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MUTISM, ELECTIVE MUTISM, SELECTIVE MUTISM
By Svea Gold
(Names of the children are altered.)
Without Samuel the term elective mutism would have had only a fleeting interest for me. What I knew about it came from a fascinating chapter on the subject in Sally Goddard´s book "Reflexes, Learning and Behavior".
And then came Samuel, five-year-old twin boy of one of my friends. For a whole year Samuel never opened his mouth in pre-school. If the teacher tried to find out if he had learned what she had tried to teach, there was no reaction. The parents did not particularly worry about this, because when he came home, Samuel would cheerfully tell his mother everything that went on in class, and showed her what he had learned. Obviously, Samuel was not stupid!
Then came kindergarten. The twins were placed into different classrooms, because otherwise the boy twin would usually follow whatever his sister told him to do. Thus, when the two were separated, it became obvious that there was a huge difference in their behavior. The little girl took an active part in class, and played with others during recess. Samuel never talked in class and in the schoolyard just stood motionless on the sidelines.
At this point the parents finally asked me to look at the children. As the parents watched, I did the "Quick Functional Screening" (This is available for downloading on our fernridge.com website.) It became obvious that the neurological function of the boy lagged behind that of the girl. (As if we did not know that already.) Since the girl had some problems with eyes that did not work together as did an older sister´s, the family decided to do the entire neurodevelopmental program together it would be more fun that way.
In less than three weeks, the mother reported that Samuel was raising his hand in class, asked and answered questions. He asked to be on stage to sing with the Christmas choir.
Once the mother walked into the classroom to find Samuel sitting at the front of the class. "What happened" she asked "Did he do something wrong?" "Oh, no," the teacher said, "He´s telling a joke!"
What had happened? DSM IV identifies elective/selective mutism as "the persistent failure to speak in specific social situations, (e.g. school, with playmates) where speaking is expected, despite speaking in other situations."
Sally Goddard looks at these symptoms, not from a psychological point of view, but from a neurological one. Her approach (that of the Institute of Neuro-Physiological Psychology where she is a director) is to look for reflexes that should have disappeared and reflexes that should be there and are not. This provides a roadmap to find out what is happening in the brain. She relates the first symptom, the inability to speak, to a retained fear paralysis reflex. This is an early reflex that exists in utero. It is eventually transformed into the Moro reflex, but never fully disappears. When we are faced with a sudden shocking situation we may freeze Ð totally unable to move. (I refer to it as the "frightened deer" reaction. When you come across deer they won´t just run away, they stand there, completely still. It´s not that they are brave Ð they can´t move. It´s a protective mechanism, because an immobile target is harder to see for a predator.)
Essentially what Goddard is saying, is that the child does not "elect" or "select" whether or not to talk; under certain circumstances the child cannot talk. Now Goddard takes an entire chapter to explain the function of the fear paralysis reflex in inhibiting the breathing apparatus that is needed to start speech. She goes on to say that if the fear paralysis reflex persists, so probably does the More reflex. The Moro reflex is the first reaction a baby has when there is a sudden noise, a sudden change in position, or a switch from hot to cold. The arms fling out, and then close back over the chest and the child screams.
When the Moro reflex is still in existence, the child may not actually have these movements, but is constantly busy keeping them from happening. This child is in constant overload from many stimuli that other children can simply ignore. As a result there will be the behavior problems that DSM IV describes as secondary characteristics: Excessive shyness, fear of social embarrassment, social isolation and withdrawal, clinging, compulsive traits, temper tantrums or other controlling or oppositional behavior, particularly at home.
In the case of Samuel, we had a special difficulty in identifying the problem because Samuel is the child of first generation Chinese parents, and it was hard to tell if his shyness was simply a culturally expected subdued behavior or really a problem that could be cured. The saving situation in this case was that the girl twin was quite different, so that ruled out the first possibility.
DSM Diagnostic and Statistical Manual of Mental Disorders is published by the American Psychiatric Association The function of DSM is to give a name to psychological problems so that doctors and lawyers can use these terms to identify them legally in court or an insurance application. Sally Goddard, however, in Reflexes, Learning and Behavior identifies mutism in terms of neurological reactions that influence how the child responds to his surroundings.
