experience with selective mutism. Read as much as you can about the disorder.

How is selective mutism treated?

The main goal with treatment is to lower anxiety while increasing self-esteem.

A professional should devise an "individualized plan" for each child consisting of psychotherapy, medication, school involvement and other methodologies.

To learn more, visit the Selective Mutism Group—Childhood Anxiety Network’s Website at www.selectivemutism.org.