Social Phobia/Selective mutism/Reduced communication

[piedpiper4]

Hi, I'm a newbie but I'm hoping that some of you kind and knowledgeable MN'ers will be able to help.
My dd (6.9) suffers from Social phobia. She has previously suffered from selective mutism, but with a lot of work she is now speaking. However, this is not what you would consider to be at a normal level for her age. She will speak when she feels able to-but this is not consistent ie. she might be able to say hello to her friends one day, but not the next.
Her social phobia means that she is frightened of people, and is now begining to display a new symptom: whispering when in public. Before she has always been able to talk to us normally, but not respond to anyone else.

My problem is that her peers are now begginning to pick up on her behaviour and have begun to 'mention' her lack of speech. It is also becoming more and more apparent that she is finding mixing with her peers and joining in at play time difficult ie. she stays with the teacher.

She is a very small school and has been in the same mixed class for 3 years. In September she will be moving class into a mixed year 3-6 class.
I have no help with this: I did speak to the primary mental health worker last year who was less than useless. Her current teacher is fantastic, but has had a hard time understanding the concept of reduced communication. However, after parents evening tonight I think she is now very concerned.

My questions are these:
*Does anyone have any ideas on how I can help reduce her stress further and help her to interact with her peers better?

*Can anyone recommend any avenues for help? I am reluctant to contact the PMHW again after last year, but will do if necessary.

Thanks for your help guys.

[AlysWho]

Does she have a diagnosis?
Have you been to your GP? sounds like she could do with some extra help at school, a GP could flag up issues to get other professionals involved, eg CAMHS, speech and lang therapists, Pedaitricians etc..Not heard of PMHW sorry.

[piedpiper4]

Hi Alyswho,
Thanks for your reply. She has never been formally assessed as I've been reluctant to go down that route. The first step towards this was the meeting with the primary mental health worker last year, which was arranged by the school nurse. I think the pmhw is part of the CAMHS team and the school nurse suggested I saw her as it would be quicker.
(I should add that I'm early years trained and have worked with children with these problems before).
However, whilst the pmhw confirmed she has social phobia she wasn't any help. In fact as she gave me the information she'd prepared she said 'I know this is going to be like teaching you to suck eggs but..'. I was devastated at the time as I really needed help, but hey ho. Luckily littley turned a corner then, it's the longer term impact that is now showing.

[mullymummy]

Hi there, you may find 'circle of friends' a useful intervention. It's a whole class approach which helps other children understand the child in question better and to think about ways that they think they can help. It requires an adult who knows about c of f to do the first session and group sessions but can be very effective. Sorry i haven't gone into more detail - currently breast feeding and typing with one hand!

[piedpiper4]

Hi Mullymummy,
Thanks for your suggestion, much appreciated especially when your busy:). I've had a quick google and sadly I don't think this will work for her. Being placed in such a social situation will be unbearable for her. She hates any attention being put on her at all.
C of F sounds a lovely idea though, thank you.

[mole1]

Hi

I sympathise as my dd1 who is 12 has similar difficulties which really began at around age 7 or 8. Since going to secondary school, it has become worse for her. We did go down the CAMHS route, partly because she has OCD type tendencies as well, and she is now on a waiting list for an assessment to see if they think she might have Aspergers. Overall I think she has selective mutism which affects her in school and out and about in the local area, but not away from our home town or at home, where she is quite lively and talkative! I've yet to find a solution to this, but school are about to start 1:1 sessions to try to improve her self-confidence/self-esteem. They also have a 'home room' at lunchtime where she can go if she feels lonely.

Does your dd socialise out of school with any friends or is she able to go to any out of school activities? Is there a particular friend that might be able to help her to join in at school? My dd had a close friend at primary school who, although very dominant of her, did help her to fit in - but the friend moved to a completely different area which has now left dd isolated.

Sorry that I don't have any solutions, but I feel maybe a formal assessment might be the way to access more help for your dd.

[pinkorkid]

I wonder if she would be able to access cognitive behavioural therapy. This is based on individual work with a qualified therapist with parents involved where appropriate. Our ds is 13 and has Asperger's; he is very uncomfortable in social situations to the extent that he refused to eat at school because of finding unstructured playtimes so stressful and eventually became too frightened to attend school. While we found he did not benefit from social skills group - too overwhelming, he has however responded really well to cbt and been able to reflect on feelings, thought and behaviours in a constructive way. We had a ridiculously long wait to access cbt via camhs - possibly more to do with local recruitment problems than anything else. But hopefully you might be able to get help quickly.

