The Selective Mutism Journal (Japanese)

The Selective Mutism Journal (Japanese)

https://smjournal.com/

A Japanese TV program featured an ex-SM sufferer in the UK

A popular Japanese TV program featured a UK model on February 13 who once suffered from selective mutism. During and after the broadcast, at least hundreds of people, including those who had not known SM until then, made comments about SM on the Internet.

The TV program is Za! Sekai Gyouten News broadcast by Nippon Television Network Corporation (NTV). A popular comedian Tsurube Shofukutei and a popular singer Masahiro Nakai host the program. Gyouten is broadcast almost all across the country every week on prime time (Wed 21:00-21:54). On February 13 NTV broadcast a two hour special (20:00-21:54) including a SM story.

The protagonist of the story is a girl named Kirsty Heslewood, born in the UK. She suffered from SM but overcame it thanks to her mother and teacher. She now works as a model. I guess some readers of my blog may know her because her story appeared in the Daily Mail when she was selected as a finalist of Miss England.

During and after the broadcast, at least hundreds of viewers of the program commented about SM via Twitter, Facebook, BBS, blogs, etc. I have never known so many Japanese people comment about SM. Interestingly, not a few of them had not known SM until then. Gyouten seems to increase awareness of SM.

But some express concern. Knet, a SM support group based in Japan, warned viewers not to show videos of children with SM talking in their house without their permission like Kirsty's story. Knet says that often worsens symptoms or breaks trust among children, parents, and teachers.

Adult selective mutism and Hikikomori in Japan

Diamond Online, a Japanese business website, published articles about adult selective mutism with Hikikomori. Diamond Online publishes business articles as well as health ones.

First article [May 18, 2012]
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Second article [June 28, 2012]
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Third article [July 26, 2012]
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Hikikomori is a Japanese term that means long term social withdrawal typically by adolescent and adult males. Usually the concept of Hikikomori excludes symptoms of schizophrenia. Today hundreds and thousands of Japanese people are considered to withdraw from society.

All articles above are interviews with members of Association of Selective Mutism in Japan who experienced selective mutism. ASMJ is one of the major selective mutism support group in Japan, which, in my view, emphasizes adult selective mutism.

We can find many Japanese Hikikomori people who really suffer(ed) or seem(ed) to suffer from selective mutism in academic literature, books, on Internet websites, etc. But it is not clear how many people suffer from such difficulties.

According to a study by Ministry of Health, Labor and Welfare, out of 149 Hikikomori cases which visited 5 Mental Health and Welfare Centers and received diagnoses of mental ilnesses, one case was diagnosed as selective mutism. But it is not clear whether about 0.67(1/149) percent of Hikikomori people have selective mutism because most Hikikomori people do not visit Mental Health and Welfare Center.

Little is known for certain about Hikikomori people with selective mutism. Most writings are their personal experiences or case study. Diamond Online's article is no exception.

Children with SM in evacuation centers

Great earthquake and tsunami hit north-east Japan in March 2011, and myriad of people forced to live in evacuation centers. Evacuees must have included children with selective mutism. How did they spend their daily time?


Selective mutism is an anxiety disorder characterized by persistent failure to speak in unfamiliar social settings and to unfamiliar people. Typically they are children and can not utter words at schools although they speak normally at their homes.

Evacuation centers were unfamiliar settings for selectively mute children. A typical evacuation center was set up at a gymnasium or a community center. In many cases there were cubicles that separate living space. But  such cubicles were not necessarily placed. So, many selectively mute children must have been surrounded with unfamiliar people.

Images of evacuation centers in Japan
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On the other hand, in many cases, children in evacuation centers lived with their families without cubicles. I suppose they spent a lot of their time close to their families. In other words, they were together with their familiar people.

So, how did the environment affect the children? It is not clear, because nobody researches it.
I suppose one possibility is that they were mute all day long because they were surrounded with unfamiliar people. If so, I feel a pang of sympathy for them. Another possibility is that they spoke freely because they were always with their families. A third possibility is the middle of the first and second possibility. In other words, they spoke a little.

I hope such complex environment helps children to desensitize unfamiliar social setting and people.

