What should I do if these four types of children have not been talkative since childhood?

The child is 4 years old and can communicate normally with his family at home. However, when he goes to school or other occasions, he remains silent whether facing teachers, classmates or strangers.

Are you timid? shy? Or is there another reason?

Recently, Taiwanese gold medal director Luo Jingren’s new film "The Third Wish" tells the story of a girl who grew up in a crematorium and successfully got out of the "selective mutism" with the help of her teachers and family. haze.

Why did you choose such a niche but real adaptation case?

Director Luo Jingren said that these decisions cannot make the film more sensational and may even be counterproductive. But in the end they still decided to do it. Their motivations included not only protecting the parties concerned, but also ensuring the popularity of the film: allowing the audience to enter the entire story with a lower threshold, and at the same time, allow them to gain a preliminary understanding of this little-known disease in the right direction.

What is "selective mutism"?

It is a relatively rare childhood disease characterized by the inability of children with language function to express themselves in specific social environments, such as schools and social situations, but in other situations. Can speak and communicate normally in an environment like home.

The childhood prevalence of selective mutism is 0.7 to 0.8, and it is more common in girls and bilinguals.

This kind of psychological behavioral disorder is not like autism. It has a certain degree of invisibility because children are completely normal in a familiar environment. Therefore, before going to school, because there is no comparison experience with other children, parents It is often difficult to detect abnormalities by oneself. It is usually thought that the child is just a little timid and shy and does not care much about it.

However, some scholars believe that selective mutism is not a rare disease, and that children of immigrants and ethnic minorities are at a higher risk of developing the disease than those in the area where they originally live.

For example, the incidence rate of selective mutism among ordinary children in Israel is 7.6/1000, and the prevalence among children with immigrant backgrounds is three times higher than that of ordinary children (22/1000).

The Diagnostic and Statistical Manual of Mental Disorders DSM4 of the American Psychiatric Association defines the diagnosis of selective mutism as the following four aspects:

1. Consistent speaking in situations where speech is expected. Showing no speech, such as in school or kindergarten.

2. Silent behavior seriously hinders the patient's education or study, work achievements and social communication.

3. The patient's mute behavior must last for more than one month, but does not include the first month of enrollment. For example, a child who has just entered school may not speak when faced with a strange environment, but a child with selective mutism still does not speak a month later.

4. If the mutism is simply due to a lack of knowledge required for social situations, physical discomfort, or an inappropriate situation, this situation cannot be diagnosed as selective mutism. For example, if the child is placed abroad in a non-native language and is not familiar with the local language, in this case, the child's silence cannot be diagnosed as "selective mutism".

Four types of "selective mutism"

The first type is that people are naturally silent.

Children are overly dependent on their mothers. When they are shy, anxious, and fearful, they use silence to control their environment and achieve the purpose of controlling the environment.

The second type is verbal fear-induced mutism.

Children of this type are afraid of their own voices. They feel that their own voices are very unpleasant, and they like to communicate in ways other than words to avoid hearing their own voices.

The third type: reactive silence.

Children who refuse to speak may have encountered major traumatic events, such as trauma to the mouth or throat, or have been loudly scolded to shut up, always shut up, and stop talking. Children of this type often display depressed, depressed emotional states.

The fourth type: passive resistance and silence.

Children of this type usually use silence as a means of hostility. They often show antisocial behavior and try to control their lives by resisting talking to others to achieve the rewards they want. Purpose.

Xiaowei in "The Third Wish" belongs to the third type of reactive silence.

The real reason why Xiaowei chose to remain silent was that her father had oral cancer and was unable to eat or speak. In order to become the same person as her father, Xiaowei also chose not to speak.

“I don’t want dad to be alone.” I believe many people were moved to tears by Xiaowei’s words.

Faced with depressed and dull parents, in a repressive family and growing up atmosphere, it was difficult for Xiaowei to be as innocent, lively, and smiling as other children. She became less and less willing to talk, and the more she became Come further and further away from the audience.

Simply looking at these four types, there is a clear difference between selective mutism and childhood autism. Most of it is caused by the family and social environment. Of course, physiological speech development delays or vocal disorders are not excluded.

If a child is diagnosed with "selective mutism", how to carry out non-drug intervention?

1. Cognitive behavioral therapy

Lang et al. designed modular cognitive behavioral therapy for the long-term treatment of children with selective mutism. Intervention Content includes:

(1) Psychological education for children and parents;

(2) Physiological training - breathing and muscle relaxation;

(3) Cognition Cognitive training - symptom externalization and cognitive restructuring;

(4) Behavioral training - emergency management, exposure level development, modeling, shaping, progressive desensitization;

(5) Parent training - improve parents' skills in helping their children;

(6) Education or other environment training - focus on training their behavior in schools and other environments and their role in promoting social speech .

2. Family therapy

During the treatment process, cooperation and understanding from parents and siblings help children overcome anxiety and avoidance, and help them reduce their own dependence (for parents Strong attachment and extreme dependence, leading to fear and distrust of the external world) and ambivalence. Family therapy focuses on reducing the parent's empowering behavior and the child's avoidant behavior.

3. Game therapy

When shaping in a game environment, games are the main reinforcing factor. Contains three key components: game space, role play and dramatic projection.

Cultivate children's positive self-esteem and high degree of spontaneity, helping them become more sociable and flexible.

In the film "The Third Wish", with the very loving help of the teacher, Xiaowei gradually opens her heart:

She no longer refuses to talk to fear; she learns to integrate As a group, we went to the welfare club with our classmates to participate in social activities; after school, we shared interesting things about school with our parents to make them happy; we also invited good friends to celebrate their birthdays at home and made three wishes: to become a painter, for my mother to no longer have back pain, and for my father to Grow up with her...

The director wrote in his notes that this is a story about a preset position.

Innocent children are originally ignorant, happy, curious and noisy. When they are silent and do not say a word, we feel miserable.

Misfortune is a series of preset scenes, and when a child is in that scene, we can't help but feel pity.

What is mercy?

When we see the misfortune of others and realize our own happiness, we will act to show compassion to the less fortunate. People who are full of happiness delegate the remaining happiness to those they think are unfortunate, so pity forms a class.

The distance between classes makes us forget to understand. And understanding is equal. We are often in pity and forget to understand others equally.

In short, the basis of tolerance is understanding, and the basis of understanding is feeling; sincere feeling is the beginning of all healing.