The sto­ry of Se­ung-Hui Cho, who killed 32 peo­ple and wound­ed 25 oth­ers at Vir­ginia Tech in April 2007, is sad and ter­ri­fy­ing. Along with schiz­o­phre­nia and de­pres­sion, Cho suf­fered from se­lec­tive mutism.He was treat­ed with med­ica­tion and ther­a­py, but ap­par­ent­ly was nev­er cured. On his dor­mi­to­ry wall, he had writ­ten telling lyrics from the song Shine by the band Col­lec­tive Soul: "Teach me how to speak, teach me how to share." He ul­ti­mate­ly made his voice known in the most grue­some way pos­si­ble.Se­lec­tive mutism (SM) is a rare anx­i­ety dis­or­der in which peo­ple speak com­fort­ably in some places or with some peo­ple, and are struck ut­ter­ly mute in oth­er sit­u­a­tions.

For par­ents, it is a sad, con­found­ing, and frus­trat­ing con­di­tion. For chil­dren, SM can be painful­ly de­bil­i­tat­ing and can hin­der their abil­i­ty to ad­vance in school, make friends, and par­tic­i­pate in ac­tiv­i­ties. If left un­treat­ed, it can lead to adult anx­i­ety and de­pres­sion.SM is recog­nised by the Amer­i­can Psy­chi­atric As­so­ci­a­tion as a re­al men­tal dis­or­der of­ten as­so­ci­at­ed with so­cial pho­bia. De­spite this fact, teach­ers, pe­di­a­tri­cians, and oth­er peo­ple too of­ten dis­miss this af­flic­tion as mere shy­ness.

"He'll grow out of it, my kid was shy too and he's fine," are among the more com­mon words of ad­vice some par­ents of chil­dren with SM are of­fered.But ac­cord­ing to Dr Elisa Shipon-Blum, a recog­nised ex­pert on SM, the dis­or­der is "the most mis­di­ag­nosed, mis­man­aged, and mis­treat­ed anx­i­ety dis­or­der of child­hood.Chil­dren with se­lec­tive mutism tru­ly suf­fer in si­lence, and yet most peo­ple com­plete­ly mis­un­der­stand the child's si­lence." This pa­tro­n­is­ing at­ti­tude can de­prive mute chil­dren of the ther­a­py or med­ica­tion-and even just the em­pa­thy-that SM re­quires.

SM is usu­al­ly di­ag­nosed dur­ing the preschool years, when chil­dren face the first re­al per­for­mance pres­sure of their lives. The psy­chi­atric pro­fes­sion changed the name in 1994 to re­flect its cur­rent un­der­stand­ing that mutism is ac­tu­al­ly an in­vol­un­tary anx­ious re­sponse.While SM is not on the autism spec­trum, the one is of­ten con­fused with the oth­er, and be­hav­iors and treat­ments can be sim­i­lar

Five signs your child might have SM

• The child talks com­fort­ably in cer­tain places, such as home, but rou­tine­ly does not speak in an­oth­er so­cial sit­u­a­tion, such as school.

• The du­ra­tion of the mutism lasts at least one month and is not lim­it­ed to the first month of school.

• The in­abil­i­ty to speak is not re­lat­ed to a lack of flu­en­cy in the pri­ma­ry lan­guage used in a par­tic­u­lar so­cial sit­u­a­tion.

• The mutism does not ap­pear to be re­lat­ed to a com­mu­ni­ca­tion dis­or­der, such as stut­ter­ing, or an­oth­er men­tal dis­or­der.

• The mutism in­ter­feres with so­cial re­la­tion­ships or ed­u­ca­tion­al achieve­ment.

Di­ag­nos­ing se­lec­tive­mutism

A child with se­lec­tive mutism should be seen by a speech-lan­guage pathol­o­gist (SLP), in ad­di­tion to a pe­di­a­tri­cian and a psy­chol­o­gist or psy­chi­a­trist. These pro­fes­sion­als will work as a team with teach­ers, fam­i­ly, and the in­di­vid­ual.It is im­por­tant that a com­plete back­ground his­to­ry is gath­ered, as well as an ed­u­ca­tion­al his­to­ry re­view, hear­ing screen­ing, oral-mo­tor ex­am­i­na­tion, par­ent/care­giv­er in­ter­view, and a speech and lan­guage eval­u­a­tion.

Treat­ing se­lec­tive­mutism

The type of in­ter­ven­tion of­fered by an SLP will dif­fer de­pend­ing on the needs of the child and his or her fam­i­ly.The child's treat­ment may use a com­bi­na­tion of strate­gies, again de­pend­ing on in­di­vid­ual needs. The SLP may cre­ate a be­hav­ioral treat­ment pro­gram, fo­cus on spe­cif­ic speech and lan­guage prob­lems, and/or work in the child's class­room with teach­ers.

How to talk wheny­our child's not talk­ing

• Do not ad­dress the mutism di­rect­ly.

• Do not ask open-end­ed ques­tions that re­quire a ver­bal re­sponse.

Yes-or-no ques­tions work best.

• In­stead of ques­tions, do make com­ments that could in­vite a ver­bal re­sponse if the child so de­sires.

• Al­low for non­ver­bal com­mu­ni­ca­tion, such as point­ing, sounds.

• If the child does be­gin speak­ing, act com­plete­ly nor­mal.

Mute chil­dren of­ten will con­tin­ue the mutism out of a fear that peo­ple will make a fuss once they speak.