Selective Mutism in Children: Causes, Signs, and Treatment

Is your child being a “chatterbox” at home, yet they stay completely mute or use non-verbal gestures in other settings? For instance, they engage in lively conversations with their siblings but avoid speaking in class and appear withdrawn. If so, this could be a sign of selective mutism in children.

Selective mutism can appear typically around the time kids engage in social interactions outside of the home environment. Usually, they affect those entering school age [*].

What is selective mutism and what are its causes? If you think your child might be exhibiting symptoms of selective mutism, read this article where we’ll discuss signs, tips, treatments, and more.

What is Selective Mutism?

Selective mutism is an anxiety disorder that affects a small percentage of the population, around 1-2% of the population. Individuals with this condition consistently fail to speak in specific social situations, such as school, despite being able to do so comfortably with family members [*].

As a result, affected children may experience academic difficulties and social isolation, and miss out on opportunities because of their inability to speak. Some theories suggest that selective mutism can result from learned behaviors — e.g. avoidance — and may be associated with social phobia or social anxiety.

Causes of Selective Mutism in Children

The causes of selective mutism are not always clear, but there are some potential causes that we can consider. These include the following:

• Genetics
• Shy or inhibited temperaments
• Past trauma (abuse, neglect, loss, and other significant life events)
• Underlying speech or language disorders
• Certain family dynamics or parenting styles

Although not fully understood, selective mutism may result from different factors combined, such as the ones mentioned above.

Signs of Selective Mutism in Children

Children with selective mutism may consistently exhibit the following in their behaviors. Watch out for:

• Consistent silence in social gatherings or public places
• Avoidance of eye contact or looking away when they feel uncomfortable
• Respond to questions by using gestures, nods, or notes
• Restlessness, tension, or blushing when expected to speak
• Avoidance of situations or stimuli that lead to discomfort
• Preference for solitary activities or interactions only with familiar people

Compulsive traits or repetitive actions, such as engaging in certain movements before speaking, may also be noted in these kids. This is their way of trying to cope with their anxiety.

Diagnosing Selective Mutism in Children

Over time, the avoidance behaviors can become reinforced as the child learns that avoiding speaking makes them less anxious. As a result, their silence becomes a habit that is difficult to break.

This is why early diagnosis is important — it helps parents and caregivers recognize the symptoms of selective mutism early on and receive appropriate support. The sooner it is identified and treated, the quicker a child’s response to treatment and the better the overall prognosis.

Mental health professionals who diagnose selective mutism in children include psychiatrists, psychologists, and those familiar with anxiety disorders.

Treating Selective Mutism in Children

There are various treatment options for selective mutism. Here are several that you can consider if your child has received a diagnosis for this condition:

Cognitive-behavioral therapy (CBT)

A comprehensive review conducted in 2006 provides support for the effectiveness of cognitive-behavioral therapy (CBT) in treating selective mutism. CBT helps children understand the connection between their thoughts, feelings, and behaviors [*].

The strategies taught in CBT help children recognize anxiety and then challenge their negative thoughts. For instance, if a child struggles with thoughts like "If I speak, people will laugh at me," the therapist would encourage the child to verbalize these thoughts and consider alternative, more realistic perspectives.

Speech therapy

Although selective mutism is primarily characterized by difficulty speaking in certain situations or around certain people, speech therapists can be valuable sources of support. Their role is to help a child feel more comfortable talking in different situations.

Here are some of the techniques they use [*]:

• Stimulus fading. This involves gradually exposing the child to stimuli that would normally cause them to feel anxious. To help with the transition, the therapist would start by exposing the child to someone they’re already comfortable talking to, and then slowly introducing new people into the environment.
• Self-modeling. For this technique, video or audio recordings of the child talking in a comfortable setting are used. These recordings will then be edited to show the child speaking in different situations or with different people. When a child sees themselves communicating successfully in challenging situations, they’ll feel more confident.
• Shaping. In shaping, the speech therapist rewards the child for attempting to communicate, even though the child uses only gestures or non-verbal communication. The process of shaping can be formal and structured in that the child moves from one sound to another and blends them to form words and complete sentences.

Medication

Studies have shown that among medication-based options, selective serotonin reuptake inhibitors (SSRIs) have been shown to improve mutism. Although they are mainly used for depression, they can be used to treat anxiety-related disorders [*].

Other medicines are being explored, particularly ones that affect one or more neurotransmitters such as serotonin, norepinephrine, GABA, and dopamine.

Medication is often used in combination with behavioral and other therapeutic techniques to achieve more successful outcomes.

