Selective mutism (SM) is a type of anxiety disorder that prevents people from speaking in social situations. This holds true even when a person freely speaks their mind in a household setting.
While this condition tends to be a characteristic of childhood, it can persist into adulthood if left untreated.
Throughout this article, we’re going to take a deeper look at selective mutism, it’s signs and symptoms, and how to properly treat it. At the end, we invite you to ask further questions.
Selective Mutism Defined
Considered a severe anxiety disorder, selective mutism (SM) is when a person cannot speak in specific social situations, such as at school, work, or around relatives. ¹
When we look at selective mutism in children, it may appear as though they’re simply choosing not to speak. However, children with this condition are actually unable to speak.
This is due to the fact that a social situation triggers a freeze response – leaving the person struggling in a state of panic. In such a state, talking isn’t possible.
With enough time, a person will learn to anticipate when their selective mutism is present. As such, they’re also able to overcome this freeze response.
For this reason, SM is more prevalent in children rather than adults. However, if left untreated, this condition can persist into adulthood.
Furthermore, selective mutism is quite rare – affecting 1 in 140 children. ² Its prevalence is more common among girls than boys, especially in children who are learning a second language (i.e. immigrants).
Selective Mutism Symptoms
Starting in early childhood, parents can expect to see the condition appear between the ages of 2 and 4. Chances are you’ll first notice signs when a child must interact with people outside of their home, such as at school or a nursery.
In terms of warning signs, the ultimate to look out for is whether or not a child is able to engage in social interactions with different people. If you find your child becomes frozen (both in body and facial expression) when outside their comfort zone, they may struggle with SM.
Other signs and symptoms to keep an eye out for include:
- Disinterested, rude
- Poor coordination
- Social awkwardness
- Shy and withdrawn
- Stubbornness or aggressiveness
In children with mild cases of SM, it’s possible for parents to develop some form of communication under these circumstances. For example, you may have your child nod their head “yes” or shake their head “no” even when in a panic.
However, if your child is severely affected, it’s unlikely they’ll be able to perform any kind of communication.
Selective Mutism Causes
Since SM is a form of anxiety, it’s believed the cause of the condition is similar to those of other anxiety disorders. These include: ³
- Brain structure irregularities
- Environmental factors
- Traumatic experiences
However, there are other reasons a child or adult may experience SM. These include:
- Busy Environments – May cause child to become overwhelmed with what’s around them “shut down.”
- Language Disorder – Difficulty with speech and hearing.
- Post-Traumatic Stress Disorder (PTSD) – When a child or adult returns to a traumatic memory, they may suddenly stop as a defensive mechanism.
- Separation Anxiety – Children may become stressed and anxious when separated from parents. ⁴
It’s worth noting that as of this time, no research indicates SM is caused by or associated with autism. ⁵
Furthermore, some research speculates it may play a role in the development of a social anxiety disorder later in life. ⁶
How is Selective Mutism Diagnosed?
Since SM has recognizable signs and symptoms, it’s easy for both parents and medical professionals to come to a diagnosable conclusion. However, it remains important that SM is treated as soon as possible – for if left untreated, it can lead to other mental health conditions.
In order to for an SM diagnosis, you or your child must meet the following guidelines: ⁷
- Avoid speaking in specific situations, such as at school or in public
- Inability to speak interferes with ability to function
- The speaking problem is not explained by another mental health condition
- Their inability to speak in specific situations lasts at least 1 month (2 months when placed in a new setting)
- When comfortable (such as alone with a parent), they can speak normally
Diagnosing Selective Mutism in Adults
As mentioned, adults can also struggle with SM. Though, these cases are much rarer than those present in children.
In most cases, SM is a characteristic of another condition, such as a social anxiety disorder. Therefore, treating such cases will require a separate mental disorder diagnosis.
Challenges in Diagnosis
While signs and symptoms of SM can be obvious, they can also be confused with other physical and mental complications – leading to a false diagnosis. Such instances may include:
- Generalized anxiety disorder
- Post-traumatic stress disorder (PTSD)
- Social anxiety disorder
- Urinary infection
Furthermore, a child may be going through a bout of difficulties that may appear as SM. For example, if their typical routine suddenly shifts (i.e. by a move), they may have tendencies of SM for a short period of time.
Selective Mutism Treatment
In order to treat SM, a mental health professional must learn the following: ⁸
- The length of time a person has been selectively mute
- Whether there are other mental difficulties at play (such as a learning disorder or anxiety)
Instead of targeting speaking itself, SM treatment involves overcoming the anxiety that causes a child to be mute.
In very young children, overcoming SM requires the cooperation of parents, other family members, and schools. By slowly encouraging your child to speak in difficult situations, they’ll gradually learn to overcome it.
In order to further this process, parents should:
- Avoid telling children when they’re anxious
- Concentrate on having a good time
- Praise efforts the child makes to interact with others
- Reassure them about their speaking
Furthermore, parents should avoid showing surprise when a child speaks. It’s more beneficial to respond to your child as you would other children.
In older children and adults, these steps can also be taken. However, you’ll likely also need to incorporate another form of anxiety treatment. The most common for children and adolescents is cognitive behavioral therapy (CBT). ⁹ In adults, medication may also be a requirement.
While selective mutism may initially seem like a difficult challenge to overcome, we guarantee that with the right treatment path, any child can recover.
Naturally, this requires a lot of effort on the end of the parent. Most notably, to be conscious of the child’s social interactions and their efforts to overcome SM.
In cases of adolescents and adulthood, further treatment options are a requirement.
Regardless of the age, it’s key to ensure SM is addressed as early as possible. The sooner you identify and work at the condition, the better chance you or your child has at overcoming it.
Still have questions concerning what is selective mutism?
We invite you to ask them in the comments section below. If you have any further advice to share – whether personal or professional – we’d also love to hear from you.
² National Organization for Rare Disorders (NORD): Mutism, Selective
³ National Institute of Mental Health (NIMH): Anxiety Disorders
⁴ Journal of Psychiatry for Neuroscience: Rapid resolution of social anxiety disorder, selective mutism, and separation anxiety with paroxetine in an 8-year-old girl
⁵ Neuropsychiatric Disease and Treatment: Children with autism spectrum disorders and selective mutism
⁶ Clinical Child and Family Psychology Review: Selective Mutism and Its Relations to Social Anxiety Disorder and Autism Spectrum Disorder
⁷ Psychology Research and Behavior Management: Current Challenges in the Diagnosis and Management of Selective Mutism in Children
⁸ European Child & Adolescent Psychiatry: Treatment of selective mutism: a 5-year follow-up study
⁹ Dialogues in Clinical Neuroscience: Cognitive-behavioral therapy for anxiety disorders: an update on the empirical evidence