Selective Mutism & Autism

As it is now officially autism awareness week, I thought today might be a good time to write about the topic of SM and ASD/ ASC.

This particular post, or topic, has been on my mind for a while, but it is not easy to write about nor is it easy to not cause misunderstandings or upset! I want and need to explain that I definitely am NOT an expert, or even close to being, in autism spectrum disorders, though I have worked with children and young people with ASD for a few years, I still have a considerable amount more to learn on the matter.

Where to start? I suppose a good place to start would be to say; selective mutism is not on the autism spectrum, although the two have many similarities and the traits of each overlap quite a lot, there are also many marked differences. It is fairly common for the two disorders to co-occur, but by no means does that mean that everyone, or even most, have both. Not all people with SM have ASD; not all people with ASD have SM. However, it is becoming increasingly apparent to me that it is definitely not uncommon for people who have SM to also have ASD, especially high functioning autism/ Asperger syndrome.

Asperger syndrome and SM can be hard to separate and distinguish in some cases. Many people with SM have been misdiagnosed with ASD and therefore have received irrelevant or incorrect support. This is very understandable; many people with AS struggle with communication, social interaction, social thinking, social reasoning, expressing and understanding emotion, eye contact, understanding other’s intentions, many are perfectionists, many have average or above average intelligence and the most prominent emotion is anxiety for many with AS. Some of the common co-morbid disorders with AS can often include; selective mutism, social anxiety disorder, depression, mood disorders, eating disorders (anorexia nervosa in particular), OCD, agoraphobia, auditory processing disorder and sensory processing disorder.

Many people with SM struggle with; social interaction, communication, expressing emotion, eye contact, social thinking*, most have average or above average intelligence, most are perfectionists and the most prominent emotion for most is anxiety. Common co-morbid disorders with SM can include; social anxiety disorder, generalised anxiety disorder, agoraphobia, depression, ASD (in particular Asperger syndrome), eating disorders, OCD and it is not uncommon for those with SM to also have sensory processing disorder.

*As well as this, in some cases, especially cases when a SM has become quite entrenched after suffering with the disorder for a prolonged period, social reasoning, social thinking and understanding other’s intention’s can also become more of a difficulty.

Most people with selective mutism are highly sensitive; most people with an autism spectrum condition are highly sensitive.

The key difference between selective mutism and autism is; autism is a lifelong neurological developmental disorder. Selective mutism is a severe anxiety disorder, or a severe situational communication disorder, which can be overcome or at least significantly decreased in severity. For most with SM, the disorder was present from early childhood, some believe they had it since birth, which is somewhat similar to ASD. However, some with SM experienced a trigger point, where the selective mutism began to develop or become apparent. For me, I started to struggle with SM at the age of 7.5 years old due to an environmental change, or trigger. Most people with SM started struggling with the disorder before the age of 4, but this is not the case for plenty. ASD is present from early childhood, though it is not always identified until later life, this is especially true for those with high functioning autism/ Asperger syndrome and particularly true for females. SM too is also often not identified until some time after the person began struggling with the disorder, especially those with low profile SM. This is often the case with those with SM due to the fact SM does not affect a person in all situation, or with all people. Those with ASD present with ASD in all situations and with all people, however this is arguably not accurately the case for those with ASD who mask. Even though some people with ASD are able to mask and present as a social chameleon, the ASD will still always be present, you just have to look deeper and more carefully.

Although there are many similarities between SM and ASD, there are many differences. It is important to remember though, autism is a spectrum and no two people with ASD are the same, the condition affects everyone differently, but often similarly. This is also the case for those with SM; selective mutism affects us all slightly differently.

Many people with ASD struggle with the empathy, or social imagination, involved in understanding what another person is thinking or how they’re feeling especially if they do not give verbal clues, however this is not the case for all. I also think it is important to say that actually it is a bit of a myth that those with ASD lack empathy, this is becoming increasingly well documented. Another difference is, people with ASD are often very black and white in the way they think or the way they process information, which also means they are often very literal and so therefore can often misunderstand or misinterpret information. This does not appear to be particularly common with those with SM. However, those with SM can often misunderstand or misinterpret information due overwhelming anxiety, lack of concentration and inability to block out sensory input (particularity if SPD is co-occurring). If a person with SM misunderstands something they cannot ask for someone to repeat what they said, nor can they themselves be corrected by another person if they are unable to express what they think to be the case or true.

