Centre intégré universitaire de santé et de services sociaux de l’Ouest-de-l’Île-de-Montréal
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Ask the expert

How is selective mutism treated?

It is treated just like any other anxiety. Usually, children will grow out of most of their fears over time. If they do not want to go to school or talk to anyone, you need to help them make small steps in that direction. What is really debilitating is not anxiety itself, but rather the fear of anxiety. Ultimately you want to teach children that it is okay to be scared. If you encourage them and give them tiny steps, they can usually face their fears.
-Camillo Zacchia, PhD, Mini-Psych School 2010

Around what age are children able to put themselves in other people's shoes?

The transition generally happens at the beginning of adolescence, maybe a little sooner. The exact moment may not be so categorical, as we all have a certain degree of empathy. When teens get to high school though, they are more worried, they suppress their opinions more, they pay more attention to how they look; this is when we start to see a difference.
-Camillo Zacchia, PhD, Mini-Psych School 2010

How do you treat a nine-year-old who has difficulty eating and then vomits and has difficulty identifying the object of fear?

Sometimes the problem is difficult to pinpoint and we don't really know the cause. Sometimes the reaction is purely physical. The child can be afraid of this physical reaction and associate it with school. If the child is afraid of school for a specific reason, the child will still be afraid even if I remove that reason, due to months of association. The reason for the fear is no longer important—it is a fear that the child simply needs to face. For example, people who are afraid of elevators do not need to take the elevator alone; they can face the fear with a supportive friend. Eventually, they can get into the elevator with the door open to get used to it, and so on. This is a bit how it works with young people; it's a gradual process.
-Camillo Zacchia, PhD, Mini-Psych School 2010

How can we reduce anxiety in children?

I have noticed from personal experience that medical students become very anxious when I modify my courses too much, as this detracts from their ability to learn. I believe that the same goes for children. Day care workers always tell us that it is very important for children to have a routine. This doesn't meant you can't change things once in a while, but generally speaking, routine has a lot of value for children. I think that this is key.
- Johanne Renaud, MD, Mini-Psych School 2010

Is there a relationship between anxiety and attention deficit disorder?

There always is a certain overlap between psychiatric problems. Attention deficit disorder (ADD) is different from anxiety. You can be anxious no matter what your attention level, but if you are hyperactive, you have more energy and therefore will question yourself more or attempt to have greater control when things aren't going well. A young person who is hyperactive and anxious might have more difficulty managing situations than someone who suffers from anxiety alone. One thing is certain: children with ADHD tend to be misjudged by their peers. They are ostracized and therefore at a greater risk of developing social phobias. But the relationship is not a direct one.
-Camillo Zacchia, PhD, Mini-Psych School 2010

What causes anxiety in children?

We know that genetic factors contribute to anxiety disorders. Factors in the environment, such as an unstable family environment, can also be important. We don't have good studies in this area. However, based on my clinical experience, I see that children with strong anxiety problems have a lot of instability in their home life.

(Mimi Israël, MD) I believe this goes along with the fact that there is a very high percentage of children, even in Canada, who are maltreated and neglected. There is also a rising divorce rate, which creates instability in the family because children depend on both their parents to feel secure. In addition, some children are more susceptible to anxiety disorders for genetic reasons. With these combined factors, it's not surprising that anxiety disorders are common.
-Ridha Joober, MD, PhD, Mini-Psych School 2006

Why do children refuse to speak for long periods of time?

Selective mutism is extremely common. The signs are generally when children go to school and refuse to speak to anyone. For example, I have two adopted children; one of them, of Vietnamese origin, is very verbal. When I adopted him, he smiled a lot and was very friendly, but he did not reply to any of the interpreter's questions. When we came back to Montreal, he did not speak to anybody for several months and then gradually started talking. It was clear for me that he was in a very stressful situation; he was seven years old and was in a new country. Mutism is an indication that children are experiencing a lot of anxiety.
-Camillo Zacchia, PhD, Mini-Psych School 2010

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