Selective Mutism in Adults (A 3 point guide)

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The current blogspot will focus on the question “what is selective mutism in adults?”. We will discuss the definition of selective mutism, the various symptoms of selective mutism in adults, the causes of selective mutism, the associated features of selective mutism and the treatment options for selective mutism in adults.

What is selective mutism in adults?

Selective mutism is a type of anxiety disorder. It is characterized in a person by an inability to speak in certain situations like in social gatherings, at family functions, in professional meetings and any group of people that may be familiar or unfamiliar. 

Selective mutism does not involve being reluctant to talk to anyone or any speech impairments, rather adults diagnosed with selective mutism actua;;y cannot talk in certain situations whereas in other situations they perform really well and are able to communicate appropriately.

The selective mutism usually first occurs in childhood and if left unattended and untreated it persists to adulthood. Adults with selective mutism feel a freezing response that is triggered when they think about talking to a certain group of people or going to a particular social setting.

Selective mutism is not a conscious decision of an adult to avoid talking to the people they don’t feel like talking to. Rather, such individuals are unable to physically talk when coming in contact with certain people or social scenarios. As a matter of fact they may choose to avoid the specific group of people or social scenarios to prevent themselves from humiliation and guilt.

At the core of the selective mutism is the anxiety and panic associated with unpleasant feelings about meeting certain people or engaging in a social scenario. The anxiety often gets overwhelming to the extent that the adults with selective mutism are unable to speak at all.

The adults with selective mutism are often aware of the negative consequences that result due to their silence and inability to speak in various social situations. They often go through the unpleasant feelings of  social ostracism, social withdrawal, humiliation, guilt and shame that hinder their subjective well-being.

The symptoms of Selective Mutism among adults

The major symptoms of selective mutism among adults as defined in the Diagnostic and statistical manual of mental disorder – 5th edition are :

  • The consistent failure of adults to speak in specific situations while being comfortable in speaking at other social situations.
  • The disturbance interferes with the social or occupational functioning of the adult and with the academic functioning.
  • The duration of the disturbance due to selective mutism among adults is at least one month.
  • The failure to speak in a social situation is not due to the lack of knowledge, training and skills required to speak a language in that specific situation. If you want to know more about language in autism, check out the article about Relational Frame Theory.
  • The selective mutism is not better accounted for by any other type of mental disorder like communication disorder, autism spectrum disorder and schizophrenia.

Besides the above major symptoms, the adults with selective mutism also display the following characteristic behaviors:

  • Shyness
  • Social anxiety
  • Social withdrawal
  • Isolation
  • Fear of social embarrassment
  • Difficulty maintaining appropriate eye contact
  • Flat expressions
  • Reluctant to smile or portray a positive gesture while meeting people
  • Difficulty expressing and addressing their feelings, even to the known people
  • A constant state of worry and apprehension
  • Increased sensitivity to noise and crowds

Adults with selective mutism are often labeled as rude, harsh and inconsiderate. Since most people expect an adult to speak during the conversations, when they fail to do so they are negatively evaluated for their interpersonal skills and social skills. 

To improve this, check out the 7 Social Skills worksheet for adults with mental illness.

Other people often regard adults with selective mutism as being intentionally resistant and distanced.  They believe selective mutism as “adamant refusal” rather than a response to overwhelming anxiety and constant state of worry.

Adults with selective mutism are unable to stand for themselves or speak for their rights when they are being overpowered by someone or they are being wrongly held for a situation.

Often the adults with selective mutism face the unpleasant consequences in daily life situations. They are unable to communicate their needs and their thoughts at the right moment to the right people.

Selective mutism among adults and associated disorders

The selective mutism in adults is closely related to the following disorders among adults:

  • Social anxiety disorder
  • Autism Spectrum Disorder

Researchers believe that social anxiety disorder is common among adults and children going through selective mutism. They believe that selective mutism is the avoidance coping strategy of adults to decrease their discomfort and anxiety with regards to social situations.

The comorbidity between the social anxiety disorder and the selective mutism disorder has a high incidence. Many researchers state that the symptoms and effects of selective mutism and social anxiety disorder overlap with a significance of as high as 100 (Dummit et al, 1997; Black & Uhde, 1995).

In the case of autism spectrum disorder, if the criteria of autism spectrum disorder is being met by the adults and the symptoms of repetitive movements are prominent then the diagnosis of selective mutism is not feasible for such adults. They might not speak in certain situations due to their  underdeveloped speech and communication skills. 

The causes of selective mutism in adults

Following are the various causes associated to selective mutism in adults:

  • Childhood symptoms of selective mutism
  • A genetic predisposition to anxiety
  • Overexcitability of the amygdala that result in inhibited temperaments
  • An increased fight or flight response
  • Behavioral inhibitions resulting in emotional distress and social withdrawal 

The treatment of Selective mutism in adults

The selective mutism in adults is an anxiety disorder. The treatment of selective mutism in adults depends on the following factors :

  • The individual’s age
  • Any comorbid mental illness
  • The level of anxiety associated
  • The intensity of behavioral response due to selective mutism
  • The motivation to change

Adults diagnosed with selective mutism need to have adequate accommodations at work and in other social settings so the disorder does not impair their routine life functioning. An alternative to speaking in such social settings could be written communication. 

