Madeleine Vieira 9/22/22 Madeleine Vieira 9/22/22

Navigating Social Anxiety with Selective Mutism: Using a CBT Approach

A diagnosis of social anxiety with selective mutism (SM) can be hard to navigate.

Especially if you’re an extrovert or you just enjoy social interactions, it can be hard to put yourself in the shoes of a child that feels intense anxiety in those same circumstances. Or your child may not be able to articulate their feelings and tell you exactly what’s wrong when you go out in public.

This article will not only give you a better idea of how to spot this disorder but also the best methods for treating it.

Let’s dive into it.

A diagnosis of social anxiety with selective mutism (SM) can be hard to navigate.

This article will not only give you a better idea of how to spot this disorder but also the best methods for treating it.

Let’s dive into it.

Signs and Symptoms

So, how can you spot a child that may be struggling with social anxiety with selective mutism? The symptoms are quite similar to many anxiety disorders with the differentiator being that the anxiety is brought on or worsened by social situations.

The ‘selective’ in selective mutism means that it only happens in certain situations. The child is physically capable of speaking and forming words, but they feel such intense anxiety in certain situations that they are unable to speak.

This disorder can also involve intense fear even when just thinking about or anticipating social situations. So, parents may notice that their child stops speaking while at home when they know that they will be leaving soon for some social event.

This can seem confusing at first since their home also seems to be their safe place. Sometimes it is necessary to take a step back and examine the full situation to understand how a child may be feeling.

Other emotional symptoms of this disorder include:

Intense anxiety or panic in or about social situations
Refusal to participate in social situations
Temper tantrums
Fear of embarrassment or judgment
Expecting the worst possible consequences during social situations
Inability to interact with strangers
Lack of self-confidence
Difficulty concentrating in various settings

n addition to these emotional symptoms, a child may also experience various physical symptoms independently or as a result of their anxiety. These include:

Heart palpitations or a racing heart
Trembling
Difficulty breathing
Feelings of weakness
Excessive sweating
Fatigue
Headaches
Stomachaches
Difficulty sleeping

When any of these symptoms begin to interfere with a child’s ability to function normally, help from a professional is needed.

Causes and Risk Factors

The causes and risk actors of SM are similar to those of many other anxiety disorders. The three main risk factors are a predisposition, genetic influences, and a child’s environment.

Predisposition is the fact that some children, because of their personality or other factors, are more likely to develop SM and are less capable of handling stress in a healthy way. It may take less severe events to trigger the onset of anxiety episodes or the disorder as a whole.

Our genetic makeup also influences mental health. If a child’s parents or other people in their family tree have mental illnesses, specifically anxiety disorders, then a child is more likely to develop SM.

Certain environmental factors can also bring on a mental health crisis. These factors could include embarrassing social situations, overly controlling parents, others in their home having a mental illness, attending a new school, or being bullied. Any event that brings trauma can also bring on an anxiety disorder.

None of these factors mean that a child will for sure develop social anxiety with selective mutism, but they do make it more likely to happen.

Treatment Options

If your child is struggling with symptoms of social anxiety or has been diagnosed with social anxiety with selective mutism, there are multiple treatment options that you can consider.

Cognitive-Behavioral Therapy

Cognitive Behavioral Therapy (CBT) is the most recommended and evidence-backed form of treatment for anxiety disorders. CBT helps children identify their thought patterns and recognize how those thoughts may be helping or hurting them.

CBT can guide a child to see how what’s happening inside their heads translates into their behavior. A mental health professional will help a child use relaxation techniques, role-playing, and positive self-talk to help them face and conquer their fears.

One of my upcoming children’s books addresses social anxiety with selective mutism in specific. Darcy Deer Is Afraid to Talk, Sometimes! follows Darcy Deer as he wants to perform in the school play but is very worried that he won’t be able to say his lines. Darcy uses a science-proven, stepladder approach to face his fears.

A stepladder approach, or Graded Exposure, slowly and systematically helps a child face their fears and learn to manage the symptoms of their anxiety. It involves gradually taking on tasks that cause increasingly more anxiety. Throughout the process, a child would use the coping skills that they learned in therapy.

A child that is receiving CBT for a diagnosis of social anxiety with selective mutism will relate to Darcy Deer. They will see the hard work that he is putting into managing his symptoms. This might help them feel less alone and more confident in their ability to overcome their own anxiety.

Darcy Deer Is Afraid to Talk, Sometimes! can also be a great resource for parents. Each book contains an About Anxiety page, a Coping Strategies page, and a Stepladder page. This information will you better understand your child and give you concrete ways to help them

Darcy Deer Is Afraid to Talk, Sometimes! will be available late 2023.

Anti-Anxiety Medication

In some cases, a child may not respond as well as hoped to CBT. If therapy options have been exhausted, your child may be prescribed anti-anxiety medication. Medication can be very helpful for some children, but the benefits and risks should be weighed carefully by the parents and a child psychiatrist before medication is given.

Social anxiety with selective anxiety can be tricky to navigate and understand. Oftentimes, figuring out exactly what’s wrong is the biggest obstacle. With the right support and therapy, almost all children are able to cope with this disorder and even push beyond it and thrive.

For more tips and insight on child mental health, be sure to subscribe to my newsletter or check out my podcast Genius Little Minds.

References

Madeleine Vieira 5/17/22 Madeleine Vieira 5/17/22

More Than Childhood Fear: How to Identify and Address a Specific Phobia

Many children hang on their mother’s leg with apprehension on the first day of kindergarten. Other children struggle to sleep some nights because of the monsters they think are under the bed. Or maybe the trip to the dentist each year is a source of anxiety for your child.

