Selective Mutism

What is selective mutism?

Selective mutism is when a child can’t speak in certain settings, but can speak fine in others. For instance, a child may not be able to speak at school, but can speak with no problem at home. It's called selective mutism because the child is only mute in select situations. It’s a rare childhood condition. It can cause problems with school and social situations.

A child with selective mutism may find certain social situations very stressful. This may cause anxiety so severe that the child feels unable to speak. Selective mutism is not caused by a child’s willful refusal to speak.

In some cases, a child may have other speech problems as well. But in many cases, a child may not have any trouble at all when they feel comfortable.

Selective mutism often starts in very young children, around ages 2 to 4. But it may not be recognized until a child starts school.

What causes selective mutism?

There is no single known cause of selective mutism. Researchers are still learning about factors that can lead to selective mutism, such as:

  • An anxiety disorder

  • Poor family relationships

  • Untreated psychological issues

  • Self-esteem problems

  • Problems with sound processing

  • A speech or language problem, such as stuttering

  • Family history of anxiety disorders

  • A traumatic experience                                                                                  

Selective mutism can also run in families.

Who is at risk for selective mutism?

A family history of the condition may increase your child’s risk. Your child may also be more likely to show signs of selective mutism if anxiety disorders run in your family. A traumatic event may increase the risk, too.

What are the symptoms of selective mutism?

The main sign of selective mutism is a month or more of failure to speak only in certain social situations. The problem is not due to another communication disorder, such as autism. And it is not due to not knowing the spoken language.

Some children with selective mutism may show additional signs, such as:

  • Anxiety

  • Social withdrawal

  • Excessive shyness

  • Obsessive compulsive disorder

  • Depression

  • Developmental delay

  • Communication disorders

  • Elimination (urine or stool) disorders

How is selective mutism diagnosed?

Your child’s healthcare provider will ask you about your child’s medical history and signs and symptoms. You’ll be asked about your child’s speech and language development. It may help to bring your child’s academic reports and teacher comments to the appointment. Your child’s healthcare provider might want to observe your child at home and at school. You may be asked to record videos of your child at home or school.

Your child will be given a medical exam. This will include an exam of your child’s ears, lips, tongue, and jaws. Your child may also have a neurological exam. They may also need a hearing test. The healthcare provider will look to rule out other medical conditions, such as schizophrenia.

Other healthcare providers may help assess your child. These may include a speech-language pathologist (SLP), and a psychologist or psychiatrist. An SLP can assess your child’s ability to understand and use language. A psychologist can help find emotional issues that may cause the condition.

How is selective mutism treated?

Treatment varies based on the needs of your child, and may include:

  • Stimulus fading. Involve the child in a relaxed situation with someone they can talk to freely. Then very slowly bring someone new into the room.

  • Shaping. Using a structured approach to reinforce and encourage all efforts by your child to communicate, such as with gestures or whispering, until audible speech is achieved.

  • Self-modeling. This is done by having your child watch a video of themself communicating well at home to raise self-confidence.

  • Speech therapy. This can be done for any underlying speech problems, if needed.

  • Family and behavioral therapy. These can help with emotional issues. Some medicines may be used to lower anxiety.

  • Speaking with your child’s teachers. Your child’s teachers can help make communication at school less scary. For example, a teacher may have your child only speak in small groups at first, instead of to the whole class.

With treatment, a child is likely to stop having selective mutism. With no treatment, the speaking problems are more likely to continue.

How is selective mutism managed?

It’s important to remain patient with your child. Remember, your child is not choosing to not speak. Your child is too anxious to be able to speak.

For the best outcome, stay closely involved with your child’s therapy. You may be able to find ways to structure situations outside the home that can increase your child’s communication. Work closely with your child’s teachers.

For more resources, contact the Selective Mutism Group. It is a nonprofit group that gives support to families dealing with selective mutism.

Key points about selective mutism

Selective mutism is when a child can’t speak in certain settings, but can speak fine in others. For example, a child may not be able to speak at school, but can speak with no problem at home. It is called selective mutism because the child is only mute in select situations. It’s a rare childhood condition. It can cause problems with school and social situations.

  • Some children have additional problems, like shyness, developmental delay, or language problems.

  • A pediatrician, speech-language pathologist, and a psychologist may work together to diagnose and treat the condition.

  • Your child might need a set of different types of treatment.

  • With treatment, most children overcome selective mutism.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

  • Know the reason for your visit and what you want to happen.

  • Before your visit, write down questions you want answered.

  • Bring someone with you to help you ask questions and remember what your provider tells you.

  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.

  • Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.

  • Ask if your condition can be treated in other ways.

  • Know why a test or procedure is recommended and what the results could mean.

  • Know what to expect if you do not take the medicine or have the test or procedure.

  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.

  • Know how you can contact your provider if you have questions.

Online Medical Reviewer: Ashutosh Kacker MD
Online Medical Reviewer: Marianne Fraser MSN RN
Online Medical Reviewer: Stacey Wojcik MBA BSN RN
Date Last Reviewed: 3/1/2022
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