What is selective mutism?

Selective mutism is a situational anxiety disorder which prevents a person from speaking when they are expected to speak. It was previously known as elective mutism – which conveys how it was once misunderstood as a condition whereby a person chose not to speak. In reality a person with this condition may want to speak and be unable to. Selective mutism is thought to affect one in every 150 children.

Selective mutism is situational, meaning that a person with selective mutism might find themselves unable to speak in a certain environment or to a specific person. Selective mutism usually develops in childhood and if left untreated it can continue into adulthood. A person with selective mutism may stay silent in certain situations, even if the consequences are social ostracism or punishment, and speak very freely in others. This is why selective mutism often goes undiagnosed or misdiagnosed, as parents may not be aware of their child’s silence at school, for example, and teachers may attribute a child’s mutism to shyness.

The majority of people with selective mutism also have social anxiety disorder. Some researchers have concluded that selective mutism is a response to social anxiety, a means to reduce distress in social situations. However, the two don’t necessarily go hand in hand, as the average age for developing selective mutism (2-4 years) is much lower than the most common age to develop social anxiety (adolescence).

Particularly in young children, selective mutism can be confused with autism. A child with autism may often display other signs which aren’t characteristic of selective mutism, such as repetitive behaviours and specific hand gestures.

Signs of selective mutism

1) Consistent failure to speak in certain social situations, despite speaking in other situations

2) This interference in communication goes on for at least a month

3) The failure to speak is not due to a lack of required spoken language skills/knowledge

4) Stiff or awkward body language in particular social settings: withdrawing physically, avoiding eye contact, seeming frozen or expressionless etc.

What causes selective mutism?

It is not known exactly what causes selective mutism. The reasons are varied in each person. The majority of children with selective mutism are thought to have a genetic predisposition to anxiety, meaning that they may have inherited a tendency to be anxious from a family member (1). Some children with selective mutism have a sensory processing disorder (DSI), meaning that they struggle to process specific sensory information. This may make it difficult for them to interpret environmental and social cues. Misinterpreting these cues can lead to frustration, withdrawal from the situation and anxiety, all of which may prompt a child to respond negatively.

Between 20-30% of children with selective mutism have some type of speech or language difficulty. A difficulty finding the right word or making the required sounds to form your words properly would naturally increases the likelihood of becoming anxious in social situations where there is an expectation to speak.

Though children may develop a tendency to be withdrawn or silent after experiencing a traumatic event or suffering abuse, there is no evidence that selective mutism is an indicator of abuse, trauma or neglect.

What can I do if my child has selective mutism?

If your child has been diagnosed with selective mutism there are a few things you can do as a parent. Firstly, try to remove any expectation for the child to speak. By removing this expectation, you are letting your child know that there is no pressure, thus building their confidence and allowing them to relax. By lowering their anxiety levels, you lower the chances that their selective mutism response is activated.

Try introducing your child to social situations gently. For example, you could try taking them to into school at less busy times, or organising play dates with one or two friends from school. Be supportive of your child’s positive attributes and encourage them to explore their strengths, to boost their self-esteem. Children with selective mutism are often of above average intelligence and creative and, as with all children, talents and abilities should be praised and encouraged.

Experiment with non-verbal communication techniques to boost your child’s confidence. Verbal and non-verbal positive reinforcement should be used frequently. It’s important to send positive messages when your child seems relaxed and comfortable, as they might feel pressured by well-intentioned positive encouragement when they are feeling anxious.

Communicate with other relevant adults in your child’s life, such as their teachers, to keep up to date on any changes or developments in your child’s social life.

How can therapy help with selective mutism?

If left unaddressed, selective mutism won’t necessarily improve with time. It can in fact lead to further anxiety disorders and depression if untreated. There are many avenues to explore when it comes to treating selective mutism, and this includes therapy or counselling.

In therapy, a person with selective mutism can learn tools to combat anxious feelings. A child with selective mutism might benefit from play therapy. Play therapy doesn’t necessarily require that the child communicates verbally. A child can instead express themselves through play. Play therapy has been shown as an effective means of working with children with selective mutism, as it enables the therapist to understand the child through symbols and behaviours, and help them to build skills and master fears (2).

Cognitive behavioural therapy, which promotes positive change in a person’s patterns of thoughts, feelings and behaviour might also be effective for a child with selective mutism.