Shira Richards-Rachlin The Effects of Parental Behavior on Mutism Symptomatology

The Effects of Parental Behavior on Selective Mutism Symptomatology Shira Richards-Rachlin

Selective Mutism (SM) is a rare childhood anxiety disorder, occurring in 1% of children under five-years-old, characterized by a lack of speech in multiple settings (e.g., unfamiliar settings) where speech is normally expected (Muris, Henriks & Bot, 2015; Wong, 2010). Symptoms of SM include an inhibited and silent presentation outside comfortable social situations, where failure to speak is due to anxiety, rather than a lack of knowledge surrounding the language (Carpenter, Puliafico, Kurtz, Pincus, & Comer, 2014). For example, children with SM typically withhold speech at school or with unfamiliar adults, but engage fully at home with parents and siblings (Wong, 2010). Since parents serve a critical role in their children’s development, many experts agree that parental behaviors influence the symptomology presentation and severity in children with SM (Cunningham, McHolm, Boyle, & Patel, 2004). More specifically, parental behaviors that reinforce children’s verbal or non-verbal behaviors may encourage children to either speak or remain silent in unfamiliar social situations (Alyanak et al., 2013; Wong, 2010). Due to little psychoeducation or knowledge surrounding SM, parents may unintentionally reinforce their children’s silent behaviors in unfamiliar settings by responding inappropriately to children’s non-verbal behaviors (Alyanak et al., 2013; Wong, 2010). Thus, to better treat those with SM, it is important to study the link between parental behavior and SM symptoms in children, as parents model behaviors which children may adopt (Alyanak et al., 2013; Carpenter et al., 2014; Cohan, Chavira, & Stein, 2006; Manassis et al., 2003; Wong, 2010). Therefore, this literature review aimed to answer the following question: how does parental behavior reinforce the symptoms of children with Selective Mutism?

Family Context

To understand the influence of parental behavior on children’s SM symptoms, it is necessary to first examine the family context in which a child interacts with his or her parents, since this is the environment in which certain messages, behaviors, and values are modeled and taught by parents (Bronfrenbrenner, 1977). Family contexts may result in parental behaviors that influence the severity and frequency of a child’s verbalization (Cunningham et al., 2004). Research shows that certain family contexts characterized by trauma, stress, or little parental support, may lead to children withholding speech as a protective or coping factor (Manassis et al., 2003; Wong, 2010). Additionally, family transitions, another type of family context characterized by a recent change in family structure, are more difficult for children with SM because change may indicate new threats in the environment (Cohan et al., 2006). Thus, these children receive signals for anxiety-reducing physiological responses, including decreased verbalization or inhibited behaviors (Cohan et al., 2006; Manassis et al., 2003; Wong, 2010). Because coping behaviors are reinforced and modeled by parents, if a parent ignores anxiety inducing situations (e.g., social situations), the child learns to do the same (Cunningham et al., 2004; Wong, 2010). How a parent responds to stressful changes or times of unease in the home has the potential to both diminish and increase a child’s anxiety in social situations, as the child often follows the parent’s lead in times of stress (Alyanak et al., 2013; Cunningham et al., 2004; Wong, 2010). Furthermore, parents of children with SM report a greater number of stressful life events than parents of children with other or no anxiety disorders (Capozzi et al., 2017). These reported household events may activate the child’s adaptive response to decrease anxiety (Wong, 2010). In this population specifically, a child decreases verbalization in order to adjust to environmental stresses and cope with their anxiety (Alyanak et al., 2013; Capozzi et al., 2017). Without parent-induced buffers (e.g., bringing a child to therapy) to protect an anxious child from stress in the home environment or increased language expectations outside of the home, a child’s nonverbal behaviors are positively reinforced by a temporary reduction in anxiety (Alyanak et al., 2013; Yeganeh, Beidel, & Turner, 2006). Parents who are unaware of the appropriate anxiety management tools (e.g., due to lack of psychoeducation or knowledge about SM) in these times of heightened anxiety, may unintentionally leave their child to cope by him- or herself, and thus reinforcing nonverbalization (Manassis et al., 2003).

