What is Selective Mutism?

Photo by: M. T. Elgassier

by Andrea M. Darcy

Does your child stop talking entirely in certain environments? Have teachers mentioned there might be an issue? Or do you yourself struggle to speak in some situations and suffer because of it? It might be selective mutism.

What is selective mutism?

Selective mutism means that in certain environments, or around certain people, you experience a freeze response where you can’t speak, no matter how much you want to.

Also referred to as ‘situational mutism’, it’s most common in children, particularly girls and those who have recently moved to a new country where they must learn another language.

And it’s highly related to social anxiety disorder, with most children receiving a dual diagnosis.

Signs of selective mutism

It usually starts young, when children are between ages two and four and are being introduced to new social situations like school.

Your child will suddenly change their behaviour and even physical responses. This can look like:

• clinging to you or hiding behind you
• freezing their body and/or face
• acting sulky or distracted
• being stubborn or having a tantrum when you are going to or returning from the environment they don’t like.

In older children and adolescents signs of selective mutism can include things like:

• a marked fear of making mistakes or being the centre of attention
• unable to talk about their emotions yet highly empathic towards others
• not eating or drinking at school so they don’t have to ask to go to the toilet
• unexplained illness or medical symptoms like an upset stomach leading to many days off school
• refusing to do assignments that involve speaking in front of others
• not wanting to leave the house alone
• unable to call strangers such as booking an appointment.

A diagnosis of selective mutism

For your child to be diagnosed with selective mutism, they need to:

• have struggled  with selective speaking for at least a month
• not have difficulty only because it’s a new language for them
• have no issues with talking in environments they are comfortable in
• have enough of an issue it interferes with learning and socialising
• not have another communication issue that better explains the problem, such as stuttering or autism.

But my child is so chatty at home

photo by: Caleb Woods

Children with selective mutism are often easily social or even very chatty when around people they are comfortable with, like family and friends, and in environments that feel safe.

This is why the issue can go undiagnosed until children start school, or are otherwise presented with new environments.

And note that some children with this issue aren’t totally mute or frozen even when in full anxiety. They might use a few words, or speak in a whisper, or manage to at least use gestures or nodding to communicate. But it will be a far cry from their usual self.

Connected issues 

If your child suffers from selective mutism you might also find they suffer from the following:

• social anxiety
• shyness and trouble with eye contact
• fear of being embarrassed or singled out
• worrying, more than others their age
• hiding their feelings but hypersensitive to those of others
• environment sensitivity if things are noisy or too busy
• possible physical symptoms like stomach upset and urinary infections.

Selective mutism in adults

If selective mutism in childhood is not treated it can carry over into adulthood and heavily affect you from reaching your potential. Adults suffer social isolation, low self-esteem, and feelings of shame.

Sadly, others might misunderstand you and think you are rude or defiant. So you might also feel very lonely.

And it can make day-to-day life really difficult. Things like calling a doctor to make an appointment might take hours or be impossible. If you are accused of something you didn’t do you can be unable to defend yourself. And things like job interviews might be so stressful you simply avoid them.

Myths about selective mutism

So what myths about selective mutism do you need to know?

1. My child is being defiant.

Absolutely not. A child with selective mutism really can’t speak in certain situations no matter how much they want to. No amount of shaming or punishment can ‘make’ them speak, but it can certainly make them feel far worse than they already do.

2. My child must have been abused.

Research has found no direct link between selective mutism and abuse or trauma. While it is true that child abuse or trauma can lead to children suddenly not speaking, post-traumatic speaking issues mean a child stops talking in an environment they used to have no problems in.

3. They are choosing not to speak, I’m sure of it. 

This condition was originally called ‘elective mutism’ due to a misunderstanding (that still can persist) that sufferers don’t want to speak. But again, this isn’t the case. The brain of sufferers seems to enter an anxiety-triggered ‘freeze’ mode beyond their control. 

4. It’s a sign a child has intellectual difficulties. 

To the contrary. Many children with selective mutism have an above average IQ and sense of perception and observation. They are very aware of other people’s feelings, more so than others of their age, and are more likely to have a strong moral compass.

Is it selective mutism or autism?

By: Andrea Koerner

Autism spectrum disorder and selective mutism share some characteristics. Both diagnoses see a child experience bouts of not speaking and of being sensitive to their environments.

A main difference is that children with autism can have speech challenges even in environments they feel most safe in, such as around family. And they will also have other issues like hand flapping or rocking and repetitive behaviours.

Children with selective mutism, on the other hand, in the right environment where they feel comfortable, will appear like any other child.

This said, a child with autism can have selective mutism, in that certain environments always cause them to stop communicating. But if the mutism is due to autism, then it will diagnosed just as that.

Treatment for selective mutism

There are several forms of treatment to help, and the right treatment plan depends on age and related issues. 

Treatment generally focuses on lowering anxiety around talking rather than pushing for speech.

This can include things like ‘stimulus fading’, where your child talks with you or someone else they are comfortable with, another person is introduced, and you eventually leave. Or ‘shaping’, which introduces speech in stages like reading aloud, then interactive reading games, then talking activities, and finally a conversation. (Learn more about such treatments on the NHS Selective Mutism page).

Older children, adolescents, and adults will be offered cognitive behavioural therapy. It helps you challenge your thoughts, and understand just how your they are affecting your feelings, your body, and your behaviours.

Ready to help your child or yourself? Browse our hand selected team of London-based psychiatrists, child psychologists, and psychotherapists now, who are committed to finding a treatment plan that works for you.