Entrance Exams (2)

* * * * * * * * * *

Chapter 5 Selective mutism and my high school years

Entrance Exams (2)

* * * * * * * * * *

In the former story, I took three college entrance examinations. But I was scheduled to take one more examination. That is the secondary entrance examination to a national university. I put special importance on the examination, because I wanted to enter the national university.

Fortunately, the examination was written examination, not interview examination. So, it did not matter whether I was able to speak smoothly. Even today many Japanese colleges and schools sometimes set interview examination to applicants. So, some Japanese junior high school and high school students with selective mutism have trouble passing entrance examinations.

And I was successful in the entrance examination.

["Tomishige was all smiles"]

Soon after I knew my examination result, I went to my high school to tell the result to my teachers and thank them. But when I arrived at my school in the evening, few teachers remained there. Opening the door of the teachers' room, I found only one teacher worked. He was a teacher of the third year of the school, not my homeroom teacher. As soon as he noticed me, he walked straight up to me and said, "Congratulations, Tomishige!" He added that the college had already informed the high school of a list of students who passed the examination. He offered his hand, so I shook hands with him.

I think most students will have a happy smile if they are in the same situation. But I didn't. I was emotionless. That must be odd. I had studied hard to pass the entrance examination of prestigious colleges since I entered a high school. Now I achieved my ambition. But my selective mutism caused me to be emotionless even when I were in such a happy situation.

After I went home, my homeroom teacher called me. "Congratulations on passing your exam, Tomishige! One teacher told me you went to high school some time ago. He said Tomishige was all smiles. I felt very sorry for going home early."

I was surprised. It was contrary to the truth. I did not know why the teacher said such a thing. Perhaps he told a lie to her, because he wanted her to be pleased. Like the Japanese proverb says, Uso mo houben (Circumstances may justify a lie). Another possibility was that he confused me with other students.

* * * * * * * * * *

In this way, my high school life ended. Next, I went to university.

(To be continued)

Index of SM story

Selective mutism and developmental disorder

I've read literature on selective mutism written by Japanese researchers. From what I read, some recent Japanese researchers explore the relationship between selective mutism and developmental disorder.

Common diagnostic criteria, such as DSM-IV-TR and ICD-10, distinguish selective mutism from pervasive developmental disorder. If symptoms of selective mutism occurs during the course of pervasive developmental disorder, that is diagnosed as pervasive developmental disorder, not selective mutism based on anxiety. So, it is important to distinguish both disorders.

Indeed, there seem to be many mute children with pervasive developmental disorders. According to a famous Norwegian research, 68.5 per cent of selectively mute children met the diagnostic criteria for developmental disorder/delay compared with 13.0% in the control group (Kristensen, 2000).

And Shintaro Sagawa, a member of Hinode City Board of Education based on Tokyo, writes that he had seen many mute children, but they are not necessarily silent because of psychological problems. He writes some of them have many difficulties, including developmental disorder (Sagawa, 2006).

So, if you find a selectively child, it may be better to consider the possibility of pervasive developmental disorder. But Yasuhiro Watanabe and Sakakida Rie, a pediatrician and child psychiatrist, points out that it is difficult to distinguish both disorders (Watanabe and Sakaida, 2009). In case you do not know whether the child can be diagnosed as selective mutism or pervasive developmental disorder, it may be better to keep both possibilities in mind.

[Reference]

Kristensen, H. (2000). Selective mutism and comorbidity with developmental disorder/delay, anxiety disorder, and elimination disorder. Journal of the American Academy of Child & Adolescent Psychiatry. 39(2), 249-256.

Sagawa, S. (2006). Bamen kanmokuji heno approach. L'Esprit d'aujourd'hui. 471, 55-61.

Watanabe, U. and Sakakida, R. (2009). Four cases of selective mutism examined from in light of the austic spectrum disorders. Japanese journal of child and adolescent psychiatry. 50(5), 491-503.

Japanese children's book about selective mutism

I found a Japanese children's book about selective mutism. Issho ni asobo vamos brincar (in English, let's play with me!), published in 2003. It's a fiction novel written by Etsuko Yamamoto.

The main characters of the story are two children. One is a third-grade Brazilian girl named Juliana. She transferred to an elementary school in Japan. But she faces difficulties in speaking Japanese. The other is her classmate named Seiya. He suffers from selective mutism.

The story revolves around Juliana and Seiya. The heart of the story is Seiya's relationship with Juliana.

