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DrFee, Psychologist
Category: Mental Health
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Experience:  I help people overcome anxiety and enjoy life again.
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My 9 yr old nephew is showing behaviour problems in a social

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My 9 yr old nephew is showing behaviour problems in a social setting eg. school/summer camp interaction with other children. His body becomes frozen stiff and he shutts his eyes when surrounded by other people, young or old. He doesn't speak only knodds his head to yes/no and shruggs his shoulders for i don't know. When I take him to the store, he dosen't want to come out of the car, he only wants to be inside of the car. When at school, he does not go to the bathroom for the whole day, nor does he eat alot. Also, he has a problem when other children or teachers look at him, it makes him uncomfortable. He has a short attention span where he loses his focus quickly and is easily distracted.
This is apparent with homework. In comparison, when my nephew is with his family none of these symptoms arise. He is a happy boy expressing himself through voice and movement. He asks us numerous questions and expects anwers promptly.
My nephew was recently assessed with the disorder of silent mutism. what I have described above, is this the disorder? What is silent mutism disorder? Is this disorder reversable? Is this disorder heredity?
Thank you.
Hello! Please remember that my response is for information only, we are not establishing a therapeutic relationship.
I imagine that you and your nephew's parents are extremely concerned about his behavior. You said "silent mutism," but I assume that you meant selective mutism. Here are the symptoms of selective mutism:
1. The child is consistently unable to speak when it comes to certain social situations, (school,public, etc) however, they are able to speak in other situations (home with just their immediate family).
2. Selective mutism will interfere with the child's educational achievement and social communication. Later on, if left untreated, it will also interfere with their occupational achievement.
3. Symptoms must persist for at least one month (with the exception of the first month of school).
4. The child has difficulty maintaining eye contact.
5. The child is reluctant to smile and oftentimes he will have blank facial expressions.
6. The child's body movements are often stiff and awkward.
7. A child who has this disorder also has a tendency to worry more about things than other people do.
8. Someone who has selective mutism will be extraordinarily sensitive to noise, crowds and crowded situations (including public restrooms).
9. The child will have difficulty with both verbal and non-verbal expression.
10. A child who has selective mutism will oftentimes have frequent temper tantrums at home.
11. Those who are diagnosed with selective mutism oftentimes have compulsive traits that appear to be similar to Obsessive Compulsive Disorder (OCD)--but that does NOT mean that they have OCD.
12. When the person who has selective mutism is still young, he will cling to his parent or other caretaker.
13. A person with selective mutism may appear to be excessively shy when in reality they actually have a fear of people.
14.People with selective mutism may also have an anxiety disorder such as social phobia.
What you describe fits with many of the symptoms above, and I would say that you should trust the diagnosis that he received (although there is no harm in getting a second opinion if his parents need that reassurance).
There is no evidence that it is a hereditary disorder, however, there does seem to be a predisposition to the selective mutism if one or both parents suffer from an anxiety disorder. There is a theory that people with selective mutism have an overactive amygdala, the part of the brain that notices threats and kicks in the "fight of flight" response. The belief is that speaking is a "threat" to these people, therefore, their speech shuts down when they feel threatened.
Treatment: Psychotherapy would be the treatment of choice --and I would go with a child Psychologist who is familiar with anxiety and selective mutism. Cognitive Behavioral Therapy (CBT) would be a good choice., .
Therapy should focus on helping your nephew understand when his body feels threatened, identify triggers, and learn how to desensitize himself to the threats so that he can speak in spite of feeling anxious. Antidepressants are sometimes used, but I would encourage you to consider medication as a last resort rather than a first choice.
With a good Psychologist, the outlook for recovery is very positive.
I am happy to elaborate on any of these points, feel free to follow up with me. I will work with you until you can give a positive rating!
Dr. Fee
Customer: replied 5 years ago.

Thank you Dr.

Is it possible that my nephew may be deficient in vitamins or minerals? If so, are there any nutritional advice that you can give?

What would cause or trigger this behaviour to surface?

Also in a social setting, my nephew sqints his eyes, not fully opened, and after he came home from summer camp he was complaining of his head hurting 'i can't feel my head' he complained and I noticed him rapidly twitching his eyes (i have recorded this on video). What is the next steps to heal my nephews problem? Would you suggest seeking a psychiaritrist, psychologist or psycotherapist? Is it possible that my nephew may be deficient in vitamins or minerals? If so, are there any nutritional advice that you can give? What would cause or trigger this behaviour to surface?
I already addressed a possible cause --but I will add this -- it appears that 20-30% of children with selective mutism also have a speech disorder, so that may be a contributing factor. Some foods may trigger anxiety --I've had clients who cut out sugar, caffeine, orange juice and eat more broccoli and other green vegetables...(I'm sure he'll love that), but there's no evidence that this disorder is triggered by a deficiency per se. As stated above, I would start with a child Psychologist who has experience in this area.
You asked what would cause this behavior to surface --one of the following:
1. an overactive amygdala
2. a learned response
3. co-exists with a speech disorder.
why now? Some stressful trigger, perhaps --you said he went to camp? That could be enough to do it.
Nutritional advice? A healthy diet with limited sugar, no caffeine would be best --it's doubtful that diet caused the symptoms, but you can increase anxiety most certainly with caffeine.
DrFee and other Mental Health Specialists are ready to help you
Customer: replied 5 years ago.

Thank you very much Dr. for your clarification. I will forward this msg to my nephews parents.

Do you have links for canadian psychologists?

If this disorder originates in the parents, would therapy benefit both parent(s) and child?

You are welcome.
Here are some links for finding a therapist in Canada (the 2 most popular are listed first): (Toronto area only)
Yes, family therapy is one approach for treating this disorder --mainly to help the family learn how to most effectively interact with the child to support recovery.
Best wishes to you and your family ---
Dr. Fee
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