Answer: In your question you indicated your child won't talk in school in a normal tone of voice and only whispers to his teachers. On the contrary, at home he is chatty and verbal. Your response to this situation was to take him out of school and homeschool him. Since I don't know much more about the situation, you must have been very concerned about him to hold him out of school. It sounds like you have a plan to send him back to school in the near future but are unsure how to proceed and how serious this whispering is.

The behavior you describe might be a form of social anxiety known as "selective mutism." According to The Selective Mutism Group~Childhood Anxiety Network, "selective mutism is a childhood anxiety disorder characterized by a child's inability to speak in select social settings, such as school." Specific features of this disorder are described in the 2000 Diagnostic and Statistical Manual of Mental Disorders (pp.125-127) this way:

• Consistent failure to speak in specific social situations (in which there is an expectation for speaking, e.g., at school) despite speaking in other situations.
• Interference with educational or occupational achievement or with social communication.
• A duration of at least one month (not limited to the first month of school).
• A failure to speak that is not due to a lack of knowledge of, or comfort with, the spoken language required in the social situation.

These children understand language and are able to talk normally in settings where they are comfortable, secure and relaxed, as you described he does when he is at home with you.

No one knows why children develop this reluctance to speak in front of a group of people or feel embarrassed easily. What is clear is that children and adolescents with SM have an actual fear of speaking and of social interactions where there is an expectation to talk. They may also be unable to communicate nonverbally, unable to make eye contact and may stand motionless with fear as they are confronted with specific social settings. Your child may have a mild form of this because he does whisper to the teacher, a positive sign that he isn't so anxious he won't communicate at all.

For a parent this can be very difficult to observe in your child. For the child, it is often very debilitating. Very often, these children show signs of anxiety, such as difficulty separating from parents, moodiness, clinging behavior, inflexibility, sleep problems, frequent tantrums and crying, and extreme shyness from infancy on. When they reach the age when they begin to interact socially outside the family environment, their persistent fear of speaking or communicating begins to manifest in symptoms like whispering. The social anxiety responses are triggered by social interactions in settings such as school, the playground or social gatherings.

The treatment for selective mutism as with most social anxiety disorders is through behavioral cognitive therapy, and through patience and acceptance on the part of the parent or caregiver. Parents should remove all pressure and expectations for the child to speak, conveying to their child that they understand he feels scared to speak or has difficulty speaking at times.

Since selective mutism is an anxiety disorder, successful treatment focuses on methods to lower anxiety and increase self-esteem, confidence and communication in social settings. The emphasis should never be on "getting a child to talk" but more on getting comfortable in the environment that is producing the anxiety.

First, determine when he demonstrates this behavior of whispering. If this only happens at school, then a program can be developed that will reduce his anxiety there. Using behavioral methods, a therapist or school mental health professional can work collaboratively with the teacher to help desensitize the child's anxiety. By eliminating all pressure to verbalize, the child's anxiety is lowered and confidence increases. Verbalization will usually follow. If this does not occur spontaneously, techniques can later be added to help encourage progress.

At home reward him for using his "big voice" or "grownup voice." He will learn that when he speaks in a normal tone that positive rewards follow. Again don't pressure him to talk, but do reward him when he does.

Working collaboratively with the school personnel and providing them with information regarding this disorder is helpful. Most school personnel have little experience in this area, so be patient and collaborate with them to find a workable solution for your child.

Dr. Joseph Gianesin is a professor at Springfield College School of Social Work and a program and behavioral consultant for public schools in Massachusetts. He has more than 25 years of experience as a child and family therapist, a school social worker and a school administrator.

Advice from our experts is not a substitute for medical or other professional advice and services from a qualified health-care provider familiar with your unique situation. We recommend consulting a qualified professional if you have concerns about your child's medical or emotional condition.

May 2007