Both Juliana and Seiya have difficulties in speaking, although their problems are different. When it comes to people who have language problems in fiction, I recall a short story "Hankachi," written by Kiyoshi Shigematsu. Hankachi is included in the book Aoi Tori, a collection of short stories. The main characters of the story are one teacher and one student. The teacher has a stutter problem. On the other hand, the student suffers from selective mutism. The center of the story is their relationship.

I have mixed feeling about this. I guess writers of both stories aim to explore meaning of verbal communication by writing people who can't speak well. But I don't want to group them together. Selective mutism is different from stuttering and lack of language knowledge.

But I guess this book may give solace to children with selective mutism. They may feel they are not alone when they finish reading the book.

A new Japanese picture book about selective mutism

A new Japanese picture book about selective mutism was published in January 2011. The title is Nacchan no koe -- Gakkou de hanasenai kodomotachi no rikai no tameni (Nacchan's voice -- Understanding children who can't speak at school).

Book details by Yahoo!Japan books
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The heroine of the book is an elementary school girl who has selective mutism. We can understand the disorder through the story.

The main contents of the book are, of course, picture book. The story is very easy to understand, so even little children seem to be able to understand the disorder through the story.

The author is Miko Hayashi. She was a mother of a child who once had selective mutism. She illustrates the book as well as tells the story. Ms. Hayashi has made public her original picture stories about selective mutism on the Internet for a few years.

And at the end of the book, Yoji Kanehara, the director of Kanehara Pediatric Clinic, provides medical explanation about selective mutism for teachers and parents. In addition, one junior high school girl with selective mutism contributes her poem.

This book is edited under the supervision of Kanmoku Net (Knet), a Japanese selective mutism support group. Miko Hayashi is a member of the group.

Nacchan no Koe is not the first Japanese picutre book about selective mutism. As far as I know, the one titled Banzai! Nayakaya-kun (Hooray! Nakayama) was published in 2000. In 2002 a photo book Rika-chan ga waratta -- Hibikiau kodomo tachi (1) (Rika laughed -- Echoing children (1)) was published. However, there had been no picture books in which organizations on selective mutism involved until this book was published.

Entrance Exams (1)

* * * * * * * * * *

Chapter 5 Selective mutism and my high school years

Entrance Exams (1)

* * * * * * * * * *

When I was in junior high school, I couldn't pass the entrance exam to the high school I wanted to go to . Since then, my aim had been to enter a prestigious university.

Japanese universities then had two types of admission. One was general admission. Students granted general admission if they passed entrance exams that was mainly paper test. Unlike US, each universities conducted selective entrance exams. The other was recommended admission. Students granted recommended admission if principals of their high schools recommended them to universities and they passed entrance exams that was mainly interview exams.

I was going to apply for general admission to national universities and private universities. The schedule was as follows:

[January]
National Center Test for University Admissions (preliminary entrance exam to national universities)
[early-February]
Entrance exams to private universities
[late-February and mid-March]
Secondary entrance exams to national universities

I took NCTUA and three entrance exams. Although I was a nervous man, I felt relaxed when I sit for the exams. I think one reason for that is that my high school had students rehearse entrance examination again and again.

I was at my best at the entrance exams. I achieved a good score at NCTUA and passed exams for two private universities. But I was not confident of passing exams if applied for recommended admission and took interview exams. I didn't overcome selective mutism completely at that time, so I had no confidence to talk at interviews.

In this way, I took three exams. but one exam was left. That is secondary entrance exams to national universities.

(To be continued)

Index of SM story

Bullied to death

A Japanese junior high school student with selective mutism suffered severe violence by bullies and passed away because of the violence in 1991.

According to proceedings of a regular meeting of Toyonaka municipal assembly held March 1992, Bunichi Hotta, a member of the assembly, said, "Ms *** ***, who passed away because of bullying, had mental retardation and selective mutism. But her school didn't provide her with proper education. That was a serious problem."

(*** *** is a name of the girl who passed away)

The case seemed to be famous nationwide then. I consulted a local newspaper at that time issued in the area I live (far away from Toyonaka). The case was featured largely. Besides, the case was mentioned in Diet (Japanese Congress). Even now, Wikipedia refers to the case.

About the case in Wikipedia (Japanese)
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But few Japanese people seem to know she had selective mutism. As long as my research, some newspapers or books and so on write she had disorders. But almost all of them wrote vaguely about her disorder. For instance, "She had mild emotional disorders."

It's very regrettable the tragedy occurred. She had selective mutism as well as me. In addition, she's the similar age with me if she didn't pass away. I hope such tragedy never happens again.

[Reference]

Sachiko Takeda (2005) Anata ha kodomo no inochi wo mamoremasuka - Ijime hakusho "jisatsu, satsujin, shogai 121 nin no kokoro no sakebi!"-, Tokyo: WAVE Publishers.

Index of SM in Japan

My words had great impact

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Chapter 5 Selective mutism and my high school years

My words had great impact

* * * * * * * * * *

[I taught English to my classmates]

I was regarded a bright student, so some classmates asked me to teach Japanese history, mathematics, English, etc. Although I had selective mutism, I was able to speak quietly then. So, I taught my classmates them in a quiet voice. When I think back, it may have been a behavioural therapy.

[My words had great impact]

One day seating arrangements were changed, and my seat moved next to a female classmate. I became friendly with her.

On a certain day she felt depressed because she was rebuked by our homeroom teacher for her bad exam results. So, I offered words of encouragement to her. Of course, it was rare for me to talk to somebody, as I had selective mutism.

Fortunately, she was very pleased with my words. Girl students next to us said, "Your words have great impact. Even if talkative girls like us says the same words, that doesn't have high impact as yours." The next day the female classmates talked to other classmates about my yesterday's offering words of encouragement proudly. She seemed to be very glad about my words.

[I tended to avoid going to places where people gather]

I tended to avoid going to places where people gather. For instance, career guidance room and library in my school. But I don't know whether this was because I had selective mutism.

My school placed Akahon in the career guidance room. Akahon are Japanese student's bible that contains information about colleges and archives of colleges' entrance exams. Many students went to the career guidance room and read Akahon to gain information about colleges or to solve past colleges' entrance exams. In contrast, I didn't go to the room.

(To be continued)

Index of SM story

Selective Mutism and Hikikomori (2)

I think this description is significance, because it is written clearly in MHLW guideline that selective mutism is not only a childhood problem but can have lasting effects as Hikikomori. In fact, I hear not negligible number of Japanese people who suffered (or suffer) from selective mutism become Hikikomori. One Japanese support group for children with selective mutism claims that some children with selective mutism become Hikikomori later.

I don't know what evidence the authors of the guideline have. There are few studies on long term outcome of selective mutism also in Japan. But I guess several Hikikomori cases that have the experience of selective mutism are reported among institutions for Hikikomori people, such as Mental Health and Welfare Center, Public Health Center, etc..

It is interesting to note that the guideline mentions the relationship between school refusal and selective mutism. Traditionally it has been thought that Japanese children with selective mutism in general don't suffer from school refusal, because it's conspicuous to miss school for a long time. Children with selective mutism tend to avoid being conspicuous.

Although the guideline only make passing reference to selective mutism, I want many professionals to read the sentences about the disorder. That can help to raise awareness of selective mutism.

Last but not least, please note that not all Japanese children with selective mutism become Hikikomori later.

Index of SM in Japan

Selective Mutism and Hikikomori (1)

Hikikomori is a serious social problem in Japan.

What is Hikikomori? Ministry of Health, Labour and Welfare defines Hikikomori as "A phenomenal concept which means avoiding social participation (e.g. school attendance including compulsory education, entering the workforce including part-time job and associating with somebody outside the home) and generally remaining at home for 6 month and over in principle (including going outside without associating with somebody). Moreover, although as a general rule we define Hikikomori as nonpsychotic phenomenon excluding social withdrawal based on a positive and negative symptom of schizophrenia, keep in mind that it's not uncommon that Hikikomori includes schizophrenia before a definite diagnosis is made."

MHLW revised a guideline for assessment and support for Hikikomori people on May 19. It is thought that professionals who help Hikikomori people read the guideline.

* Here's a link to MHLW's web page on the guideline *

http://www.mhlw.go.jp/stf/houdou/2r98520000006i6f.html
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The guideline refers to selective mutism as "mental disorders that are strongly related to Hikikomori and their features."

