Chirpy at home, silent in kindergarten

At home at breakfast, Lea was still talking happily to herself and even sang a song from the Chindsgi to her dad. But as soon as she arrives at kindergarten, she seems to have flipped a switch. She seems petrified as soon as she enters the cloakroom and doesn't say a word for the whole morning. Only at home at lunchtime is she the carefree Lea of the early morning again.

Every kindergarten group is a colourful ensemble of little personalities. While some jump straight into the daily routine at kindergarten, others take longer to settle in. Sometimes, however, there are children like Lea who, even weeks after starting kindergarten, still stand petrified on the sidelines, don't get involved and stand out for one thing in particular: They don't say anything.

While shy children thaw out after a while, selective mutism, unnoticed and untreated, can intensify over time.

They don't play with other children, don't interact with the teacher, don't even say when they need to go to the toilet or have hurt themselves. If they are spoken to, they look down at the floor as if frozen. As soon as they return home, it seems as if nothing has happened.

The question of whether the child is simply very shy seems justified at first. But what if they can't make a sound even after weeks in kindergarten? As a teacher or parent, how do you know whether there is more to the supposed shyness? And what should you do if the child just won't come out of their shell?

Shyness passes

«If a child doesn't speak at all over a longer period of time and doesn't get involved in everyday kindergarten life, selective mutism may be behind the supposed shyness,» says Sabine Laerum, certified mutism therapist and speech therapist from Zollikon ZH. If nothing has changed in the child's behaviour after around four weeks, the therapist therefore advises not to hesitate for long, but to take a closer look.

Selective mutism is still a relatively unknown phenomenon, a disorder that is often categorised as an anxiety disorder. Affected children speak in familiar surroundings - for example at home with their parents - but fall silent in environments and in front of people who are unfamiliar to them.

«It is the inability to speak in specific situations, even though the ability to do so is present,» explains Siebke Melfsen, who researches selective mutism at the Centre for Child and Adolescent Psychiatry at the University of Zurich.

The earlier you recognise the disorder and intervene, the easier it is to resolve the mutism.

There are no exact figures for Switzerland; internationally, the number of children affected is somewhere between 0.2 and just under 2 per cent, depending on the study, and the number of unreported cases is high. Siebke Melfsen cites the interplay of genetics, psychological factors such as high sensitivity and social influences as the cause of the disorder. However, there is no consensus among experts as to the causes and risk factors.

There is a consensus among experts that it is treacherous to assume that shyness is the cause. «Quiet children don't disrupt lessons and don't attract much attention at first,» explains Sabine Laerum. Selective mutism is therefore often confused with extreme shyness and not recognised as a consequence.

The crucial difference, however, is that shy children thaw out after a while, while selective mutism, unnoticed and untreated, intensifies over time. This is why it is important to recognise the disorder early on. «It is then much more difficult to turn things around at school,» says the therapist.

Transitions as triggers

Many of the children affected do not make any noises, their facial expressions and body language seem petrified. Psychotherapist Babette Bürgi Wirth from Zurich explains that it is no coincidence that the symptoms of the disorder often appear in kindergarten. «They usually occur when the child enters a completely new environment for the first time, a new world.»

Children with selective mutism react strongly to changes of place, person and activity.

Sabine Laerum, speech therapist

This means that other major changes can trigger the disorder in addition to the start of kindergarten. For example, children can already show symptoms at the age of two to three when they go to playgroup or nursery. However, they are generally less noticeable there, as many children are just starting to speak at this age and talking is not expected there to the same extent as later in kindergarten.

«Children with selective mutism react strongly to changes of place, person and activity,» says Sabine Laerum. Factors that are new in kindergarten. There, affected children are confronted with everything they struggle with the most: their sensitivity to new things, their inhibited temperament and their predisposition to anxiety .

«Coming to kindergarten with this is a hot mix, everything comes together,» says the therapist. As a result, the children live in two worlds: one in which they speak and one in which they are quiet.

Do not apply pressure

Silence is not only evident in the chindsgi, but also in other situations where speaking is expected. This could be simple small talk with the neighbours or with the waitress in a restaurant. However, pressure is the wrong way to get a child to talk, says Laerum.

As silence is not voluntary, it does not help to demand that the child speaks, but rather silences the child even more. However, the other extreme, such as ignoring the child or always answering by proxy, is also not beneficial. This may make everyone feel better at first, but the child is unable to make progress in this way.

The child is quickly ignored in the group if it cannot speak and experiences great stress.

