A child with selective mutism may talk freely at home while struggling with expressing themselves in other environments, like at school. Selective mutism is more than just social anxiety or shyness. Children with selective mutism are physically incapable of speaking when put in certain social settings, such as in the classroom or on the playground. Significant social and academic complications can result from this disorder. Fortunately, there are steps you can take to support and advocate for a child with selective mutism. Ahead, we spoke with some experts to find out what exactly selective mutism is, what causes it, and how it’s diagnosed and treated.
What Does Selective Mutism Look Like?
According to Holly Schiff, MD, a clinical psychologist at the Jewish Family Services of Greenwich in Connecticut, children with selective mutism might become suddenly still, with a frozen facial expression, while potentially avoiding eye contact or appearing nervous and uneasy. “They typically are comfortable speaking freely at home with family, but become nonverbal in public settings or around strangers,” she says. “There may be anxious avoidance behaviors, sensory sensitivities, or temper tantrums,” adds Stefanie Blanco, a speech-language pathologist and professor at New York Medical College. Children affected by selective mutism may rely on other forms of communication, such as gestures, pointing, or whispering in order to express themselves, explains Blanco. Selective mutism may present differently from child to child. Some kids are able to easily speak with other children, but not with teachers or adults. Others may feel comfortable speaking with immediate family only, but not with extended family or acquaintances. Children may communicate one-on-one with teachers, but tense up in larger group settings.
Causes of Selective Mutism
According to Dr. Schiff, there is no single cause of selective mutism. However, there are certain characteristics that are common in children with the disorder. “It is related to social anxiety, shyness and an inhibited temperament, in which the individual avoids situations where they have to speak,” she explains. “This avoidant behavior gets reinforced over time.” Anton Shcherbakov, MD, licensed clinical psychologist at The Center for Emotional Health of Greater Philadelphia and co-founder of ThinkPsych, notes that both environmental and genetic factors can play a role. “Children whose parents experience significant (especially social) anxiety may be at increased risk for selective mutism,” he says. “Also, children who have very socially inhibited or overprotective parents may be more likely to develop selective mutism through the effects of modeling and learning.”
Diagnosing Selective Mutism
A number of professionals can diagnose selective mutism, including developmental pediatricians, psychologists, and speech-language pathologists. If you suspect your child may be affected by selective mutism, start by speaking with your healthcare provider, and they can refer you to the right specialist for any additional evaluation that may be necessary. Diagnosis is based on both clinical observation and a good clinical history, according to Dr. Shcherbakov. “In order to meet criteria for the diagnosis, the child must have had the difficulty for at least 1 month and it must be causing significant impairment with academic, work, or social functioning,” he adds. “[The symptoms] cannot be due to another diagnosis such as autism, communication delays, or psychosis.” This is consistent with the diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition, or DSM-5, which stipulates:
Consistent failure to speak in specific social situations in which there is an expectation for speaking (e.g. at school) despite speaking in other situations.The disturbance interferes with educational or occupational achievement, or with social communication.The duration of the disturbance is at least one month (cannot be during the first month of school).The failure to speak is not attributable to a lack of knowledge of, or comfort with, the spoken language required in the social situation.The disturbance is not better explained by a communication disorder (e.g. childhood-onset fluency disorder) and does not occur exclusively during the course of autism spectrum disorder, schizophrenia, or another psychotic disorder.
Treatment for Selective Mutism
Each child’s treatment plan will look different and may include cognitive-behavioral therapy, speech-language therapy, or family therapy. “Behavioral therapy focuses on helping children learn to speak in new settings, with new people, and during new activities,” according to Dr. Schiff. “Treatment focuses on reducing anxiety, teaching coping skills and desensitization/graded exposure.” Dr. Shcherbakov adds that cognitive-behavioral therapy is the most effective method for treating selective mutism. “It typically consists of confronting the fear of speaking in progressively more challenging situations until the child is able to better tolerate these situations.” He also emphasizes that the family can play a big role in the success of treatment. “[This method] involves a significant parent education and training component to help caregivers encourage their child in difficult social situations.” Medication and speech therapy are other forms of treatment that may be used, and are determined on a case-by-case basis. According to the American Speech-Language-Hearing Association, speech therapy aims to change your child’s behavior during those particular times it is difficult to communicate. This may include:
Stimulus Fading: A child initially speaks with someone they are comfortable around, and new communication partners are introduced over time.Shaping: The therapist works to shape your child’s current communicative behavior (e.g. gestures/pointing, whispers) to a point where they can speak comfortably in all situations. This is accomplished through the use of rewards and positive reinforcement.Self-modeling: A child watches himself speak comfortably (on video recording) with different people and in different settings to boost confidence and encourage speaking in new situations.
Other Types of Mutism
In addition to selective mutism, there are two other main types: elective mutism and total mutism. “Elective mutism is when a person chooses not to speak as a result of psychological issues. Selective mutism is when a person wants to speak, but in certain circumstances, they cannot. Total mutism is when a person doesn’t speak under any circumstance,” explains Dr. Schiff. It’s important to note that each type of mutism can manifest differently in each child, depending on the level of severity, as well as the child’s individual environment.
Tips for Parents
The biggest piece of advice for parents of children with selective mutism is to keep communication environments low pressure, says Blanco. Rather than pushing and forcing them to speak, experts advise to provide support and praise. “Parents should not pressure their child to speak and should be understanding throughout treatment,” says Dr. Schiff. “It is also important to reassure them that non-verbal communication is fine until they feel comfortable speaking.” This isn’t to say that parents can’t encourage their children throughout the treatment process and try to help them along. “The key is to empower the child to face their fears in a sequential and manageable way,” says Dr. Shcherbakov. “For example, if your child will only talk to the parents, you may encourage them to try waving to a familiar adult such as a family member. Once they feel more comfortable with that, they may be encouraged to whisper something to you that you can tell the other adult.”
A Word from Verywell
Selective mutism, a significant childhood anxiety disorder, can manifest in many different ways. Beyond typical shyness, a child may not feel comfortable communicating in certain settings or with specific people. If your child is struggling with selective mutism, there are many treatment plans that can help, such as cognitive-behavioral therapy and speech therapy. As a parent, it’s important to take pressure off your child to speak, provide emotional support and encourage any communication your child is comfortable with.
