What Is Selective Mutism and How Is It Treated?
Abby Barnes, M.S., CCC-SLP
As children grow, their unique personalities start to shine. While some children are outgoing and talkative, others may be more shy or reserved. But when a child consistently struggles to speak in certain situations, even though they can talk comfortably at home, it might be more than shyness—it could be selective mutism.
Selective mutism in children is an anxiety-based condition. Children with selective mutism have difficulty speaking in specific places and situations, even though they have the ability to communicate. Understanding the signs of selective mutism can be the first step in helping your child feel more confident and supported.
What is selective mutism?
Selective mutism is an anxiety disorder that affects a child’s ability to speak in certain situations. A child with selective mutism may talk in some places or with some people, but not in others. For example, they may talk regularly at home or with friends, but once they get to school, they seemingly lose the ability to speak.
Selective mutism is not a speech or language disorder. The child’s silence is caused by anxiety, not a lack of ability. Though it’s called “selective” mutism, it’s important to know that children with this disorder don’t choose where or when to speak. Instead, they feel more comfortable speaking in certain situations, and anxiety prevents them from speaking in others.
What are the symptoms of selective mutism in children?
Symptoms of selective mutism often appear during early childhood, between ages 3 and 6. Some common signs of selective mutism include:
Lack of eye contact
Crying
Freezing/appearing paralyzed
Hiding or running away
Speaking with some people but not others
Speaking in some situations but not others
Difficulty talking with people they are usually comfortable with when in the presence of others (for example, not talking to their parents when their teacher is nearby)
Using gestures instead of verbal communication
Lack of a speech or language disorder that may affect their ability to speak or understand others, such as stuttering
Some less affected children may whisper or gesture to communicate.
For selective mutism to be diagnosed, these symptoms must last for more than one month. That time period shouldn’t include a situation when it may be expected that your child wouldn't talk right away, such as the start of a new school year.
Selective mutism is not disobedience
When you have a child with selective mutism, it can be upsetting to watch them struggle to speak. You may even become frustrated at times.
However, it's important to remember that children with selective mutism are not intentionally choosing not to speak. This is a disorder, not a behavior problem or disobedience. They are not being defiant or stubborn. Rather, they're simply unable to communicate with certain people or in certain situations. Most children who have selective mutism also have a disorder of social phobia or social anxiety.
Children with selective mutism are not intentionally choosing not to speak.
This is why it's not appropriate to reprimand children with selective mutism. Speaking negatively to them about their inability to talk, or assuming that they're purposefully choosing not to speak, can be very hurtful. In fact, it can even make it harder for them to communicate.
Differences between selective mutism and a language delay
It's not uncommon for selective mutism to be confused with other types of language or social disorders. As much as parents, caregivers, and teachers should know what selective mutism is, it's equally as important to know what selective mutism is not.
Let’s discuss some differences between selective mutism and language delays.
Selective mutism: A child with selective mutism wants to talk but freezes when placed in difficult communication settings. They are doing their very best, but they can’t force the words to come out.
Language delay: An expressive language delay is a child’s inability to use words and sentences at an age-appropriate level to express their wants and needs. It's a developmental delay of their language abilities.
Social language delay: A social language delay happens when a child has difficulty understanding how to interact in social situations. They may find it hard to read a person’s body language or take part in conversations. This is a developmental delay in understanding various social skills.
It's important to note that language delays can co-exist with selective mutism. However, they are separate disorders. Language problems don’t cause selective mutism.
The difference between selective mutism and autism
Selective mutism and autism can look similar in some ways, but they are different. Children with selective mutism usually have trouble speaking only in situations where they feel anxious or uncomfortable. When they feel safe and comfortable, they often communicate and interact socially like other children.
On the other hand, autistic children often have challenges with communication and social skills in all settings, no matter where they are or who they’re with. Also, children with autism may show repetitive behaviors or strong interests in specific topics. These behaviors aren’t common in children with selective mutism.
What causes selective mutism?