Barbara Meile, kindergarten teacher

Barbara Meile is a kindergarten teacher in Männedorf ZH and taught a mutistic child. «I wasn't enthusiastic at first and had doubts as to whether it would work because I didn't know anything about it.» The biggest challenge was that the child was unable to participate in the circle and was not listened to, she reports.

Affected parents often put off

«Social integration was difficult, the child was quickly ignored and couldn't defend herself.» Barbara Meile was also afraid of doing something wrong. «If you ask questions in front of the group and the child can't speak, it experiences a lot of stress. It was a balancing act between exerting as little pressure as possible and giving enough input to enable progress,» she says. Thanks to the collaboration with a speech therapist and a therapist who were familiar with the phenomenon, they were ultimately able to help the child make good progress.

The sad thing for the children is that they want to speak but can't. «Communication is our superpower,» says Sabine Laerum. «These children suffer greatly because they can't get a word out.» That's why it's important to raise awareness of this phenomenon. The fact that this is absolutely necessary is shown by the obstacles that stand in the way of affected children and their parents due to a lack of knowledge. The fact that selective mutism is often mistaken for shyness is only part of the problem.

Even if parents suspect that something is wrong, they are often put off by experts and told to wait and see. «This wastes valuable time and the problem only hardens,» says Sabine Laerum. She often experiences that parents have a gut feeling for a long time that is not taken seriously.

Doing nothing is not an option

According to Siebke Melfsen, the fact that children often receive incorrect diagnoses is initially due to the fact that knowledge about social anxiety and shyness, which are similar in appearance, is much more widespread. Sabine Laerum also cites the concurrence of several disorders in mutistic children as a reason why they often receive the wrong therapy or none at all.

«Many children have social anxiety or a speech development disorder in addition to mutism. The silent behaviour is then attributed to these problems and not recognised as an independent disorder. These children are then often seen as socially phobic or simply as having limited speech and thus receive the wrong or no mutism-specific therapy,» explains Laerum.

Early diagnosis and therapy is crucial. The earlier you intervene, the easier it is to resolve the mutism. «This step is often missed with selective mutism. And the longer the children remain silent, the more it becomes ingrained.»

Parents should therefore seek therapeutic help for their children whenever possible, says Andrea Muchenberger, Head of the Support and Integration Centre at the Department of Education of the Canton of Basel-Stadt and co-editor of the newly published book «Das stille Kind ist das vergessene Kind». «Children often suffer well into adulthood and are unable to fulfil their potential as a result. Their quality of life is enormously restricted,» she says.

Difficult search for help

A reliable diagnosis can be made by a specialist who is familiar with selective mutism. This could be a psychologist or psychiatrist, or a speech therapist who has completed additional training in this field. In reality, this means that not all professionals from the above-mentioned fields are familiar with selective mutism.

«There are those who are familiar with selective mutism and those who know nothing or very little about it,» says Muchenberger. There is therefore no guarantee of finding the right person based on their specialist training alone.

Selective mutism is curable, no child should have to live with it.

«It is more important that the person counselling the parents and child has an idea of selective mutism and that the parents have somewhere to go. Whether this professional help ultimately has a psychological, speech therapy or psychiatric background is not initially relevant. However, as selective mutism is very often associated with other problems, networking between the disciplines is important. If you know something, you do something.»

There are various therapy approaches in Switzerland, the respective representatives appear to be well networked and, despite sometimes quite divergent approaches, have a common goal: to get the child to speak. According to Babette Bürgi Wirth, speech therapy is recommended if there is a speech development disorder in addition to mutism. Psychotherapeutic support, on the other hand, is preferably chosen for mutistic children who also suffer from social anxiety, separation anxiety or other disorders.

Due to the shortage of psychotherapy places and speech therapists, it is not possible to rely on the ideal therapy, says the expert. «It's simply not always as organised as it would ideally be.» If no therapeutic support can be found for the time being, you should try to work with caregivers from the daycare centre, kindergarten or school as a stopgap. «The main thing is to help the child,» says Bürgi Wirth.

Further clarification is needed

There is a great deal of uncertainty, which is why Sabine Laerum wants to encourage teachers and special school teachers to take their own suspicions seriously and discuss them with the team. Parents should also have more confidence to listen to their gut feeling.

It is still a phenomenon with many unknowns, and awareness of selective mutism needs to grow, experts agree. Parents and teachers need support so that action can be taken more quickly if it is suspected.

There needs to be easier access to support services, more therapy places, an increase in the number of speech therapists and, in the long term, standardised inclusion of the topic in curative education training. And most importantly: selective mutism is curable, no child should have to live with it. In order for it to be supported in all areas of life, it is essential that all adults involved pull together with confidence.