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Selective Mutism

Reviewed by Psychology Today Staff

Selective mutism is a rare childhood anxiety disorder in which a child experiences a trigger response and 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. The child is simply unable to speak. Symptoms and co-existing conditions can vary from individual to individual, as can treatment options.

Symptoms

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.

What are some signs of selective mutism?

Children who suffer selective mutism may appear: Shy, socially awkward, anxious, insecure and clingy, embarrassed, rude, indifferent or aloof, stiff or tense, avoids eye contact, remains expressionless, and or motionless. However, with family or other close relationships, the child may be angry and aggressive. Some will use hand gestures to communicate. With the prospect of a social event or even while preparing for school, kids with selective mutism may suffer stomachaches and headaches, or feel nauseous or suffer diarrhea.

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Causes

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 autism spectrum disorder, obsessive-compulsive disorder, developmental delays, or sensory processing difficulties.

Can selective mutism lead to mood disorders?

Selectively mute teens may also experience mood disorders like depression, and they can suffer conditions such as agoraphobia, a fear of leaving home. However, selective mutism is not catatonic depression, which is a subtype of depression where the person does not speak or is in a daze.

Are selective mutism and autism spectrum related?

Individuals on the autism spectrum have problems with social skills and communication abilities; while they do feel empathy for others, they do not always show it. Autism is a developmental disorder, and selective mutism is an anxiety disorder. If a child is mute because of autism, they are not diagnosed with selective mutism.

Treatment

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.

What happens when selective mutism is left untreated?

If untreated, selective mutism can in some cases follow a child into adulthood. It will affect school, family, social life, and work. All of which compounds appropriate development.

How can schools and teachers help a child with selective mutism?

Schools and teachers can help a child in various ways:

• Do not pressure the child to speak

• Allow time for counseling and speech therapy

• Allow smaller class sizes

• Allow seat assignment near a friend or the teacher

• Allow hand gestures and nonverbal communication

• Be aware of bullying

References
Child Mind Institute: Selective Mutism. National Health Service, UK National Institutes of Health
American Speech-Language-Hearing Institute website. Selective Mutism. 
Wong, P. Selective Mutism: A review of etiology, comorbidities, and treatment. Psychiatry. March 2010;7(3):23-31. 
Last updated: 07/07/2021