Selective mutism is a rare childhood anxiety disorder in which a child is unable to speak in certain situations or to certain people. It is not a form of shyness, though it may be thought of as extreme timidity. Nor is it an intentional refusal to speak, though it may be perceived that way. Symptoms and co-existing conditions can vary from individual to individual, as can treatment options.
The onset of selective mutism is usually between the ages of 3 and 6. Most children who develop selective mutism also suffer from social anxiety, or social phobia. Temperamentally, they are timid and cautious in new situations, even as young infants. They may experience separation anxiety. Many show physical signs, such as awkward body language, stiffness, and lack of facial expressions. Those who are comfortable in a situation may be mute but have more relaxed physical characteristics. A child with selective mutism may speak in some select situations but not in others, or with select people but not with others. For instance, the child may speak normally at home or with close friends, but not at school or other social settings, where there is the expectation or pressure to communicate. Some children with selective mutism can use nonverbal communication, such as nodding their head or moving their hands, while others may appear frozen. Others may experience so much pressure for their selective mutism that they become mute in all situations, with all people. To be labeled selectively mute, the symptoms must continue for at least a month, not including a child’s first month of school.
Children with selective mutism often have a family history of anxiety disorders. The neurological basis for selective mutism is thought to be a cascade of events in an area of the brain known as the amygdala, which receives danger signals from the environment. The anxiety from a situation perceived as dangerous to the child’s well-being causes a communication shutdown. Children with selective mutism may have a variety of co-existing disorders, such as obsessive-compulsive disorder, autism spectrum disorder, or developmental delays.
It is best to seek behavioral therapy or family therapy as early as possible for a child with selective mutism because the condition may not go away on its own. It is important to the success of therapy that the mental health care provider be a good fit for the child and the family. Treatment typically includes helping the child develop skills to control their anxiety and “unlearn” their dependence on mute behavior. In some cases, treatment may also include antidepressant or anti-anxiety medication in addition to psychotherapy.