Cover Dr Melissa Giglio and Daisy Geddes, authors of Bravery Grows

Psychologists Dr Melissa Giglio and Daisy Geddes are raising awareness of selective mutism and childhood anxiety and finding ways to address it with their debut children's book Bravery Grows

“Incidences of anxiety disorders have been rising steadily since 2000; however, research is now showing that rates of anxiety and depression in children and adolescents have doubled since the pandemic,” says clinical psychologist Dr Melissa Giglio, who practises at Central Health Southside in Hong Kong. “Cases of selective mutism have always been high, even though little is known about it; however, we have noticed an increase in referrals likely related to the inconsistency of school.”

Selective mutism is not new. The anxiety-based disorder, which appears in early childhood and manifests in children withdrawing and being unable to speak in certain social situations, was identified over a century ago, but the increasing prevalence is cause for concern. Symptoms can also include avoiding eye contact, nervousness, clinginess or a sudden change when around other people, all behaviours that can impact children’s ability to learn, ask questions, make friends, and even cry out when hurt. While relatively unknown outside of those diagnosed with it, awareness is essential as early detection and treatment is key. Selective mutism is not something that typically goes away on its own.

“The pandemic has meant disruptions in school attendance and limited opportunities to socialise. Therefore, any child already struggling in these environments has had far fewer opportunities for practice, resulting in later identification and often increased severity,” says Daisy Geddes, an assistant psychologist also at Central Health Southside. “The impact of the pandemic has meant that children susceptible to developing an anxiety disorder are at greater risk,” she adds.

The most susceptible are those with a family history of anxiety; 90 per cent of children who are diagnosed have one parent who has experienced significant anxiety in their life. Additionally, girls are twice as likely to develop selective mutism as boys.

Giglio and Geddes treat children suffering from anxiety and selective mutism at their clinic, but also wanted to look at other ways to address the condition. “So few professionals specialise in the evidence-based treatment of selective mutism. Many children are either being misdiagnosed or not getting the right care,” says Giglio, who offers training for clinicians in specific treatment for selective mutism. She’s also keen to focus on ways parents can help their children, and this has found form in Bravery Grows, a book for children, co-authored by Giglio and Geddes.

“We have seen the benefits of using books as a therapeutic tool to connect with kids,” says Giglio. Bravery Grows is “intended to be a resource for professionals and parents to normalise what my clients and others experience in their daily lives”.

The picture book, which is illustrated by Ira Baykovska, an artist from Ukraine who has worked on more than 20 children’s book and who the authors were keen to support, is targeted at three to nine-year-olds, the age of the majority of the clients they treat. It tells the story of Aria—so-called to reflect her bravery, as the name means “lioness” in Greek—as she seeks to conquer her anxiety. Aria is confident at home, but her bravery glow dims at school. When she is unable to voice her struggles, her parents’ support and strategies allow her to overcome her frustration and regain her confidence.

The tale is told in rhyme and incorporates language used by therapists to teach parents how they can support their children. “We wanted the children to hold on to the most important message—with practice and the right support, you can overcome your anxiety and build your ‘brave’ muscles,” says Giglio.

Translation of the book is underway, with Simplified and Traditional Chinese versions due out in November. “There is a lack of resources for selective mutism available in Chinese. We work with so many families in Asia where Mandarin or Cantonese is the primary language, so we feel it is important to have a book in their native language,” says Giglio.

Bravery Grows is just the beginning. The authors hope it will be translated further to support children all over the world, and are keen to create other books that are imbued with techniques and strategies to help children with various challenges and their families.

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