Selective mutism​ - overview

Key points

  • Selective mutism is an anxiety disorder, which manifests itself as a phobia of speaking in certain situations
  • A child with selective mutism will speak happily and freely in some situations, but not in others
  • Without the right support, selective mutism can have severe long-term negative consequences, which can affect academic, social and emotional functioning
  • Early intervention for children with selective mutism is associated with better outcomes in a shorter time period
  • Speech and language therapists have a key role to play in supporting early identification as well as the management of selective mutism
  • Working with adults with selective mutism is an emerging area of work that requires special consideration and raised awareness

Content published: 2018

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What is selective mutism?

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Selective mutism is an anxiety disorder (American Psychiatric Association, 2013), whereby:

  • The child speaks happily and freely in some situations, but not in others.
  • This varied speech pattern has been apparent for a month or more.
  • The disorder is not due to another communication or language learning difficulty.
  • The inability to speak in certain situations is limiting academic or social functioning.

Selective mutism is best thought of as a ‘speech phobia’. Children with selective mutism can become fearful of vocalising in other ways too, such as coughing or laughing. Over time, children with selective mutism may withdraw more generally and then fear other means of communication, such as writing or pointing. They may become ‘frozen’ and then find it difficult to point to indicate or use gesture. Eye-to-eye gaze and facial expression may also diminish.

Low and high profile selective mutism

High profile: This is when the child is totally silent with certain people in certain situations.

Low profile: This is when the child may manage to speak a little when this is absolutely necessary and when the fear of disapproval outweighs the fear of talking. There is however usually no spontaneous communication with adults.

Signs of selective mutism

Selective mutism usually starts in early childhood, between the ages of two and four. It’s often first noticed when the child starts to interact with people outside their family, such as when they begin nursery or school.

  • The main warning sign is the marked contrast in the child’s ability to engage with different people, characterised by a sudden stillness and frozen facial expression when they’re expected to talk to someone who’s outside their comfort zone.
  • They may avoid eye contact and appear:
    • nervous, uneasy or socially awkward
    • rude, disinterested or sulky
    • clingy, shy and withdrawn
    • stiff, tense or poorly co-ordinated
    • stubborn or aggressive
    • having temper tantrums when they get home from school, or getting angry when questioned by parents.
  • More confident children with selective mutism can use gestures to communicate. For example, they may nod for “yes” or shake their head for “no”.
  • More severely affected children tend to avoid any form of communication, whether this is spoken, written or gestured.
  • Some children may manage to respond with a word or two, or they may speak in an altered voice, such as a whisper.
  • Few people see the child or young person as they really are, for example, a sensitive, thoughtful individual who’s chatty, outgoing and fun-loving when relaxed and unaffected by their selective mutism.

Role of speech and language therapy

Speech and language therapists have a role in the assessment, identification and management of selective mutism, working in collaboration with school/college staff and other professionals, depending on the unique needs of the child or young person.

Resources

Books

Anxiety UK, Children and Young People with Anxiety: A Guide for Parents and Carers

Chanksy, T.E. (2014). Freeing your Child from Anxiety. (2nd ed). New York: Harmony Books.

Cresswell, C. & Willetts, L. (2007). Overcoming your Child’s Fears and Worries: A Self-Help Guide Using Cognitive Behavioural Techniques. New York: Random House.

Heubner, D. (2006). What to Do When You Worry Too Much: A Kid’s Guide to Overcoming Anxiety. Washington, DC: Magination Press (ages 6-12)

Johnson, M.& Wintgens, A. (2016) The selective mutism resource manual (2nd Edition). Milton Keynes: Speechmark Publishing..

Schab, L.M. (2008). The Anxiety Workbook for Teens: an instant help book for teens. Instant Help Books: New Harbinger Publications.

Videos

‘Finding your voice’ on BBC Radio 4 on 10th February 2015

‘My child won’t speak’ from a BBC series (2010) available on youtube

‘Help me to speak’ documentary about selective mutism on Channel 4 in 2006, also available on Youtube.

Social media

@GivingVoiceUK Twitter takeover by SMIRA, a speech and language therapist, and a person with selective mutism to mark Selective Mutism Awareness Month 2020.

Advice for parents

You may find the advice below helpful if your child has been diagnosed with selective mutism.

  • Don’t pressurise or bribe your child to encourage them to speak.
  • Let your child know you understand they’re scared to speak and have difficulty speaking at times. Tell them they can take small steps when they feel ready and reassure them that talking will get easier.
  • Don’t praise your child publicly for speaking because this can cause embarrassment. Wait until you’re alone with them and consider a special treat for their achievement.
  • Reassure your child that non-verbal communication, such as smiling and waving, is fine until they feel better about talking.
  • Don’t avoid parties or family visits, but consider what environmental changes are necessary to make the situation more comfortable for your child.
  • Ask friends and relatives to give your child time to warm up at his or her own pace and focus on fun activities rather than getting them to talk.
  • As well as verbal reassurance, give them love, support and patience.

Getting help and support

It’s only relatively recently that selective mutism has been properly understood and effective treatment approaches have been developed.

The body of expertise among healthcare professionals, educational psychologists and teaching staff is growing, but those seeking help need to be prepared for the fact that professionals in their area may not have up-to-date knowledge or experience of working with selective mutism.

If this is the case, you should seek out teachers and healthcare professionals who are willing to listen, learn and develop their specialist knowledge to provide appropriate support.

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