Are there emotional factors that would cause the mutism? Since trauma also leaves an imprint on the brain this is entirely possible. The change in the brain, however, still has to be addressed. I had experience with a different case of "elective mutism" at a time when I was still not aware of the term. I was then doing a hands-on neurodevelopmental program with about fifteen juvenile delinquents and at-risk boys. Work sessions with these kids were pretty exhausting, so when at the end of the day the probation officer asked me to evaluate still one more boy, I groaned. When I walked into the room, the teenager was filling out a form. It was almost painful to watch the awkward way he held his pencil. As he continued to write, his head came so close to the desk his nose almost touched the paper. This was a clear sign of a retained symmetrical tonic neck reflex. That symptom alone told a story of the boy´s neurodevelopmental delay! I turned and walked out " I don´t even have to test him!"
Harry had a childhood history that could make you cry. His mother told me that she stopped his father from using a pillow to suffocate the baby by hitting the man with a frying pan, at which point he threw both of them down the stairs. At age three the boy was shunted to Canada to be raised by his grandparents. When he was thirteen, unceremoniously and without warning, they threw him out: first to live with an aunt, then to live with his Mother and a strict stepfather. His academic skills were practically non-existent. No wonder he was always in trouble in school! There are enough emotional factors involved here, that is was hard to separate the neurological ones from his psychological ones.
Harry, short and fat, did not walk he rolled. And Harry barely talked to anyone. Actually it took about three weeks of the neuro-developmental program and Harry started to walk like a normal human being. But Harry still did not talk. He did the exercises they were ordered by the Court without comment: but then one day he simply refused.
So I took a pad of paper and said: "Let´s look at what you´re mad at. I´m going to write it down and then give you the paper. "To start," and I wrote it down, "you are mad that you have to be here with this old broad. Number two, you hate doing the exercises. Number three: You would rather go home instead of coming here after school. ...Ok, now it´s your turn. What else are you mad at? "
"I don´t know."
"OK, say it again. Say, I don´t know, I don´t know." He repeated that, and finally it came out. "I am mad at my stepfather."
" Ok, what else?"
The anger did not all come out at once, and not wanting to push him too far, I stopped after two or three revelations, folded the paper and gave it to him. And he was willing to work again.
Harry received no psychotherapy, counseling or other emotional help besides the support of those of us who did the developmental program. He lost weight and started to grow the movements and the sensory input stimulate growth hormones. It only took another week or so and Harry started talking. The delightful part was that once he started to talk there was no stopping him. I had to explain to his teachers that Harry had never been allowed to be three years old and was now catching up. What I did not understand at that time, was that this mutism was not only disappearing because of my periodically helping him let out his anger, but also because of the neurological changes that we had created.
(As part of the program we do trigeminal stimulation. By stroking the face, under the chin, across the ears and into the scalp, we stimulate parasympathetic nerves. This pulls the child out of the "Fight or Flight" mode. It also desensitizes the nerves that trigger the fear paralysis reflex. Not only that, but touching the skin over the ear lobes stimulates the facial nerve, which among other functions also controls the stapedius muscle. This is the tiny little muscle that when there is either a loud or a sudden noise, pulls the ossicles -- the tiny bones inside the ear-- away from the eardrum to protect the child from the full impact of the sound. Thus, when that muscle becomes more active, we also decrease the sensitivity of the child to sound.)
Both emotional and the neurological aspects have to be dealt with at the same time. As we do a neurodevelopmental program, we start allowing the two sides of the brain to function together. The corpus callosum has two functions: to carry messages across from one side to the other and also to inhibit messages from going across. Thus when the developmental movements make new connections between the two sides, many "repressed" emotional traumas become conscious. Dreams become vivid and memories long hidden may emerge. When that happens, we must help the child deal with these. Some of this could be done during the period when we helped the delinquents with their exercises, but we always had a counselor available for the child and also for the parents who had to cope with the new person who was emerging.
Neurological difficulties create problems for the child we must pinpoint those to be able to help. Some psychological problems may create neurological difficulties. We must not only be aware of that, but undo the neurological damage as well. Whether there are neurological problems or psychological traumas they create metabolic problems -- we used to call them psychosomatic. Now that it is generally accepted that the brain is plastic, we have new ways to remedy them.
Little Samuel´s mutism has disappeared, but this is only the beginning. We are still working on giving him the most control and the best functioning brain that he needs to succeed in life. In the meantime, we learn from him, just as we learn something new from every other child.
© Copyright 2003 Svea Gold. All Rights Reserved.
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