33  Elective Mutism


 “Our daughter Lisa aged 6 has suddenly stopped speaking at infant school. It has lasted three months now. She does not speak to other children or the teachers but at home she speaks to us just as she always did. She has a mild speech defect and has always been shy at nursery but nothing like this. The educational psychologist has said it is elective mutism and it won’t last much longer, but at school, not surprisingly, her teacher is getting irritated with her. We can find no reason for her behaviour and don’t understand what elective mutism is.”

Mr and Mrs C.D. Liverpool


 There are many children and adults without verbal speech who find others ways of communicating. Margaret Kennedy, of Keep Deaf Children Safe, regularly emphasises that you do not need verbal speech to have a language and that sign language is an equal language. However, for a child who has the capacity for verbal speech to not speak or to only speak in one setting is a painful experience for parents and professionals alike.


 It is not surprising that her teacher is affected. It can be powerfully tantalising to be in the presence of a child who cannot or will not speak to you. As one Head commented, “I could see she was lonely, but to hear from her mother that she chatted away to her at home when I could not get a single word out of her at school was almost too much to manage. “


 Often a mixture of organic and emotional factors or predispositions are involved. However, whatever the reason, Mr and Mrs CD have been correctly told that unlike many other childhood problems persistent elective muteness is rare. It mainly affects infant/primary age girls.


 Professor Israel Kolvin of the Tavistock Clinic and Royal Free Hospital and Dr Triam Fundudis of the Newcastle Nuffield Centre noted two different kinds of mutism. Firstly, there is elective mutism where a child can or will talk but only in one setting or to particular people, as with Lisa. Secondly, there is traumatic mutism which is a period of total non-speaking following a shock or injury. Children affected by elective mutism often showed excessive shyness at nursery age but, unlike other children troubled by shyness, these finally became electively mute at infant school.


 Sometimes, traumatic mutism is easier to understand. Jenny, aged 7, was referred after witnessing a young child killed by a hit and run driver. “Jenny and I were standing by the school bus-stop just as usual”, said her mother, “ when a car came by at enormous speed and we saw a young girl-I don’t know how- suddenly fly through the air and land with an awful thud. She died immediately. Jenny could not speak for a long time. She had literally been struck dumb by terror. “


 Other children have been rendered traumatically mute by adult orders to remain silent and not tell family secrets. Whilst abuse, death, mental illness, infidelity and addiction figure highly as family secrets there are less obvious ones. For example, John, aged 6, was totally silent for two months. He resumed speaking after a parent-teacher meeting where he heard his father offer help with the school play because “ I’ve got time as I’m out of work”. When John’s father was first made redundant he was so hurt he ordered his wife and son to remain silent and not let anyone know. He never realised how strongly that initial injunction had affected his small son.


 There can be a range of literal meanings in the symptom. Mrs Sandra Ramsden, past chair of the Association for Child Psychology and Psychiatry comments “One boy I treated found not speaking the only way he could find a voice in his family. He spoke to me first saying that if he spoke to his family they would stop listening. He found a way of speaking to them through me and then totally regained his speech.”


 For the moment Lisa’s parents cannot see a traumatic cause. However, could the speech defect itself be experienced as a trauma? Elective mutism can also be influenced by trauma. American researcher L.Wright found that one fifth of electively mute children developed mutism as a response to an underlying speech defect. Professor Sheila Hollins of St Georges Hospital Medical School has been very aware of the way some patients with a disability defensively exaggerate their problem because they find that being different is so painful. Speech therapy, the creative therapies and child psychotherapy can offer help here.


 Lisa and her family and teachers are all in a difficult position for now. Mrs C.D’s sympathy for the class teacher will help. Sometimes the adult chosen to hear verbal speech, whether a parent, friend or professional is so relieved to receive the rare treasure of words that at times she or he can experience a temporary aggressive triumph over those who are not spoken to. “Well she speaks to me!” said with meaningful emphasis is not helpful. If the adults manage to deal together with the child’s sense of power and powerless improvement is faster.