Can a child with dyspraxia also have selective mutism, and how might it be diagnosed

[AdelaofBlois]

DS1 finds speech hard, but it increasingly seems to us that he is very different to other kids in other ways as well, particularly in social situations. He is clearly capable of empathising well, and ASD has been ruled out.

The description of selective mutes seems quite applicable to him (except he does smile in some circumstances and is not really 'stiif and awkward')-basically huge awkwardness but also empathy and inquisitiveness.

His langauge is less advanced and much more disjointed when in situations outside the home-is a disjuncture an indication, or is all this just a speech problem? Anyone had a child with a speech problem and worried about these other issues-how do they investigate and separate the two? For those of you whose DCs suffer form this horrible anxiety, is it so much more noticable than we owuld think-total paralysis and terror?

Sorry, hate playing guess the SN, but he is really very odd...

How old is your DS?

Sorry, message got sent before I meant it to and I hadn't finished.

My DD has SM, but her level of anxiety varies in different situations and has varied with her age too. Even after she was diagnosed I had doubts, because she wasn't at all anxious-looking in situations where she wouldn't speak. At playgroup she would run up and tug on the teacher's clothes to attract attention, play, giggle and join in fully but she just didn't speak. In less familiar situations she would hide behind me, and even now age 9 she still sometimes freezes up in a difficult situation.

With SM it can vary from a reluctence to speak to totally freezizng. Some children's SM is more generally similar to a phobia such as spiders for example - until you actually see a spider then you are fine and simarly in SM until yuou have to speak you are fine.
Has an EP assessed your childs cognitive ability and has Non Verbal Learning Disability been ruled out as well as ASD?

DS is 3.6 now. He has a speech disorder 'consistent with 'oral dyspraxia', characterised by very inconsistent use of sounds (his speech is thus hard to make out) and by a very monotonous slow stringing together or words. He does, however, have an above average vocabulary for his age.

Obviously, being unable to speak clearly may produce an unwillingness to speak, but the following also seem to mark him out: (a) he does not like eye-contact when speaking, although is happy to make and maintain it when physically playing (b) he will often ignore others-adults and children-when entering a different environment, taking five of six minutes to stand in silence and 'reset' himself (c) he will avoid unknown adults or children if his parents or brother is around, even if they address him directly and can seem really rude (d) sometimes he won't talk at all-especially about feelings or when there is no right answer-usually just starring into space and clamming up or occasionally uttering distracting non-sequiturs (e) his speech at nursery is very much less complex than at home and (f) he often resorts to initiating conversation along 'known lines', for instance asking the same 'why' question he'd asked before, then giving the answer himself if asked 'why do you think?' back-as if he wants to talk but not to talk freely. Two parents I know who's children have SM describe almost the same-although they know because language is fine elsewhere. At the same time, he is empathetic to others (from toys through animals to needs of other people), inquisitive and very physically loving and gentle (he has a younger brother). He hasn't seen an EP but SOGS gave above average congnition skills and everything else where it should be.

All that adds up to a fairly potent combination of odd semi-rudeness which is on the borders of age-appropriate, may be caused by his speech problem, but also seems to go somewhat deeper.

Are we worrying about nothing, what have we missed?

It is possible to have both dyspraxia and SM. It's not uncommon for children with SM to also have additional communication needs as well.

I presume if he has speech difficulties, a SALT is involved. It would be worth discussing your concerns with the SALT to see what they think. They will be able to consider it in relation to his overall skills and needs across the areas of speech, language, and social communication. There can be a range of reasons for difficulty with communicating, other than speech, and it would be interesting to see if the SALT thinks that he has difficulties in areas such as social communication/social interaction. If they feel there is an element of anxiety underlying his difficulties with talking, it would be worth asking them for a referral to CAMHS. Whilst a SALT can provide support and advice with the issues that relate to communication, CAMHS deal with underlying anxiety issues.

HTH