The main difference between SM and ASD is likely that those with ASD see ,or process, the world differently to those who are neurotypical. Autism is often described as a different processing ability or operating system. Those with SM without ASD are neurotypical and process the world, or make sense of their surroundings, similarly to the next person, but never the same. We are all unique remember. Although we with SM, who do not have ASD, make sense of the world and our surroundings typically, it is also worth mentioning that many of us with SM are highly creative and are deep thinkers, who are drawn to detail which some may not be able to easily see. This is perhaps mostly to do with personality type than anything else, but it is arguably also due to this area of ability becoming heightened for us due to the issues we struggle with, or our disability (SM). When you are trapped in a silent world for a large peroration of time, you often end up with a lot of time on your hands to take to new skills.

Those with ASD are often resistant to change and need structure and routine and are often described as “rigid”. This is also often the case for those with SM. Change or the unknown causes anxiety. Those with ASD struggle to predict what might happen, or the future. many with ASD are very much in the here and now, but this is not the case for all though. Those with ASD who do struggle with prediction can therefore become quite unsettled and upset if change occurs, change means having to process lots of new information and having to make sense of the environment again. Often, those with ASD like and need predictability and sameness. This brings me on to another difference, those with ASD who struggle to predict, often have little or no sense of danger. This is not the case for most with SM, but quite the opposite instead. Those of us with SM are often over-thinkers, always thinking about the what ifs and trying to imagine every possibility to prepare ourselves for what could happen, we can fairly easily picture and imagine new situations in our head.

Behaviour changes when we are anxious, or at least it does for most of us. Our behaviour can often be misunderstood and people often see anxiety rid behaviour as behaviour associated with ASD. Many people with SM need alone time to recharge, with no demands or questions, this is also the case for those with ASD. Many people with SM benefit from sensory therapy, sensory integration or sensory equipment, so do those with ASD, but could this be due to the fact most of us are highly sensitive and sensory processing disorder is not uncommon for those with either SM, ASD or both. Many people with SM turn to familiarity and special interests for enjoyment and comfort, this is also the case for those with ASD, however the intensity of these special interests is generally much more intense in those with ASD, but not for all. Many people with SM display self soothing behaviours, self stimulation or self harm. For us with SM this is to help us calm our anxiety down and help us to gather ourselves, concentrate and feel in the moment, as some of us struggle with feeling like we’re in a fog. For those with ASD these behaviours are due to some of the same of similar reasons but also, to regulate the sensory system, express emotion and often also for comfort.

SM and ASD can be incredibly similar in some cases, especially when the SM is severe, or high profile and when the SM has become entrenched. This has been the case for me. I missed out on the social progression,or development, in my adolescents (14 – 17 years old) because I could not engage or interact with anyone outside of my family, not out of choice mind. I didn’t give eye contact and so therefore could not observe accurately visual information either. On the other hand, my listening skills were outstanding and I learnt a lot by listening to my peers, but I didn’t have the ability to practice and use what I’d heard myself. Therefore, it can be argued that when I began to overcome SM I had to go back where I left my social and emotional development, which was at around 14 years old. It is a confusing world when you have been left behind socially. I have often questioned whether not using my interaction skills, interpersonal skills, speaking and social skills has weakened them, “if you don’t use it, you lose it”. I personally have felt this has been true. I am not too great at picking up social cues, understanding sarcasm, understanding people’s intention’s or facial expressions unless I know the person fairly well, but I have found that the further into my SM recovery journey I have got, the easier and more possible it has become for me to understand these things and the social world more broadly. Therefore, I do not think I am on the autism spectrum because autism is something that would always be there. I have questioned many of times, “Am I autistic?” and many people have assumed I am autistic throughout my life. I have thought about it long and hard and although I’m not 100% sure, I have also come to the conclusion that I am me, I have autistic traits, but we all do. You can fit pretty much anyone on to the autism spectrum if you try hard enough. I believe my seemingly autistic traits will, and actually are, becoming less intense and less apparent. This is particularly the case most recently as I’ve taken significant steps forward into progression or recovery. I feel like I am relearning, rediscovering and improving on my social and communication skills, those very skills I had to neglect, or the skills my SM forced me to neglect should I say.  I am quirky, socially different/ awkward and introverted, but I do not feel this qualifies me to be diagnosed. I feel my social differences are becoming less of an issue as each day goes by. I also do not think autism is a bad thing at all, in fact I think it is more of a positive thing.

So, there we go. I hope I have explained and got the message across that SM is not autism, but there are many cross overs and it is seemingly increasingly common for people who have SM to also have ASD, particularly females. I haven’t yet managed to mention that actually SM can sometimes hide or mask the traits of ASD, meaning those with SM and ASD slip out of the network of support and do not receive a diagnosis of autism until later in life when the SM has been overcome, or decreased in intensity. This was an area that concerned me about myself. As I started to overcome SM my autistic traits became fairly obvious, but as I’ve continued to recover and therefore improved my social, emotional and communication skills, the traits have become less apparent and some do not appear to be present at all anymore. It can be very confusing and difficult when working out if it is just SM or is it SM and ASD. I feel more research needs to be done on the two.

