What Is Selective Mutism?

It's normal for children to develop their speech at different paces. It's common for children to be shy in certain situations, such as in large groups or when meeting new people. However, if your child can talk freely and confidently at home but consistently freezes up and stays silent in public, it could point to an anxiety disorder called Selective Mutism.

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Selective Mutism (SM) is often poorly understood by the general public, and even well-intentioned professionals can minimize symptoms and assure parents that their child's symptoms will subside with time. While that may be true for some children, early intervention can produce far better outcomes.

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What is Selective Mutism?

Selective Mutism is a childhood anxiety disorder that affects around 1% of the population. Children with Selective Mutism (SM) are unable to speak in situations where speaking is expected of them. For instance, kids with SM may speak freely in specific settings where they feel safe, such as the home, but are unable to speak in more public settings or around strangers.

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At home, your child may be inquisitive and talkative, often described as chatterboxes, only to be told by a concerned teacher that they are not speaking at school. Rather than shutting down completely, a child with SM might whisper to a close friend or family member, communicating via the other person.

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Signs and Symptoms

Selective Mutism is not to be confused with being shy. Children with SM appear to freeze in social situations, finding themselves unable to communicate, despite expressing themselves freely at home. This differs from children with shyness, who might speak softly or say fewer words but can still respond to questions. The following symptoms may encourage you to speak to an experienced SM provider:

• Speaking freely at home but becoming non-verbal in public settings or around strangers.
• Speaking through somebody they trust, e.g., whispering responses to a parent.
• Shutting down entirely and looking frozen when anxious and unable to communicate.
• Struggling to make eye contact when feeling anxious.
• Relying on non-verbal communication such as nodding or shaking their head.

Selective Mutism presents differently in every child. Some children might seem extremely anxious, motionless, and expressionless in non-verbal situations, while others may seem at ease despite being unable to communicate. It isn't uncommon for children to exhibit anxiety symptoms in many ways. Some children may become overly controlling and rigid at home, while others may become disruptive and have out-sized tantrums.

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Common Myths

There needs to be more information about what SM is and isn't. Selective Mutism is often mistaken for autism or severe shyness. However, it's quite different. Many adults will often believe a child with SM is being willful or defiant, yet this is a common myth that minimizes a child's anxiety. Another common myth is that children with SM cannot communicate because they've suffered from trauma, neglect, or abuse. There's no evidence that children with SM are more likely to have experienced trauma than other children.

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Another troubling misconception about SM is that symptoms will diminish with time. While we may see a child with mild symptoms become more comfortable verbalizing over time, it's not guaranteed for every child. It depends on their severity level and exposure to anxiety-inducing situations. We know that accurate diagnosis, early intervention, and working with a trained SM professional using evidence-based treatments will reduce symptoms. It has been shown that as children get older, some symptoms may increase in severity, and they are at risk of developing subsequent comorbid mental health disorders.

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Diagnosis

If you suspect your child may have SM, seek an experienced professional for a diagnosis. Many experienced child and adolescent mental health professionals lack the specific experience to treat children with SM, and traditional therapies may not reduce symptoms. Find providers trained in SM treatments through the Selective Mutism Association and inquire about their training and experience.
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There's no one cause of Selective Mutism. Most research indicates that it is a combination of nature and nurture: a genetic predisposition paired with a cycle of negative reinforcement for not speaking. It's common to have specific comorbidities with Selective Mutism, such as other anxiety disorders (e.g., Social Anxiety Disorder, Generalized Anxiety Disorder) or language and communication disorders. Children from bilingual households are also at a higher risk of developing Selective Mutism. To diagnose SM, medical professionals will look for the following criteria:

• Consistent inability to speak in specific social situations, despite speaking freely in other scenarios.
• An inability to communicate interferes with their ability to function (e.g., participate in school, interact with peers, etc.).
• Symptoms must be present for at least one month, not exclusive to the first month of school.  
• The failure to speak isn't the result of a lack of knowledge or confidence in the spoken language that the situation requires. The expectation that children can pick up a second language almost overnight can sometimes cause parents to underestimate the complexity of a child's language learning. It is essential to look out for this for children of multilingual families.
• The behavior is not explained by a communication disorder such as stuttering or neurodivergence.

Treatment

There's no one size fits all approach to treating this anxiety disorder, and what works for another child might not work for yours. Many professionals recommend behavioral therapy, such as Parent-Child Interaction Therapy (PCIT-SM) or Cognitive Behavioral Therapy (CBT). Here's what the two types of therapy involve:

• PCIT-SM: This research-tested form of behavioral therapy aims to improve verbal and non-verbal participation while reducing parental accommodations. A certified PCIT-SM mental health provider will coach you and your child through your interactions to increase verbalizations with new people in new places.
• Cognitive Behavioral Therapy: CBT is an action-based and problem-solving form of talking therapy by trained therapists. These techniques to shape behavior can begin by exposing the child to moderately anxiety-inducing situations and slowly growing their confidence by gradually working to more anxiety-provoking scenarios.

In cases where behavioral therapy has not managed to treat a child's SM entirely, anti-anxiety medications may be used in conjunction with behavioral therapy to reduce symptom severity. Medication is always carefully considered with a child's age, symptom severity, and inability to function in mind.

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As with any childhood mental health disorder, your child will benefit significantly from love, patience, and support throughout the process. Understanding the signs and symptoms of SM is critical for diagnosis and treatment, so if you suspect your child has SM, act as soon as possible. To learn more about Selective Mutism support at Foundations Therapy or additional parental resources, contact us at hello@foundationsnyc.com.

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^{Disclaimer: This information is for educational purposes only and is not meant nor intended to be health care advice or treatment. Should you need assistance with any mental health or psychological issue, including any parenting issues, you should contact a mental health professional.}

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