Suffering in Silence
The shy child
Samantha Williams seems like a typical 11-year-old, enchanted with the prospect of teenage life as she begins to lose interest in childish activities. But at the end-of-the-year cookout she's planning for the girls in her fifth-grade class, Samantha will stand out in one particular way: Most of Samantha's friends have never heard the sound of her voice. Since kindergarten, she has never spoken to any of her teachers or uttered a single word in class, and until very recently, she hasn't made so much as a peep on the playground.
Samantha has a form of childhood social anxiety known as selective mutism. She can comprehend spoken language and she is able to speak, but because she is very shy and anxious around even familiar people, she is unable to talk in public. About 1 percent of kids are like Samantha and have extreme trouble talking to strangers. These children almost always converse easily with their parents-one or both of whom are likely to suffer themselves from some form of social phobia.
Selective mutism has been mistakenly associated in the past with childhood abuse or trauma, charges that researchers say are not supported by scientific evidence. Until recently, it was called "elective mutism," but doctors changed the name because it implied a willful stubbornness of the child that "we've found is really not the case," says Anne Marie Albano, director of the anxiety disorders program at the New York University Child Study Center.
A child's inability to speak in public is not only frustrating for parents, it can also be frightening. When Samantha missed the bus home from school one day, she was unable to tell school officials that she needed to call home for a ride. Instead she began the 2 1/2-mile trek home, until her mother, in a frantic search of the neighborhood, spotted her. "I worry about her safety," her mother says. "I especially worry that she won't be able to ask for help if she needs it."
Fortunately, behavioral therapy can be effective. Parents, teachers, and friends can play a role, too, says NYU's Albano. "Everyone must maintain the expectation that the child will speak," she says. "We offer rewards and privileges when kids do talk, and we let them experience the consequences when they don't speak," such as earning a poor grade if they miss an oral report in class.
For some children, medication such as Prozac is helpful, but it can take months before the drugs take effect. "One third of the kids we treat get a great deal of benefit from the medication," says Bruce Black, assistant professor of psychiatry at Tufts University School of Medicine. Another third see some benefit, and the rest don't respond at all, he says. Samantha Williams has been taking Paxil, a drug similar to Prozac, for a few months. Her parents hope she will respond as well as 10-year-old Jenna, a selective mute from Maine. After six months of Prozac, Jenna silently decided one day last November that she would talk in school. When she did, her classmates cheered-and her teachers cried.
This story appears in the June 21, 1999 print edition of U.S. News & World Report.
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