Selective Mutism in Children - A Comprehensive Overview
Children are often known to be enthusiastic when it comes to speaking with other people. But what if your child is very selective about who they talk to? They may speak freely at home but shut down in public spaces. When new people are around, your child clams up and doesn’t talk. Your child may even do this at school, choosing only to nod and point or talk to the teacher instead of his or her classmates.
Selective mutism in children can appear when they reach the early stages of socializing in childhood. If you think your child might be exhibiting symptoms of selective mutism, then now is a good time to learn all about it.
Here, we’ll discuss what selective mutism is, its causes and symptoms, and how to help your child through any challenges they may have with it.
Selective Mutism in Children
Selective mutism is when children can’t or will not speak in certain places, with certain people, or during selected social activities. However, children will comfortably speak with their parents or immediate family at home. Selective mutism is a common type of anxiety disorder, and it is this that prevents children from speaking comfortably around different people and situations.
What Causes Selective Mutism in a Child?
The causes of selective mutism are not always clear, but there are several that we can consider when examining children’s behavior.
Selective mutism is, in part, caused by a fear of talking to certain people. Children who develop selective mutism may sometimes have an underlying condition, such as anxiety disorders. If they have speech and language disorders or hearing problems, it can make speaking to people they are not comfortable with even more stressful.
Some children may also have trouble processing sensory information, such as loud noises and too much visual stimuli. This makes them “shut down” and unable to speak as they are overwhelmed in a busy environment.
Selective mutism can also occur as a symptom of post-traumatic stress. In this case, this condition follows a different pattern where the child stops talking in environments where they previously had no difficulty.
Other causes may include poor family relationships, self-esteem problems, other psychological problems, and speech problems (like stuttering).
Behavioral Characteristics of a Child with Selective Mutism
There are several symptoms of selective mutism that manifest in a child’s behavior. You may notice that children who have this condition are very timid, cautious, and restrained. They will often not speak to you in places where others might see them talking. Children with selective mutism will also lower their voices or use fewer words [*].
Selective mutism often appears as a type of social anxiety in children. It is often difficult for children with selective mutism to join in play or other activities with peers and friends. They will also avoid being the center of attention, refusing to join activities such as having their photo taken, giving something to their teacher, or performing in front of other people. These children may find it difficult to ask for help with things, even if they’ve been hurt or need to go to the restroom.
What to Do If I Suspect My Child Having Selective Mutism?
Parents who think that their child might have selective mutism may immediately think about how to get a child with selective mutism to talk. It is important to remove all the pressure and expectations for the child to speak, especially initially. You can also convey that you understand your child is scared and that it may be difficult for them to get the words out.
Reassure your child that you will help them through this difficult time. Offer praise for their efforts and accomplishments, but also acknowledge the difficulties and frustrations they may be experiencing.
At What Age Do Most Children Get Diagnosed with Selective Mutism?
If a child has selective mutism, then they are usually diagnosed between three to eight years of age. When mutism persists for more than a month, it is a sign to bring this to the attention of a medical professional.
Why Early Diagnosis is Crucial for Children with Selective Mutism?
Early diagnosis of selective mutism can lead to more positive outcomes [*]. The sooner it is identified and treated, the quicker a child’s response to treatment and the better the overall prognosis. Selective mutism can be reinforced as a conditioned response early on, making it a difficult habit to break.
Since selective mutism is a type of anxiety in children, it can have negative consequences on a child’s life the longer it is left untreated. These may include academic, social, and emotional repercussions such as the following:
- More anxiety
- Social withdrawal and isolation
- Low confidence and self-esteem
- Poor academic performance
- School refusal
Diagnosing early will allow children to develop the proper coping skills to overcome their anxiety. After diagnosis, you can employ several tools to help your child, such as using guided worksheets with coping statements for anxiety. This should be approved by and in combination with your mental health professional’s recommended treatments.