There is no single cause of selective mutism. Several factors can contribute to or cause selective mutism. These might include:
Having an anxiety disorder
Having a family history of social anxiety or selective mutism
Being very shy or worried about embarrassing themselves in public
Each child is different, and their selective mutism may result from a combination of these factors.
How does selective mutism affect children?
Imagine wanting to be able to communicate with those around you but being completely stuck. You'd likely feel extremely discouraged and probably embarrassed. Children with selective mutism have these feelings daily.
While every child with selective mutism is different, many find it difficult to speak in school. When children can't communicate with teachers, it can lead to poor academic performance. For example, they may not raise their hand in class or ask for help, even for basic needs such as using the restroom.
While every child with selective mutism is different, many find it difficult to speak in school.
These socially anxious feelings don't just extend to their interactions with adults. Some children with selective mutism have trouble talking with kids their own age. During early childhood and school-age, children play and socialize together in the classroom, on the playground, and during extracurricular activities. There is so much social learning that goes on during these times. When children can't speak during these activities, it can negatively impact their social development and their mental health and well-being.
How is selective mutism treated in children?
Because selective mutism is an anxiety disorder that impacts the ability to communicate, it should be treated by a team of professionals. That team might include speech therapists, teachers, behavioral health professionals, and other school staff.
Speech therapy for selective mutism has two main focuses:
1. Reducing your child’s anxiety
2. Helping your child feel more comfortable communicating in different situations
Treatment often involves a combination of techniques to help your child at home, at school, and in the community. A speech therapist will use a slow, step-by-step program to encourage your child to communicate. They will help your child practice speaking in easier settings, then gradually move on to more challenging situations.
If your child has other speech or language challenges, the speech therapist will address these once your child is more comfortable communicating. For example, they may work on speech sounds, vocabulary, or confidence in expressing ideas.
What to do if you think your child has selective mutism
Sometimes, children with selective mutism are simply labeled as “shy.” However, if it’s not recognized, selective mutism can cause serious problems for your child down the line.
If you think your child has selective mutism, or if you notice the symptoms described in this article, be sure to talk with your child’s pediatrician. You may also need to talk with a psychiatrist or psychologist. It's important to get a professional’s opinion so your child can have an evaluation.
The importance of diagnosing selective mutism early
The earlier a child is diagnosed with selective mutism, the better. Children often respond positively to early intervention. The longer a child goes without a diagnosis, the later treatment starts.
Early treatment can help prevent selective mutism from lasting into adulthood. It can also prevent symptoms from becoming worse. According to The SMart Center, delaying treatment for selective mutism can cause:
Worsening anxiety
Depression and other anxiety disorders
Social isolation and withdrawal
Poor self-esteem and self-confidence
School refusal, poor academic performance, and the possibility of quitting school
Problems in the workplace
How to communicate with a child who has selective mutism
Apart from therapy, there are simple techniques you can use to make communication more positive for your child with selective mutism.
Don't draw attention to your child's lack of speech. Also, try to avoid putting pressure on them. This only makes it harder for them to express themselves. Removing pressure may help your child relax and feel more comfortable. When they feel supported, they may be more likely to talk.
When talking with your child, you don’t need to make eye contact. Eye contact can be overwhelming for children with selective mutism. Your child may also prefer that you sit next to them when talking, instead of being face-to-face.
Continue the conversation even if your child doesn't respond. Give them plenty of time and take intentional pauses so they have a chance to answer. If they don’t answer, keep talking and providing more opportunities for conversation.
Talk about an activity your child enjoys, perhaps one that you do together. As you talk, give your child lots of chances to comment or respond.
Always encourage your child and praise their efforts to communicate. They're doing the very best they can, and they will greatly benefit from knowing you’re cheering them on along the way!
Do you have questions about selective mutism?
Expressable speech therapists are experienced in treating children with selective mutism. If you’re concerned about your child’s speech, schedule a free consultation call with one of our specialists. We’re here to answer your questions and help guide you in supporting your child.