[mullymummy]

Hi again, I did think about the social implications as soon as I'd posted it! However, I do think it would benefit other children in the class if they had more understanding about your daughter and how to approach in a way that she won't find too scary (on their own, just smile or wave etc)

Perhaps she needs an approach which follows along the same lines as the techniques used for children with selective mutism.... no pressure put on her to speak, small steps - identifying just one very small change that she can make and moving on like that. CBT uses similar techniques to this too and would definitely be worth looking into further. If you can't access this through CAMHS you could have a look at a book called 'think good, feel good' which has some great ideas in it. The author has escaped my memory - Paul Stoppard or something I think.

[mullymummy]

It's Paul Stallard!

[piedpiper4]

Thanks for all your replies.
Mole1 I'm sorry to hear of your dd's difficulties. I'm glad the school are being so supportive.
Pinkorkid and mullymummy- I think that cbt may be a way forward, although I'm not sure if it's available for someone her age. (Don't know why I think that though...will have to check).
A lot of the work I have done with her up til now has been very cbt based, lots of desensitisation work etc. (DD had the associated SM toilet phobia and many a happy hour was spent visiting random 'scarey' toilets and saying 'see it's not scarey really':). Worked in the end though!)
Thanks again, it's really helpful reading your replies.

[devientenigma]

My son also has social phobia among other diagnosis. His psychiatrist has asked his psycologist to do CBT with him, however she is a bit reluctant that this will work. He's 10, however functions around 3 yo, so don't know if this is why.

[ilovesprouts]

hi my sons never spoke hes 4.3 makes me

[ButterflySally]

You could try the 'selective mutism resource manual' by alison wintgens and maggie johnson. It will help explain the condition to your child's teacher and contains loads of useful strategies that can be used in school and at home.

I would try and pursue a more formal assessment of your child - the first thing that comes to mind is CAMHS but if you've gone down that route and it hasn't been successful, I'm not sure where to go from there.

One idea that springs to mind is that SALTs in some areas work with SM as it affects communication so it may be worth accessing your local SALT services to see what they can offer. They can assess your child's communication as a whole so can consider your child's reluctant to talk in context of her communication skills in general. If they don't feel they can offer support, they may be able to refer on for you to the appropriate services in your area.

HTH

[ButterflySally]

Sorry, *reluctance

[piedpiper4]

Hi Guys, thanks for your responses.
Deviantenigma-thanks for the info. I don't know why, but soemthing tells me that cbt isn't right for children under 12. Possibly something I've read, or perhaps it's connected to this type of condition. Good luck with finding something that will help your ds.

Ilovesprouts- I'm really sorry to hear about your ds. I can imagine how sad that makes you feel. Even with all the problems dd has, at least I get to hear her beautiful voice at home. Good luck with getting something that will help your ds too.

Butterflysally- Thanks for the info. I use the resource manual (excellent book) and have taken it into school. I think it's been a question of time for them, as well as a misapprehension. Basically, I think they've been working under the assumption 'she's talking so no problems'. As she's getting older, it's becoming increasingly more apparent that this isn't the whole story, and I think they're finally beggining to understand that.

Thanks everyone for taking the time to reply.
PP

[plumfairy78]