As your child’s caregiver, always remember to speak with their healthcare provider regarding their medications. You can ask questions that will help you decide on the best treatment as well as their potential side effects.

School-Based Interventions

Treatment does not occur in a vacuum. It may involve other key individuals and groups in your child’s life, including their school. Parents need to make teachers and school personnel aware of selective mutism.

By learning more about it, they can help your child progress without pressuring them to speak when they are not ready.

As teachers and students become aware of selective mutism in a classmate, they will understand that verbal communication is difficult. With that, they can initially focus on accepting and encouraging nonverbal forms of communication, such as gestures and facial expressions.

Teachers can help the child feel more involved by assigning them tasks that do not require verbal communication.

As your child improves with their treatments, the teacher should be made aware of their progress so that they can adjust lessons and activities accordingly. It is also worth talking to the school counselor about other ways to assist your child.

Parent education

Educating parents is an important aspect of selective mutism treatment. When a child has selective mutism, changes in parenting styles and expectations will often be necessary to meet the needs of the child.

Parents will benefit from learning about the signs and triggers of selective mutism — e.g., unfamiliar environments, social situations, and transitioning between activities.

During the process, it is important to always avoid pressuring or forcing your child to speak as this may only cause more anxiety. Have one-on-one time with your child at home where they will not feel any pressure. Here, you can discuss your child’s feelings. This allows them to open up and relieves stress.

Tips to Help Children with Selective Mutism Talk

Dealing with selective mutism takes time and a lot of patience. What’s most important is that we create a type of environment that will encourage them to gradually overcome their communication struggles.

Here’s how to get a child with selective mutism to talk:

• Before expecting the child to speak, provide a warm-up period where they do not feel pressured.
• Show acceptance of non-verbal forms of communication, and respond to them positively.
• Avoid reprimanding or pressuring them to speak as this only increases anxiety.
• Enroll your child in activities that align with their interests to give them opportunities to interact with like-minded peers.
• Take advantage of family outings or gatherings where the child can practice engaging in casual conversations.
• Continue educating yourself as well as those who surround your child, such as their teachers and caregivers.

Frequently Asked Questions

Because selective mutism may take some more time to understand, there are many questions that people tend to ask about it. Here are some that you may want to know more about:

What is the difference between selective mutism and communication disorder?

Selective mutism and communication disorders are two distinct conditions that can affect a child's ability to communicate effectively.

Whereas selective mutism is characterized by an inability to speak and communicate in select social settings, despite having the ability to understand and speak, a communication disorder affects a child’s ability to process concepts and it is not fear-based. Someone with a communication disorder can misuse words, use repetitive sounds, and not be able to communicate in an understandable way.

Is selective mutism a form of autism?

No, selective mutism is not a form of autism. However, a child can have both autism and selective mutism. Some kids with autism may demonstrate symptoms of selective mutism.

Can children outgrow selective mutism?

Although selective mutism can vary widely in its duration (how long it lasts), research shows that most kids tend to outgrow it spontaneously for unknown reasons [*]. Regardless, early treatment is important, which includes CBT and parent support.

The Bottom Line

Being able to speak with our peers and new individuals is an important life skill. Selective mutism as a form of anxiety can hinder that and, thus, hamper a child’s growth and development.

By learning more about this condition and the treatment options available, your child will become more confident and comfortable with speaking to others outside your home.

We recommend speaking with a professional if your child’s selective mutism does not improve. It is always best to get the feedback of a trained practitioner.

To support kids experiencing anxiety, we recommend exploring our anxiety worksheets collection.

References:

1. Wong P. (2010). Selective mutism: a review of etiology, comorbidities, and treatment. Psychiatry (Edgmont (Pa. : Township)), 7(3), 23–31.
2. Pereira, C. R., Ensink, J., Güldner, M. G., Lindauer, R., Jonge, M., & Utens, E. M. W. J. (2021, December 1). Diagnosing selective mutism: a critical review of measures for clinical practice and research. European Child & Adolescent Psychiatry. https://doi.org/10.1007/s00787-021-01907-2
3. Oerbeck, B., Overgaard, K. R., Stein, M. B., Pripp, A. H., & Kristensen, H. (2018). Treatment of selective mutism: a 5-year follow-up study. European child & adolescent psychiatry, 27(8), 997–1009. https://doi.org/10.1007/s00787-018-1110-7
4. Selective Mutism. (n.d.). https://www.asha.org/public/speech/disorders/selective-mutism/
5. Professional, C. C. M. (n.d.). Selective Mutism. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/selective-mutism