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Sometimes It’s Not Just Shyness

“Most of the kids we see often will say, ‘I want to talk but I’m scared’ or ‘I want to talk but the words are stuck in my throat,’” said Dr. Busman.

When Ethan Henwood started preschool, “he wouldn’t make a sound — he didn’t even laugh,” his mother Vanessa recalled. “And the teachers just said, ‘Oh, he’s just shy, he’ll come out of his shell eventually.’” Like many children with selective mutism, Ethan got quiet not just among strangers, like the cashier at the grocery store, but even around relatives, such as his grandmother, said Henwood, a 37-year-old stay-at-home mom in Zephyrhills, Fla.

Many people are unaware of the disorder, which can make it difficult to identify and treat early. Just 15 percent of U.S. adults have heard of it, according to a 2017 Harris Poll survey conducted in partnership with the Selective Mutism Association.

So it’s important for parents to seek an evaluation from professionals with experience diagnosing and treating selective mutism if their child speaks only in certain situations. Doctors unfamiliar with selective mutism, like the pediatrician who instructed an Arizona mother to ignore her daughter’s silence, may dismiss the symptoms, delaying treatment. And for bilingual children, diagnosis can be more complicated if they speak different languages in different settings, because they may be in a natural “silent period” of language acquisition if they are quiet only when their second language is being spoken.

Experts recommended treatments based on evidence-based methods like cognitive behavioral therapy. Parents should be wary of accommodating the child’s anxiety by avoiding discomfort, said Steven Kurtz, the founder and former director of the selective mutism programs at the Child Mind Institute and New York University Langone Health’s Child Study Center.

Instead of jumping in to answer questions directed at the child or, at the other extreme, exerting too much pressure to speak, Dr. Kurtz suggested that parents acknowledge the difficulty of tasks that may be anxiety-inducing for children with selective mutism, like saying hello to grandma, answering the phone without knowing who’s on the other end or speaking above a whisper. At the same time, parents should express confidence in the child’s ability: We know picking up the phone is hard for you, but we’re sure you can do it.

Dr. Kurtz recommended that parents focus on small steps that let children practice using their voices, like running a pretend restaurant for each relative individually instead of wading into a family gathering all at once.

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