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Selective Mutism

Selective mutism often starts in childhood and is a rare anxiety disorder, whereby the child or adult can’t speak in certain social situations e.g. in school/work, or with relatives, they don’t know well. It is often misunderstood as refusal to speak or manipulative when it’s actually extreme anxiety which prevents them from being able to. There are misconceptions that selective mutism is related to autism or a sign of shyness but that is not necessarily the case. 

Someone experiencing selective mutism has a “freeze” response when met with an expectation to speak, making it impossible to talk. This “freeze” response can be so distressing that it causes people to avoid situations where they have to speak. However, with people they feel closer to or more comfortable with, they may speak more freely as this interaction does not trigger the “freeze” response. 

Selective mutism is commonly seen in girls and children who have migrated and are learning a second language. Selective mutism can be identified when a child has to interact with individuals outside of the family, which can be as young as two years old. Children with selective mutism are no more likely to have experienced neglect, abuse or trauma. But they may have a family history of anxiety disorders or co-existing issues e.g. sensory processing disorder.

Symptoms

Identifying features of someone experiencing selective mutism include showing a frozen facial expression, and appearing to be sulky, disinterested, stiff, tense, poorly co-ordinated, clingy or socially awkward and nervous. Some children/adults with mutism can use gestures e.g. nods or single words, yes and no. Some children can make tiny replies in a whisper. They may also show poor eye contact.

The anxiety the individual feels may at times also be transferred to those around them as they try to break the silence. 

If mutism occurs following a traumatic event, this is different the child will suddenly stop talking in a context they were once comfortable in before

Selective mutism is serious and shouldn’t be neglected. Ruling out a speech and language problem initially might be a helpful first step. Staff and family need help to reduce a child’s anxiety.

In order to be diagnosed with selective mutism, you must have the following;

  • Do not speak in lessons or when overheard in public
  • Speak normally in situations they feel comfortable e..g with parents at home
  • Inability to speak for over 1 month. 
  • Inability to speak is interfering with your ability to function in the setting e.g. school or work. 
  • Inability to speak is not better understood by another developmental, behavioural or communication disorder.

Treatment

Treatment focuses on reducing the anxiety associated with speaking. Cognitive Behavioural Therapy (CBT) and behavioural techniques are useful treatments. Graded exposure to situations causing the least anxiety is tackled first. Behaviour shaping and positive reinforcement can be used to encourage non-avoidance. Some play/art therapy alongside the above treatments can also be helpful. You can read more about our experts in this field, Hayley Su and Dr Jennifer Greene

Helpful Resources

To find out more about selective mutism check out the following links: