Relationships: my seven-year-old daughter refuses to talk at school

Our family moved to Hong Kong this summer from Italy. We used to live in a small town, with extended family nearby. I have three girls aged five, seven and 11. My elder and younger have settled well, but my middle child simply refuses to talk in school. She has pretty much relied on her older sister to do the talking during break time. She can understand English; however, when she speaks, it is hardly audible. She used to enjoy school before the move and loved that her old school taught English as a second language. At home we speak Italian and she has no problems expressing herself, although she is often quiet compared with her sisters. A teacher suggested I look up selective mutism, but I could not find any books in Hong Kong on that topic. Is there anything I could do to help her settle in at school and start to talk?

It is frustrating and worrying to see your child suffer in school and not able to settle down, like your other two daughters.

From what you describe, it seems your daughter is able to talk, which indicates it might not be an organic problem that affects her speech.

I could not give you a diagnosis here, but it does sound like her situation matches closely some of the diagnostic criteria for selective mutism (SM). Some of the main hallmarks of SM are social anxiety, oppositional behaviour and communication problems.

According to the American Psychiatric Association, a key diagnostic feature of the condition is "persistent failure to speak in specific social situations where speech is expected, despite speaking in other situations".

However, if you want a diagnosis, it is best to have her seen by a speech-language pathologist, in addition to a paediatrician and a psychologist or psychiatrist. You should aim to work with them as a team and to develop an intervention plan. Shyness, bilingualism and her age group (four to eight) are some of the predisposing factors of SM. It is often triggered by relocation, especially to a place where the child needs to adapt to another language and culture.

SM is often caused by social anxiety, therefore affected children tend to respond well to a short course of behaviour therapy or exposure-based therapy.

Home-based therapy also helps build your child's confidence without causing additional anxiety. Once trust has been built, the therapy session can move to the school, which usually helps strengthen the child's confidence there, too.

One thing you could do to really help your daughter is change your mindset. Parents' anxiety often creates paradoxical effects: the more you think about the problem and the more you chase a solution, the bigger the issue becomes.

We form most of our identity during childhood. If you can't accept your daughter as she is, how can she accept herself completely?

Focus on the doughnut, not the hole. The less you focus on the problem, the more you will see other aspects of your daughter thriving.

The best way to help her speak in school and adapt to her new life in Hong Kong might be to have faith in her and accept her the way she is.

Communicate to her that you know how difficult it must be and that you are there to help, instead of to judge and push.

But, first, you need to work on yourself and your family to change your mindset.

To be proactive, try to find children with a similar temperament in her class and set up a play date for your daughter at home. Once your child is able to communicate with another child at home, she will feel more at ease speaking in school with that child. The ripple effect could be very dramatic.

One thing worth checking with your daughter is whether the condition is a result of bullying or a traumatic experience (your daughter's definition of a trauma might be different to your own, remember).

The environment in school might be very different, or much louder, compared with what she is used to. If that is the case, make sure she has a qualified professional to talk to, so she can process her anxiety and develop effective strategies to cope with it. Check if there is a school counsellor she can talk to, and communicate your concern.

There are number of good books on SM for parents, but it seems you might have to get them online from the US or Britain.

Can I Tell You About Selective Mutism? is a great book that explains the condition from a child's perspective and what you and your family can do to help. You could read the book with your daughters. The more you and your family understand her difficulties as a phase instead of a problem, the quicker your child will move forward.

If you are not able to find a therapist to help, The Selective Mutism Treatment Guide: Manuals for Parents, Teachers, and Therapists: Still Waters Run Deep is a great book that explains what you, as a parent, can do.

You could try to run your own therapeutic session, following the manual for therapists.

Lora Lee is a child therapist and parenting counsellor with a background in developmental psychology, play therapy and post-separation counselling