Diagnostic Criteria for Selective Mutism
Following the correct diagnostic criteria is just as important as diagnosing children on time for selective mutism. According to the DSM-V-TR (2018), selective mutism must follow these criteria:
- 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 1 month (not limited to the first month of school).
- The failure to speak is not due to a lack of knowledge of, or comfort with, the spoken language required in the social situation.
- The disturbance is not better accounted for by a Communication Disorder (e.g., stuttering) and does not occur exclusively during a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder.
How is Selective Mutism in Children Treated?
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:
1. Family acceptance and involvement
The first important step in selective mutism treatment is full acceptance and involvement from the family. When a child has selective mutism, changes in parenting styles and expectations will often be necessary to meet the needs of the child. However, 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.
2. Frequent socialization
As much as possible, encourage socialization without pushing your child. Try to arrange frequent play dates with friends and classmates. Group interactions with people that your child knows well can also help. The goal should be to get your child feeling comfortable enough with their peers so that speaking will occur naturally. They may feel more at ease speaking with their friend at home. Get them used to it until it feels just as safe to do so in school or other places.
3. School involvement
Treatment does not occur in a vacuum. It always involves 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 your child improves with their other 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.
4. Improving self-esteem
Self-esteem is a key component in the treatment of anxiety disorders, including selective mutism. By emphasizing your child’s positive attributes, they can build more confidence in several areas of their life and eventually apply that to speaking with others. It may also help to guide them in letting go of their anxious thoughts to improve their self-esteem.
Studies have shown that among medication-based options, selective serotonin reuptake inhibitors (SSRIs) have been shown to improve mutism and anxiety [*]. This includes medicines such a Prozac and Zoloft. 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.
6. Behavioral Therapy
Some behavioral techniques such as positive reinforcement and desensitization are used to treat selective mutism. The emphasis of these treatments is understanding the child and acknowledging their anxiety. It focuses on introducing the child to social environments in gradual and non-threatening ways to help them feel more comfortable. These treatments include elements such as gradual exposures, shaping, and stimulus fading to treat anxiety.
When your child is able to move up from one or two friends to small groups, it is important to reinforce this behavior. However, verbalized positive reinforcement should only be given when anxiety is lowered and the child is in a comfortable environment that is right for encouragement.
7. Other therapeutic approaches
Other therapeutic approaches may include Cognitive Behavioral Therapy, which involves working with a patient to help them understand the impact of their thoughts and feelings on their behaviors. This is recognized as one of the most effective treatments for selective mutism.
Supporting a Child with Selective Mutism
Supporting a child with selective mutism is not as difficult as it seems! Here are some tips that you can follow:
- Educate yourself and others about selective mutism.
- Give kids time to warm up
- Give praise when a child communicates of their own free will
- Play games that practice verbal skills
- Avoid having your child answer in large groups
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 traumatic mutism?
Kids with selective mutism speak in at least one setting, but they are rarely mute in all settings. However, those with traumatic mutism typically develop mutism in all situations.
Is selective mutism a form of autism?
No, selective mutism is not a form of autism. However, children with autism may demonstrate symptoms of selective mutism.
Is selective mutism classed as a disability?
Selective mutism is not in itself considered a disability. Unfortunately, some of these children are often wrongly diagnosed with speech and language difficulties, autism, or learning disabilities.
Is selective mutism part of ADHD?
Selective mutism can be part of ADHD. However, it does not automatically mean that a child has ADHD if they have selective mutism.
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 in the event that your child’s selective mutism does not improve. It is always best to get the feedback of a trained practitioner.
- Ford M, Sladeczek I, Carlson J, et al. Selective mutism: Phenomenological characteristics. 1998
- Wright H, Miller D, Cook M, et al. Early Identification and Intervention with Children Who Refuse to Speak. 1984 March 22.
- Wong P. Selective Mutism: A Review of Etiology, Comorbidities, and Treatment. 2010 March.