Children who talk at home, but are unresponsive to others at school or in public for at least a month might have selective mutism (SM), an anxiety disorder, the Selective Mutism Association of Taiwan said on Sunday.
One in 140 Taiwanese schoolchildren has SM, but the resources for treating the disorder are limited, the association said, adding that it invited Ruth Perednik, an English-born Israeli psychologist and pioneer in the field, to give a lecture on Sunday about how to care for children with SM.
SM has an incidence rate of six to eight per 1,000 people — not a low rate — and is marked by an inability to speak out in certain environments, even when called on by a teacher, said Ministry of Health and Welfare Department of Mental and Oral Health Director-General Chen Li-chung (諶立中), who attended the lecture in Taipei.
These children are often viewed as shy introverts and are more likely to be bullied at school, he said.
Many believe the behaviors exhibited by children with the disorder are taught by their parents, while many parents think their children just do not like to talk and therefore do not require medical attention, Chen said, adding that he has not treated a single SM patient in his 30 years as a practicing psychiatrist.
Lin Tzu-hsin (林姿杏), a special education teacher at Tuku Junior High School in Yunlin County, said she has taught six students with SM over the past three years, most of whom were diagnosed after showing learning disabilities, meaning that students with SM who have good grades are difficult to identify.
Most students will take out their books and materials after sitting down in the classroom, but students with serious SM will sit straight in their seats without moving, only reacting when their teacher gives them instructions, she said.
The students’ classmates often think they are strange for sitting still, not talking and not making facial expressions, while some teachers will mistake their behavior for deliberate insubordination, she added.
However, in situations they find comfortable, such as at home or in a familiar environment, they will act and talk normally, Lin said.
Perednik said she became interested in SM after her then-four-year-old son was misdiagnosed and mistreated after he suddenly stopped speaking outside the home.
The onset of SM often occurs between two and six years old, and is slightly more common in girls, she said, adding that affected children feel anxious when they are asked to speak and relieved when they try not speaking.
SM can be categorized into four types in order of severity. Children with the mildest form speak selectively or whisper in certain environments, while those with more severe forms are unable to communicate verbally, but can respond with body language. The most severe type is typified by a stiff posture and lack of facial expressions.
Children with SM might seem totally different at home than at school, cannot express themselves and are tense in some environments, so if the condition persists for more than a month, parents should seek medical attention, Perednik said.
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