According to the guideline, some children with selective mutism become Hikikomori: 'Some children who didn't speak at kindergartens or schools in early childhood such as selective mutism gradually become school refusal and then become Hikikomori. Others remain at home after graduating from high schools without determining their course.'

(To be continued)

Index of SM in Japan

Selective Mutism and SNS in Japan

Many Japanese people who are interested in selective mutism also use social network services. They share information about selective mutism in SNS.

Popular SNS among them are mixi and Twitter. Facebook and Myspace are not so popular among Japanese people.

* mixi *

Mixi is the most popular social networking site among Japanese. Mixi is a Japanese website, so I guess most users are Japanese.

For more detail about Mixi, see http://en.wikipedia.org/wiki/Mixi

At present there are 6 communities about selective mutism on mixi. The largest community has over 260 users.

* Twitter *

Twitter is also popular among Japanese people. Yukio Hatoyama, Japanese Prime Minister, and Sadakazu Tanigaki, a party leader of Japan's largest opposition party, are also Twitter users.

Japanese people who are interested in selective mutism also use Twitter. Some of them are members of a Japanese support group for selective mutism and share information about the group activities.

* My mixi and Twitter pages *

I also use mixi and Twitter. All my posts are Japanese, not English, though. But I don't join any community on mixi. I only keep a diary on mixi to record updates of my website. I don't also communicate with people through Twitter very much. Usually I tweet to myself.

My mixi and Twitter pages are here. I'm afraid you can't access my mixi page unless you're a mixi member.

http://mixi.jp/show_friend.pl?id=8699233
http://twitter.com/nesamimus

Index of SM in Japan

Facial muscles

By and large, children with selective mutism lacks facial expression in kindergarten, school, etc.. They spend hours with expressionless face every day. Some of them may overcome the disorder soon. But others may continue to be mute several years.

The problem is the latter. If they suffer from selective mutism for years and spend hours with expressionless face every day in school or kindergarten, what effect do facial muscles have?

I guess they don't use their facial muscles very much. If facial muscles aren't used very much in childhood or adolescence, what happens?

I don't know about facial muscles well.

But I guess one possibility is that it becomes more difficult for them to create facial expressions. Of course, many of them are forced to have blank facial expressions by anxiety. But if their anxiety decreases, I guess their undeveloped facial muscles may prevent them from creating facial expressions. That can influence communication. In general, the less expressive face a person shows in face-to-face contact, the less he or she can communicate successfully. They may need to train their facial muscles if they want to communicate with other people successfully.

Speaking of facial muscles, some Japanese women train their facial muscles for cosmetic purpose. It is said that people tend to look old for their age if their facial muscles are weakened. If so, do children or people with selective mutism look old ? ... I don't know.

I became a senior in high school

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Chapter 5 Selective mutism and my high school years

I became a senior in high school.

* * * * * * * * * *

I became a senior in high school.

My class was a looping class. My homeroom teacher was the same as before, so were almost all of my classmates. But only A, the most beautiful girl in my class, moved to other class. She was an outstanding student, so she moved to the class which is made up of excellent students.

College entrance exams were approaching within a year. As a college oriented class, teachers assigned us more homework. In addition to school homework, we students did our own studies to pass the entrance exams. We needed to study harder.

Therefore, my interest in overcoming selective mutism became less and less.

* * * * * * * * * *

At that time, the relationship between M and I changed dramatically. But I won't even go into detail. I'll let you imagine the rest.

* M was my female classmate. When she and I were in the sixth grade, there was a rumor that she loved me.

* * * * * * * * * *

When we became a senior, our English grammar teacher changed. He was a strict teacher. He had a stern look on his face. But he was lenient only with me. I guess that's probably because he thought I was obedient and serious student. In Japan, if a mute and quite student like me study hard and get high marks in tests, he or she are more likely to be regarded as an obedient and serious student.

Another possibility is he thought that he should not take strict attitude toward me, because I was so shy. I guess he thought that I'll be too daunted if he was strict with me.

Like him, there were many strict teachers in my school, but no one took strict attitude almost only toward me. I was fearful of them.

(To be continued)

Index of SM story

Do Japanese children with selective mutism show their symptoms later?