Besides adequate accommodations, following strategies are of use for such individuals with selective  mutism:

  • Self modeling
  • Stimulus fading
  • Desensitization
  • Mystery motivators
  • Shaping
  • Spacing
  • Drug treatment
  • Psychotherapy

Self modeling

Self modeling involves talking to the self in the mirror and being a keen observer of one’s own self while speaking in front of the mirror. Another way to self modeling is based on watching recordings of self while speaking in various social situations to weaken the anxiety related to speaking in various social settings. 

Besides, the recording of an adult with selective mutism while conversing well in the situations that feel comfortable  can be played in the anxiety provoking situations to praise him or her for her speech and language abilities along with communication skills.

Stimulus fading

The stimulus fading technique is used to treat the uncomfortable aspect of the anxiety and constant worry in selective mutism. In adults with selective mutism the stimulus fading technique can be used by making the adult first communicate with a familiar person in an anxiety provoking situation. Once the person feels at ease, the other people gradually enter the environment and become part of the same environment. Hence, the anxiety provoking stimuli in the form of other people fade in with regard to the comfort level of the selective autism adult with the familiar person. 

Desensitization

The adult with selective mutism communicates with the people in the anxiety provoking situation through various other mechanisms that include whispering to a familiar person in presence of the anxiety provoking person, emails, letters, brief notes or text messages.

In this way the adults with selective mutism overcome their roadblock to effective relationships in social settings.

Mystery motivators

Mystery motivators are the various desirable items or activities that sound pleasant to the adults with autism. The adult is prompted to communicate verbally with the other people in an anxiety provoking situation and the positive change in behavior is regarded by positive reinforcement in the forms of mystery rewards that might be tangible or intangible.

Shaping

The adult with selective mutism is slowly motivated to speak in an anxiety provoking scenario. They are first reinforced for behaving appropriately by dis[laying adequate body gestures and non verbal behaviors and then assigned realistic achievable tasks to be achieved step by step. For example starting with a pleasant smile first, then greeting the people and eventually saying a few words or sentences. 

Spacing

Spacing strategy is related to the timing with shaping, mystery motivation and self modeling. Spacing is necessary to let the adult with autism integrate in the anxiety provoking situations. Repeated intervals or distant intervals with spacing are recommended ideally to observe a positive behavior change in the adult with selective autism.

Drug treatment

Drug treatment for adults with selective autism is suggested with the adults who believe they are unable to overcome their anxiety and the associated symptoms . Anxiolytics, Selective serotonin reuptake inhibitors and Fluoxetine are considered to be effective drugs of choice for adults with selective mutism.

The drug treatments often help by decreasing the anxiety levels among the adults with selective mutism and enabling them to focus more on the desired outcome. 

While being on medicine treatment, the adult with selective mutism also needs to take therapy to learn behavior modification and effective coping.

Counseling and Psychotherapy

Counseling and Psychotherapy is a treatment of choice for the adults with selective mutism. The counselling for adults with selective mutism focuses on the wellness of the individual by making him aware of the healthy coping strategies to overcome the anxiety related to the relative social situations. 

On the other hand the psychotherapy focuses on the underlying conflicts that give rise to the symptoms of selective mutism in adults and seeks to treat the dadult through successful conflict resolution and anxiety management.

The counseling and psychotherapy is majorly based on :

  • Cognitive behavior therapy techniques
  • Rational emotive behavior therapy
  • Social skills training
  • Psychoanalytic techniques
  • Solution focused problem solving skills
  • Emotional regulation
  • Positive psychology strategies

Conclusion

The current blogspot focused on the selective mutism disorder among adults. We learned the causes, symptoms and treatment of selective mutism. We also discussed the various strategies to modify the mutism in selective mutism in adults.

Frequently asked questions (FAQs): Selective mutism in adults

What causes mutism in adults?

Selective mutism among adults is caused by :

Childhood evidence of selective mutism
An increased anxiety level
Genetic predispositions
Dysfunctional amygdala 

What triggers selective mutism in adults?

The selective mutism is triggered by :

A constant state of worry in response to social situation or socialization
Negative thoughts related to anxiety and apprehensions
Fear of being evaluated or judged
Lack of self worth

What are the consequences if selective mutism is left untreated?

Following are the consequences if selective mutism is left untreated:

Functionally imapired social and executive life
Disturbed interpersonal relations
Low self esteem
Increased anxiety
Decreased subjective well-being

Citations 

https://www.nami.org/Blogs/NAMI-Blog/January-2017/Selective-Mutism-Frozen-in-Silence

https://www.asha.org/practice-portal/clinical-topics/selective-mutism/

https://www.anxiety.org/selective-mutism-in-teens-and-adults-treatment-and-accommodation

https://www.priorygroup.com/mental-health/selective-mutism-treatment

https://www.nhs.uk/mental-health/conditions/selective-mutism/

American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (Fifth ed.). Arlington, VA: American Psychiatric Publishing. p. 195. ISBN 978-0-89042-555-8.

 Dummit, E. S.; Klein, R. G.; Tancer, N. K.; Asche, B.; Martin, J.; Fairbanks, J. A. (1997). “Systematic Assessment of 50 Children with Selective Mutism”. Journal of the American Academy of Child & Adolescent Psychiatry. 36 (5): 653–660.

Black, B.; Uhde, T. W. (1995). “Psychiatric Characteristics of Children with Selective Mutism: A Pilot Study”. Journal of the American Academy of Child & Adolescent Psychiatry. 34 (7): 847–856.

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