Hi piedpiper4

I have a five year old boy, who within the last 6 months has been diagnosed with selevtive mutism. It has taken us a long time to get answers, I know he is only 5 but from a very early age things were brought to our attention by his nursery. It is a very long story and I suppose in a sense I am not being much help to you but it may help to chat being as we are going through similar experiences. Anway, I will keep it brief. When he started nursery at two, withinin six months they asked us if he could talk, which he didnt much at home as he was a late talker. Then he started playschool at 2 1/2 and still no talking. He began talking at home by three, but still not in public, nursery or playschool. This went on until he started school part time at four. Between the ages of two and four we saw health visitor, doctor, speech therapist and peadiatrian (sorry about spelling!). The weird thing was that the night before the health visitor came round it was on our local news about a girl that had selective mutism (we had never heard of it till then). First off we were told he may has aspergers and then later it was confirmed this wasnt the case. for the last 18 months we have been researching SM adn were convinced he had it but never mentioned it to any experts as we wanted them to come up with there own conclusion. We were then reffered to a speech therapist last October (who dischrged us first time round with no concerns) who told us she thought he had SM. We have now been reffered to CAHMS. I have been told they need alot of chasing up and after the first appointment about three months ago, we are now waiting for them to start their 'treatment' on him. Anyway, that was our procedure and he is very hard work to deal with in publice. He has been in school full time since Spetember & as yet hasnt uttered a sinlge word. When in public he will only whisper what he wants or what he wants me to say to people. At home he gives us a headache! I dont know how he goes a full day without talking! I worry myself to death all day every day & it is VERY hard work. My main fear is that on day he may become the victim of bullies. The teachers do say he is well liked by all other pupils and he has a best friend, goodness knows how they communicate! But i know if he doesnt get over it, the older he gets the harder it is going to get.

Like I say, I know I havent been much help. But you are not on your own and if you ever need help or support, we can be there for each other and compare, help and support.

N x

[wasuup3000]

For anyone wanting help or advice about selective mutism please register for full access on the website for leaflets and handouts, forum chat and general information : //www.selectivemutism.co.uk

Aspergers and Selective Mutism can go hand in hand piedpiper4 and Aspergers in girls can be subtle such as having strong interests in Ballet, Barbie or the colour pink for example - all normal interests maybe at 8 or 9 but not so normal as they get older.

[piedpiper4]

Just rechecked this and noticed the last two replies.

Plumfairy78- I'm pleased to hear you are getting the support you need for your ds. it sounds as if it's been picked up early, which will help immensly. Regarding communication with his best friend-are you sure they are not speaking? I know this may sound silly, but I have noticed (and not just with my dd, but with the 2 other SM children who I worked with before) that they do in fact talk to each other.
Watching my dd I can see that she struggles to 'trust' others, hence the SM. When that bond is made, she 'loves' them unconditionally and therefore has no need for the SM. She chatters to her best friend (in school etc) like there's no problem at all. Another reason why the school says there's nothing to worry about.
wasuup3000 thanks for the link. I have looked at the website before. I'm as sure as I can be that dd doesn't have Aspergers. I have worked with AS children before, and she isn't showing any signs. She has no 'strong interests' of a nature that would concern me.

[piedpiper4]

Thank you MC- it's great to hear your dd is now speaking.

I do believe there is a huge 'now or never' process that goes on inside SM children. My dd was totally mute in pre-school. We'd had meetings with her reception teacher before starting school. She even came and visited dd in her pre-school, and we all expected her to be mute when she started school. From the very first moment she stepped into the classroom, she spoke. We were all amazed, but it was if she decided 'if I don't do it as soon as I walk in, I never will'. She's never spoken properly (has had reduced communication), but was never totally mute in school. That was a huge leap forward, but again has stopped the school from taking this totally seriously.

I like the idea of the tape. Unfortunately, my dd is nearly 7, and although she has begun to be able to express what it means to strruggle with speaking, I think she is too young to really be able to explain what is going on yet. The other children in the class are still asking why she doesn't speak. 2 of her close friends asked me this week in fact, but I think SM is so hard to understand if you're not living it.

She is beginning to be able to wave to people and acknowledge when people say hi. She now has a huge sense of pride when she can do this, as she acknowledges this was impossible 6 months ago. She can now speak to her Grandad, again impossible a year ago. Before we go shopping, I remind her to try and speak up and, although she is still whispering, she is trying to speak louder. These are small steps, but they seem huge when you're fighting something like this.

The school situation was really bad at the end of last half term, but seems better atm (touch wood). She's had 'ishoos' with her best friend, but they seem to be resolving now. Mainly because dd listened to the advice we gave her and refused to wait around for her friend to play. Big steps for a littley with little confidence. I can't tell you how worried I was last term, but how proud I am of her this one. (I'm always proud of her, just even more so for showing so much courage going through this).

I know the person that my daughter shows to the world is so far removed from the person she really is. Gradually, I just have to find a way to move her through this....small steps and all that.

Phew...sorry this is so long!