Comparing researches on selective mutism in Japan with that in Western countries, I found that there are differences in age of onset. Reported average age of onset in Japan is higher than that in Western countries. In Japan, average age of onset is about 5 years old. On the other hand, in Western countries, average age of onset is about 3 years old.

There are a small number of researches that report age of onset, so it may be premature to conclude that Japanese children with selective mutism show their symptoms later. But I'm curious about the difference.

[The average age of onset of SM and SM literature]

Here are major researches that report the age of onset of selective mutism. Regrettably, I can't collect all reports.

I write the average and standard deviation of age of onset here as possible. But some researches doesn't report them. In that case, I calculate them. And in some cases, the age of onset are reported to be a-b years. (e.g. 3-5 years). In that case, I regard it a+b/2 years (e.g. 4 years).

[Points keep in mind when comparing the age of onset]

* Diagnostic criteria

There are many studies on selective mutism, but old researches, especially Japanese ones, tend to use various diagnostic criteria. On the other hand, recent researches, especially Western ones, tend to use standardized diagnostic criteria, such as DSM and ICD. So, it is difficult to make a simple comparison of them.

* Subjects

The average age of onset depend on subjects. For instance, like Elizur et al. (2003), the average age of onset can't be old if children were recruited from preschools. On the other hand, like Minami et al. (1987) or Ichitani et al. (1973), the average age of onset can be older if children were recruited from child consultation centers which aim at children under 18 years.

[SM literature in Japan]

* Shiina et al., 1998

The average age of onset is 4.9 years. 38 out of 46 cases presented symptoms from 2 to 7 years. The data is based on case studies published from 1980 to 1996.

* Souma, 1991

25 out of 35 cases presented symptoms before they enroll in elementary school. The data is based on case studies published from 1980 to 1989.

* Minami et al., 1987

The average age of onset is 5.0 and standard deviation is 2.3 except 2 unclear cases. 28 cases showed their symptoms first in their childhood (3-5 years). 3 cases showed their symptoms first when they were in elementary school (6-11 years). 2 cases showed their symptoms first at puberty (after age 12). 1 case was unclear. The data is based on patients who receive medical consultation at Kyoto City child consultation center from fiscal 1960 to 1987.

* Muramoto, 1983

Out of 17 cases, the average age of onset is 6.4 years and standard deviation is 2.8 years. 3 cases were 3 years. 2 cases were 4 years. 2 cases were 5 years. 3 cases were 6 years. 2 cases were 7 years. 1 case were 8 years. 1 case was 11 years. 1 case was 13 years. The data is based on questionnaire survey conducted at public elementary and junior high schools in Kamikawa, Hokkaido, northern Japan.

* Oi et al., 1979

Out of 24 cases, the average age of onset is 3.8 years and standard deviation is 0.8 years except 1 unclear case. 9 cases were 3 years. 10 cases were 4 years. 3 cases were 5 years. 1 case was 6 years. The data is based on patients Oi was related to intensively at child psychiatry clinic at Nagoya University and Kusunoki Gakuen, a residential treatment center for emotionally disturbed children.

* Araki, 1979

Out of 34 cases, the average age of onset is 5.9 years and standard deviation is 2.2 years. 1 case was 2 years. 2 cases were 3 years. 6 cases were 4 years. 7 cases were 5 years. 11 cases were 6 years. 1 case was 7-8 years. 6 cases were 9-11 years. The data is based on patients who visited department of psychiatry at Kyushu University from 1963 to 1976.

* Ichitani et al., 1973

Out of 20 cases, the average age of onset is 5.4 years and standard deviation is 1.6 except 1 unclear case. 10 patients showed symptoms first when they started kindergartens or nursery schools. 5 patients showed symptoms first when they entered elementary schools. 4 patients showed symptoms first a few years after they entered elementary schools. 1 patient was unclear. The data is based on 20 elementary school students who visited Osaka City and Kyoto City child consultation centers and were diagnosed as selective mutism from May 1964 to December 1970.

[SM literature in Western countries (written in English)]

* Cunningham et al., 2004

Out of 52 cases, the average age of onset is 3.3 years. The age of onset ranged from 3 to 5. Children were diagnosed according to DSM-IV criteria. They were recruited over a period of 9 years from a regional service providing child assessments, school consultations, and workshops for parents and teachers.

