“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”.