In the DSM-IV selective mutism is described as a rare psychological disorder in children. Children (and adults) with the disorder are fully capable of speech and understanding language, but fail to speak in certain social situations when it is expected of them. They function normally in other areas of behaviour and learning, though appear severely withdrawn and might be unwilling to participate in group activities. It is like an extreme form of shyness, but the intensity and duration distinguish it. As an example, a child may be completely silent at school, for years at a time, but speak quite freely or even excessively at home.

The disorder is not regarded as a communication disorder, in that most children communicate through facial expressions, gestures, etc. In some cases, selective mutism is a symptom of a pervasive developmental disorder or a psychotic disorder.

In diagnosis, it can be easily confused with autistic spectrum disorder, or Aspergers, especially if the child acts particularly withdrawn around his or her psychologist. Unfortunately, this can lead to incorrect treatment.

Selective mutism is usually characterised by the following:

The person does not speak in specific places such as school or other social events.
The person can speak normally in at least one environment. Normally this is in the home.
The person's inability to speak interferes with his or her ability to function in educational and/or social settings.
The mutism has persisted for at least a month and is not related to change in the environment.
The mutism is not caused by another communication disorder and does not occur as part of other mental disorders.

The former name elective mutism indicates a widespread misconception even among psychologists that selective mute people choose to be silent in certain situations, while the truth is that they are forced by their extreme anxiety to remain silent; despite their will to speak they just cannot make any voice. To reflect the involuntary nature of this disorder, its name has been changed to selective mutism in 1994. However, misconceptions still prevail; for instance, the ABC News erroneously attributed the cause of selective mutism to trauma and described it as willful in a report dated May 26, 2005.

The incidence of selective mutism is not certain. Owing to the poor understanding of the general public on this condition, many cases are undiagnosed. Based on the number of reported cases, the figure is commonly estimated to be 1 in 1000. However, in a 2002 study in The Journal of the American Academy of Child and Adolescent Psychiatry, the figure has increased to 7 in 1000.

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Schools That Heal: Real Life Solutions
From Childhood Education, 7/1/03 by Varnell, Joy

SCHOOLS THAT HEAL: Real Life Solutions. Lesley Koplow. New York: Teachers College Press, 2002. 231 pp. $17.95 paper. "If we value the children who attend our elementary schools and want to be realistically hopeful about the people they will become as they move through middle school and high school toward young adulthood, we can no longer leave their emotional well-being to chance," writes Lesley Koplow in Schools That Heal (p. 16).

Koplow challenges educators to make schools places of healing for children who come to school with emotional damage. She believes that teachers, principals, and clinicians have clear-cut roles in that endeavor. Koplow, a psychotherapist and the Director of the Center for Emotionally Responsive Practice at the Bank Street College of Education, has written several books on the mental health of children.

Koplow's premise is that we cannot teach children who are so emotionally bruised that they are unable to attend to their lessons. She writes about understanding children's social and emotional needs and discusses how to read children's signs of distress. For example, abused children often cast one adult as "all bad" and another as "all good." Although depression may be exhibited in "low activity levels, sleepiness, lack of interest and motivation and sad affects similar to a depressive picture of an adult," Koplow notes that "most children who are depressed also present a different constellation of symptoms. These may include teasing and provocative behavior, hyperactivity, evidence of low self-worth, isolation from peers, performance anxiety, aggression, irritability, intolerance of others, encopresis, selective mutism, reckless behavior, and suicidal and homicidal ideation expressed in the form of fantasy" (p. 26).

A unique feature of this thorough and well-organized book is a 10-- session model of staff development on emotionally responsive schools, complete with handouts. Koplow also challenges policymakers to see the emotional needs of their students and to act to mend them. For example, she describes an emotionally responsive classroom as one where the teacher creates an environment in which children feel welcome to express themselves, and at the same time sets boundaries of self-expression and behavior that maintains a feeling of safety for all of the children.

This is a timely book that addresses a need of which educators have long been aware, but perhaps did not fully understand. Koplow makes the consequences of emotional illness crystal clear. Children who have been damaged emotionally exhibit a range of developmental, psychological, and academic problems. These children often are hypervigilant, unable to concentrate or attend to neutral stimuli, and may be unable to develop trust. Children with such limitations are distinctly disadvantaged not only in school, but also throughout life. Koplow's ideas have the potential to help schools heal our children. This book should become required reading for educators and policymakers. Reviewed by Joy Varnell, Doctoral Student, Azusa Pacific University, Azusa, CA

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