Parental Adjustment

Parents may also reinforce non-verbalization through their different parenting styles, including their sensitivity and ability to adjust to their child’s needs, which may influence the behaviors they use to encourage or discourage a shy or anxious child to verbalize (Cunningham et al., 2004). Parental sensitivity encompasses the ways in which parents adapt their behavior to meet their child’s needs; extreme insensitivity, and, conversely, extreme sensitivity may both contribute to the development of SM symptoms (Alyanak et al., 2013; Yeganeh et al., 2006). Parents who set appropriate expectations for their children’s verbalization (e.g., by only accepting verbal

responses when communicating with their children), help their children reduce avoidant behaviors because they discourage nonverbal behavior (Manassis et al., 2003; Yeganeh et al., 2006). In contrast, parents who are overly sensitive (e.g., parents who ‘rescue’ their child from needing to speak by speaking for him or her) may support inhibited behaviors by allowing their child to respond nonverbally; therefore, reinforcing him or her to stay silent (Wong, 2010; Yeganeh et al., 2006). Additionally, insensitive parents may set unrealistic goals for their child’s verbal responses (e.g., asking many open-ended questions); in doing so however, this increases the child’s anxiety (Carpenter et al., 2014; Cunningham et al., 2004). When parents do not adjust their behavior towards a child presenting with SM symptoms, the symptoms may persist, leading to worse outcomes (e.g., complete silence at school, refusal to talk to peers) in both symptom, severity and duration (Carpenter et al., 2014). As children exhibit more SM symptoms (i.e., less verbalization), parents must alter their own behavior by asking questions and/or waiting for answers to adjust to their child’s verbal and nonverbal needs, thus encouraging speech (Carpenter et al., 2014; Cohan et al., 2006). A parent who does not adjust may expect too little or too much speech from the child, which could result in parents asking a large number of questions to increase the child’s chances of being verbal (Carpenter et al., 2014; Cohan et al., 2006; Wong, 2010; Yeganeh et al., 2006).

Parental Anxiety and Control

In addition to the influence of family context and parental adjustment, parental behaviors that reinforce SM symptoms in children may also result from parental psychopathology (Wong, 2010). Parents of children exhibiting SM symptoms report higher rates of anxiety, emotional withdrawal, and shyness compared to other parents (Alyanak et al., 2013). Additionally, high incidences of SM are reported in parents with social phobia histories, suggesting both a genetic and a modeled behavioral response in the child (Manassis et al., 2003; Wong, 2010). Parents who are withdrawn or suffer from untreated social anxiety not only model these maladaptive behaviors for their children (e.g., by avoiding social situations), but they may also fail to recognize the symptoms in their child; therefore, allowing their child to further escape anxious situations by withholding speech (Wong, 2010). When parents model ineffective problem solving and/or few to no calming strategies, the child is reinforced to stay silent as a coping mechanism (Cunningham et al., 2004). Furthermore, a parent suffering from anxiety may use overly-controlling behaviors and give few opportunities for his or her child to feel independent (Edison et al., 2011; Wong, 2010). For example, parents with anxiety disorders give less psychological autonomy to children (e.g., less freedom to explore independently), leading the child to rely heavily on his or her parent (Wong, 2010; Yeganeh et al., 2006). Without psychological autonomy, the child’s feeling of competence is lowered, and his or her ability to cope with anxiety is negatively affected, resulting in less verbalization (Yeganeh et al., 2006). As such, when the child leaves his or her parent, he or she does not know how to cope in anxiety-provoking situations where speech is required (Cunningham, et al., 2004). Controlling behaviors may also result from an overprotective parenting style. Parents of children with SM report higher levels of overprotective parenting characterized by controlling, anxious, and demanding parental attitudes and behaviors compared to parents of children without SM (Alyanak et al., 2013; Cunningham et al., 2004). As a result, overprotective parenting may lead to behaviorally inhibited symptoms in children, which manifest as shyness, anxiety, and emotional withdrawal from new stimuli or situations (Cunningham et al., 2004). Overly-controlling parents may have children who are unhealthily dependent on them, exhibiting separation anxiety or general anxiety when making independent choices, and subsequently fear strangers or new situations (Wong, 2010). Without a parent present, the child displays behaviorally inhibited symptoms such as withdrawal and visible anxiety, lowering the likelihood of verbal speech, and therefore reinforcing silence (Cunningham et al., 2004; Muris et al., 2015).

Conclusion

Although research on SM is sparse, current studies show that different parental behaviors have the potential to influence children’s SM symptoms by either reinforcing or discouraging their verbalization (Muris et al., 2015; Yeganeh et al., 2006). Thus, understanding the effects of parental reinforcement and modeling is crucial to helping families display alternative responses to non-verbal behaviors (Cunningham et al., 2004). However, when studying SM, it is hard to differentiate environmental influences (i.e., parental behaviors) from genetic factors (i.e., inherited anxiety) which poses a limitation in this research. While this paper generally explored the influence of parental behaviors on their children’s symptomatology, further research can focus on the prevalence of behavior inhibition characteristics in children with SM, as this will give clinicians and researchers a better understanding of personality traits that predict SM symptoms. Understanding how parental behaviors reinforce or discourage children’s symptoms can inform future research on interventions focusing on family functioning as a protective factor against developing SM symptoms, parental psychoeducation, as well as effective parenting strategies to model appropriate behaviors for coping with anxiety.

References

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