I hope I haven’t caused any misunderstandings, upset or negative emotions. I am not an expert on the subject, I have written this using my own personal experience with SM, from the people I know with SM, ASD or both. I have undoubtedly got some things wrong, I will likely adjust this post as I learn more about the topic.

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6 thoughts on “Selective Mutism & Autism

  1. Your article is very insightful!
    Our son, 14, was diagnosed with SM about 1yr ago by a clinic that specializes in SM. Although he has been struggling with his condition for over 8yrs. Before that he was a cheerful boy and full of interest in life. It started slowly early in the grade school by stoping to talk with his schoolmates, then teachers…and progressed to a severe condition where he doesn’t speak to anyone at home, his siblings, parents. Also he uses harsh coping techniques to deal with his condition like shutting his ears, shaking, and lately repetitively hitting his body. He finds his comfort in playing computer games and has no interest in anything else whatsoever.
    His diagnosis were not 100% clear. Although he was diagnosed with SM, the SM specialized clinic left it open to a possibility of ASD. He started using medication prescribed by a psychiatrist for an anxiety disorder, and it is not making any impact on his condition, which has progressed even further to even more severe coping methods.
    Although the SM and ASD are very similar like you described in your article, my understanding is that the treatment for each is different, especially when it comes to a medication. Could you comment on this, or direct me to several sources that can help ?

    Thank you very much for being a change in this World! Or son is 14yrs old, and we watch the life pass him by without knowing how to help him.

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    1. Hi – Thank you for your comment. It’s very interesting to read of your sons current situation. Would I be right in thinking, the severe condition you’re referring to is Progressive Mutism? How is he doing currently with talking with you, or in his home/ comfort zone, if he is able to do so at all? I think it is always worth going through with an ASD assessment if you can see the possibilities too. You are right to say SM and ASD are indeed treated differently, though of course ASD is not cure-able, but can become more manageable. SM can be overcome. I’m sad to read his coping methods have become more complex, It sounds like his medication needs reviewing, and possibly changing, if this hasn’t already been done. I do not know enough about your son’s behaviour/ situation to be able to direct you to specific relevant sources, but i’ll try and find some kind of useful information! However, I cannot comment on any recommendations for medication, I have not myself tried using medication for my SM, and I do not know enough about medication and the risks, or advantages and I wouldn’t like to give out information that is potentially wrong. For SM, my advice would be to read the Selective Mutism Resource Manuel and find a professional or key person to work with him in the places where he most needs and wants to be able to talk; using the sliding in method, gradual exposure, shaping, etc. Other treatment/ therapy worth looking into include; sensory therapy, animal therapy, art therapy, speech therapy, counseling, CBT, and if in general the pressure and expectancy is kept off him as much as possible, maybe see if he can write a small list of tiny stepping stone goals, with a realistic time frame to achieve them in. Routine, structure and preparation can be very beneficial and this would fit in with both the SM and the possible ASD. Other useful options that could help him, that fits in with ASD include; visual timetables, familiarity, social thinking training, weighted blankets are also very helpful, this could possibly help with his harmful coping methods. That is all the information I have for you off the top of my head, but should I remember more, or come across some good sources online I will get back to you. All the best – Natasha

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  2. After my husband was diagnosed with Dyslexia aged 43 I have discovered many dyslexic traits cross too and may explain a lot of my social interaction issues along with my totally obvious but undiagnosed SM. It is worth reading about Dyslexia too. Do you know if symptoms can resurface? Life is very stressful and I am losing words again and also panicking about job interviews I haven’t got yet which I only appear to get through, by having a sympathetic interviewer

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    1. Hi Juelieann – This is a very interesting area, and not one that I know very much about, but I will continue to look into it! I have heard of the two crossing over before. Symptoms of SM can resurface, however I only know of this happening when the SM had not previously been overcome, but decreased in intensity. For example, a friend of mine overcame high profile SM and was left with Low profile SM , she was doing well but then began being bullied which increased her anxiety and therefore made her SM recovery regress. I am sorry to read you’re having a difficult time at the moment, are you receiving any support from health professionals at all to help with your anxiety levels? I wish you the best of luck for your future interviews, things will improve for you soon, don’t give up! – Natasha

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      1. Thanks for your reply. I plan to discuss SM with the doctor this week as I have only accidentally discovered about it within the last few days, having spent the majority of 40 years wondering why I couldn’t just talk to people as I wanted to. I am hoping that knowing more about myself will help. With many thanks and best wishes to you x

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