* Elizuret et al., 2003

Out of 19 cases, the average age of onset was 3 years and 4 months. Onset was significantly earlier among native children (2.7 years) versus immigrant children (3.9 years). Children were recruited from West Jerusalem's obligatory and pre-obligatory state preschools. and diagnosed according to DSM-IV criteria.

* Remschmid et al., 2001

In 43 out of 45 cases, the first age of manifestation was three years. Only in two cases take, the first manifestation did place later. Children had been referred between 1964 and 1979 to the Department of Child and Adolescent Psychiatry (impatient and outpatient unit) and to the Child Guidance Clinic which works closely together with the department. They were diagnosed according to DSM-III-R criteria.

* Kristensen, 2000

Out of 54 cases, the average age of onset is 3.7 years and standard deviation is 1.7 years. Children were diagnosed according to DSM-IV criteria, but exclusion criteria for SM on Asperger's disorder and communication disorder were ignored to look for comorbidity. Children were recruited by mailing announcements to all 63 outpatient clinics for child and adolescent psychiatry and all 278 school psychology services in Norway.

* Dummit et al., 1997

Out of 54 cases, the average age of onset is 3.4 years and standard deviation is 1.3 years. Children were diagnosed according to DSM-IV criteria. They were recruited through advertising and referral from local schools and the Selective Mutism Foundation.

* Steinhausen et al., 1996

Out of 100 cases, the average age of onset is 49.5 months and standard deviation is 32.5 months. In the SHG sample, the average age of onset is 43.9 months and standard deviation is 26.3 months. In the ZH sample, the average age of onset is 45.8 months and standard deviation is 25.5 months. In the B sample, the average age of onset is 63.9 months and standard deviation is 52.4 months. Children were diagnosed according to ICD-10 criteria.

SHG sample (n = 19) was personally assessed by the senior author in 1992 and 1993 because of personal contacts with a parents' self-help group that had been formed in the German-speaking cantons of Switzerland. ZH sample (n = 59) was seen between 1979 and 1992 in the Child and Adolescent Psychiatric Service of Canton of Zurich. B sample (n = 22) represents the entire group of electively mute children who were identified in the case files of the Department of Child and Adolescent Psychiatry at the Free University of Berlin.

* Black et al., 1995

Out of 30 cases, the average age of onset is 2.7 years and standard deviation is 1.4 years (range: 1 through 5 years). All children satisfied the diagnostic criteria for both DSM-III-R and DSM-IV.

* Black et al., 1981

unclear.

* Hayden 1980

Sorry, I dont't understand the age of onset reported in the paper.

* Wergeland, 1979

All patients (n = 11) represented symptoms at 3 - 4 years. The age at which they were referred varied from 6 to 11 years with an average of 9 1/2 years. One of the children was referred by kindergarten staff, the other 10 by the school authorities.

Index of SM in Japan

Selective Mutism in the media (Japan)

Selective mutism is sometimes featured in the media in English-speaking countries. For example, in America, the big three networks (ABC, CBS, NBC) all have featured selective mutism. In the UK, Channel 4 has featured selective mutism. In addition to the TV media, newspapers (e.g. The New York Times, The Washington Post, The Times, The Guardian, etc.) and magazines (e.g. TIME, People, etc.) also have featured the anxiety disorder.

But when it comes to the Japanese media, I seldom heard such things. As far as I know, Yomiuri Shimbun, the largest newspaper circulation in the world, featured selective mutism in 1986 and 1988. In 1988 NHK, Japan's national public broadcasting organization, also featured it. Major Japanese media featured selective mutism in the late 80's, because Minoru Yamamoto, a professor at Yamagata University, published books about selective mutism then. But except for that period, the term "selective mutism (Bamen Kanmoku in Japanese)" rarely appeared in the Japanese media.

Recently however, local editions of Japanese major newspapers featured selective mutism. The Asahi Shimbun (2008), The Mainichi Shimbun (2009) and The Chunichi Shimbun (2009) featured selective mutism. In every case Knet, a Japanese selective mutism support group established in 2007, was involved. In addition to that, The Chugoku Shimbun (October 7th 2009) featured selective mutism in response to a request from a former sufferer of selective mutism. And The Asahi Shimbun (2007) printed a contribution from a reader who appealed for help to children with selective mutism.