These are all normal childhood fears. They are specific to one experience, and they can be worked through, and the child quickly moves on from them.

When a child’s fears become disproportionate to the actual situation and are long-standing, bleeding into many areas of the child’s life, there may be more going on, such as a Specific Phobia.

A Specific Phobia centers on one particular activity, object, animal, or situation. The fear that the child feels drives them to avoid that trigger at all costs. An inability to avoid the trigger causes intense distress.

Girl walking away carrying lion stuffed toy

These are all normal childhood fears. They are specific to one experience, and they can be worked through, and the child quickly moves on from them.

When a child’s fears become disproportionate to the actual situation and are long-standing, bleeding into many areas of the child’s life, there may be more going on, such as a Specific Phobia.(1)

Fear of water (Aquaphobia)
Fear of the dark (Nyctophobia)
Fear of thunder and lightning (Astraphobia)
Fear of insects (Entomophobia)
Fear of dogs (Cynophobia)
Fear of places or situations that might cause panic (Agoraphobia)
Fear of social situations (Social Phobia)

This isn’t an exhaustive list. There are many other things that children may develop a Specific Phobia around. Looking for the tell-tale symptoms and speaking to a mental health professional are the best ways to determine if your child is suffering from a Specific Phobia.

Symptoms

Children with Specific Phobia can experience both emotional and physiological symptoms. The emotional symptoms of intense, unrealistic fear and panic around a specific situation or thing are what most people think of when they think of a Specific Phobia.(2) However, children can also feel a compelling need to avoid the object of their anxiety. This need for avoidance shapes their behavior and influences how they make decisions.

Physical symptoms that are experienced with Specific Phobia can include headaches, stomachaches, a racing heart, trembling, difficulty breathing, sweating, and feelings of weakness.(5) Children can experience any combination of these physical symptoms in addition to the emotional symptoms they experience.

Specific Phobia can interfere with many aspects of a child’s life by disrupting their sleep patterns or ability to have fun.(4) It can also cause concentration problems that often result in behavior issues in the classroom. If the symptoms of Specific Phobia have progressed to this point, the child needs help from a mental health professional.

Causes

The three main causes of Specific Phobia are predisposition, genes, and environment. Predisposition speaks to a child’s personality. Some children are more prone to be anxious and are less capable of handling stressors in their lives.

Mental illnesses can be hereditary or related to genetics.(3) A child with more anxious people in their family history is more likely to be diagnosed with a Specific Phobia. Finally, if a child’s environment is stressful, that can also be a cause of Specific Phobia. These environments could include living in a volatile home, feeling stressed at school, having parents going through a divorce, or a loss of a family member.

Very rarely is just one of these factors at play with a diagnosis of Specific Phobia. More often two or three factors are involved to varying degrees.

Treatments

Cognitive Behavioral Therapy (CBT) is often the most effective type of therapy to treat a Specific Phobia.(7) CBT works to help a child identify their thought patterns and how those thoughts may be helping or hurting them. As they begin to recognize what their thought patterns are and the power that they hold, children can work to change those thoughts and, in turn, change their behavior.

One technique of CBT, known as Graded Exposure, helps children systemically face their fears and more effectively manage their symptoms.(6) Through repeated practice of Graded Exposure, a child can gain mastery over their fear.

The mental health professional may help your child understand how the outcome that they imagine when they are anxious is not realistic. They might teach your child how to use self-talk to combat fear. Therapy sessions may also consist of your child learning various relaxation techniques, like breathing exercises.(6) The exercises are great for you as the parent to learn as well so that you can help coach your child through them when they are anxious.

For a child suffering from a Specific Phobia and their parents, an effective technique like Graded Exposure can be an amazing tool. So let me tell you a bit more about implementing Graded Exposure with your child.

Graded Exposure

While treatment of a Specific Phobia should always be overseen by a mental health professional, there are strategies that can be practiced at home to help your child.

My anxiety disorder series, I’M AFRAID, has a book focused on Specific Phobia. Sophia Swan Is Afraid of Water! follows Sophia as she faces her intense fear of water. She uses Graded Exposure to slowly expose herself to water and address her fear step-by-step.

This book can be a wonderful tool to see the practical application of Graded Exposure. Your child may see themselves in Sophia. They can watch as a character that feels the same fear that they do is able to succeed in facing her fears.

The book also has a page outlining this stepladder approach and other coping strategies that may be useful.

Other Therapy Strategies

The mental health professional you partner with may also try other techniques to help your child address their fear.

Role-playing techniques can be a great tool to work through a worst-case scenario that a child is picturing. Through role-playing, the child can most often see how that scenario is not likely or even not possible.

A mental health professional can help a child find the combination of different strategies that work best specifically for them. They can also provide the space and encouragement to continue to practice these techniques until the child is able to use them successfully.

Remember, some childhood fears are normal. The many new and unusual things that a child experiences are bound to bring out some feelings of trepidation. However, if any anxiety is beginning to seem prolonged and unrealistic, reach out for help.(2) Even if there is no diagnosis, it never hurts to have someone come alongside you and your child and give you strategies to cope with anxiety.

Pre-order Sophia Swan Is Afraid of Water! HERE. To check out other books in the I’M AFRAID anxiety disorder series, visit: www.DrMadeleineVieira.com/books/imafraid

Would you like more information on childhood anxiety? Listen to my Genius Little Minds two-part podcast series on childhood anxiety disorders now! Click here for part 1 and Click here for part 2.

And don’t forget to subscribe to my monthly newsletter to stay up-to-date on the latest blogs and podcasts on infant and childhood mental health!

References