There seem to be a growing consciousness among Japanese people involved in selective mutism that awareness of selective mutism should be raised, so they encourage the media to feature the anxiety disorder.

Index of SM in Japan

Study was everything

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Chapter 5 Selective mutism and my high school years

Study was everything

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[Which colleges we wanted to apply to ?]

When I was a sophomore in high school, one day our school had us take a nationwide practice entrance exam.

Before we took the exam, we were required to write which colleges we wanted to apply to on prescribed forms. After the exam, the organizer of the exam showed us possibilities that we pass the entrance exams for colleges we wanted to apply to on the basis of data obtained by the exam.

I also wrote my preferred colleges on a prescribed form. I wrote three colleges. A college, B college and C college. But after I submitted the paper, my homeroom teacher called me into a teachers' room. She asked me why I wrote the name of C college. She said she couldn't believe her eyes when she saw the name of the college. According to her, C college had bad reputation, and most alumni of our high school who went to C colleges were ones with very low academic achievement. "I can't understand why did student like you write such college's name?"

From what she saw, I underestimated me. But from what I saw, she overestimated me.

I went through similar experience when I was the 5th grade. My homeroom teacher thought highly of me. But I had the opposite view (see "My self-evaluation").

Did she misunderstood me because I spoke nothing? Did selective mutism affect my self-esteem and cause me to underestimate myself?

[Study was everything]

Many students in my class studied hard to pass college entrance exams. Maybe because of that, there was an atmosphere in my class that study was everything. If student get high marks, he or she gains respect. Even if high-achievement students had some problems, their problems tended to be ignored.

My selective mutism didn't disappeared completely then. But I studied hard to pass college entrance exams rather than tried to overcome my anxiety disorder. As a result, I got high marks in regular exams. My classmates showed respect for me. My homeroom teacher also thought highly of me. I had only to study.

(To be continued)

Index of SM story

How to overcome selective mutism by myself (2)

I try to write how to overcome selective mutism by myself. But I recommend not trusting in what I write, because I am not a professional. In addition, I don't know whether this method is really effective.

[Principle]

I apply to the principle of behavior therapy. First, setting stepwise goals. Second, uttering words gradually.

[Concrete examples]

I'll explain my idea more concretely. Let's take school life for example.

* I spent my school years in Japan. So, I write an example based on my experience in Japanese schools. I'm sorry if what I write can't apply to schools in your country.*

As a first step, for instance, greet teachers and classmates. When I went to Japanese schools, schoolchildren and students had to greet teachers. If your school require you to do so, it might be a good opportunity. Even if your school don't, I think it's a way to take a first step to overcome fear of speaking. Of course, it's not easy for mute children to greet people. So, at first, whisper to teachers and classmates good morning or good bye. Repeating the process increase the chance of greeting teachers and classmates in a loud voice.

As a second step, for instance, utter words loudly as possible as you can in class when you are called on by teachers. Some Japanese former sufferers say they could manage to read textbooks in class when they were called on by their teachers and asked to read textbooks. I guess such experiences helped them to lower their anxiety of speaking.

As a third step, for instance, try to talk with familiar classmates. If you can do that, try to talk with unfamiliar people gradually.

I refer to a study on selective mutism (Uchiyama, 1959) to describe this method. Although it's an old study, the treatment principle has in common with Helping your child with selective mutism (2005).

[Points to Keep in Mind]

1 Try step by step

It's very difficult for children with selective mutism to chat with others. Chatting requires children to talk what they want to say in order. That's a very tall order for them. When I had selective mutism, I tried to do so but failed. So, I felt frustrated. But it's no wonder you fail if you try difficult thing at first.

But it's easier to use short formulaic expressions, such as good morning. Try the easiest thing first. Then, try more difficult things. The point is to try step by step.

2 Don't aim at perfection

Don't aim at perfection. Many children with selective mutism seem to be perfectionists.

3 Don't try too hard

Last, but not least, don't try too hard. Some Japanese SM current and former sufferers say they tried hard to overcome selective mutism, but that caused their conditions to worsen.

[limitation]

The first limitation of this method is difficulty in setting up suitable situations for speaking step by step by myself.

Another limitation is that it's time consuming.

[References]

Uchiyama, K. (1959). Studies on the childhood mutism 2 -therapeutic procedures- The Kitakanto Medical Journal, 9, 786-799.