What is selective mutism?

Shyness is a personality trait that influences how people move through the world and build relationships. On its own, it isn’t a sign of a mental health condition. Selective mutism, however, is more than shyness. When someone’s shyness is so severe that it prevents them from speaking in specific social situations, it could be a sign of an anxiety disorder called selective mutism.

Selective mutism occurs when a child has the ability to communicate and comprehend language, and will speak up in comfortable settings like home, but becomes nonverbal in stressful environments like school. In these scenarios, a child may feel stuck or frozen, unable to speak because of their anxiety.

Selective mutism is relatively rare, affecting less than 1% of people. It typically manifests in early childhood between the ages of two and four, but is most often recognized when the child enters school. Left untreated, selective mutism can persist throughout a person’s life. But with early detection and intervention, children can manage their anxiety, overcome selective mutism, and develop the confidence to speak in stressful situations.

Is selective mutism a choice?

It’s important to remember that children with selective mutism can speak. Their mutism isn’t due to a hearing issue, language impairment, developmental delay, or other health concern. Selective mutism is also not a conscious choice or a sign of obstinance or stubbornness.

Children with selective mutism can speak freely when they’re at ease. They typically have no trouble talking when they’re at home or around familiar people like family. However, because of their anxiety, these children become nonverbal when they’re around strangers, at school, or in other uncomfortable settings.

Signs and symptoms of selective mutism

Children with selective mutism may feel intense anxiety in situations where they are expected to speak. In these moments, they may feel frozen or unable to get words out — even when they want to communicate.

In addition to occasionally losing the ability to speak, they may also exhibit other signs of selective mutism, like:

• Trouble making eye contact

• Relying on pointing or physical gestures instead of verbal communication

• Attempting to speak through someone else (i.e. whispering to a parent and asking them to relay a message instead of speaking to another person directly)

• Difficulty making friends or interacting with their peer group because of a fear of speaking in public

• Appearing nervous, inhibited, or withdrawn

Possible causes of selective mutism

Given its rarity, there isn’t a lot of information on the causes of selective mutism. However, research points to a few factors that may contribute to the onset of the condition:

• Psychological: Having a co-occurring mental health condition like social anxiety disorder, social phobia, or obsessive-compulsive disorder (OCD)

• Genetics: Having a close relative like a sibling or parent with selective mutism,social anxiety disorder or other related anxiety disorders

• Environment: Experiencing limited social interaction opportunities, which may hinder the development of social skills

• Biological: Having an overactive nervous system and sensory sensitivities

• Temperament: Being a naturally shy, behaviorally inhibited, or sensitive to social situations

Is selective mutism related to autism?

Selective mutism and autism are sometimes confused with one another because they can cause similar challenges with language and social communication. However, there’s a key difference between the two conditions. Children with selective mutism don’t experience anxiety symptoms or speech challenges when they’re comfortable. In contrast, children with autism experience these challenges in all settings, to some degree.

It’s also possible for a child to have selective mutism and autism at the same time. Co-occurring conditions can make treatment more complex. But fortunately, there are complementary supports available for children and families affected by both selective mutism and autism.

Managing and treating selective mutism

Selective mutism can improve significantly with the right support. Many children learn to speak more comfortably across different settings with appropriate treatment.

If you have a child who speaks freely at home but appears to shut down and can’t communicate in other settings, the best thing you can do is seek a professional evaluation. A therapist can provide an accurate diagnosis and help ensure your child gets the right care for their needs.

Everyone’s journey to overcoming selective mutism is unique. But the following evidence-based supports will likely be a part of your child’s treatment experience:

• Cognitive behavioral therapy (CBT): CBT is one of the most effective treatments for anxiety disorders like selective mutism. It helps children explore the underlying reasons for their distress, regulate their behavior, and adopt new coping strategies.

• Speech therapy: In some instances, working with a speech therapist who specializes in treating speech disorders can help improve verbal skills and reduce anxiety related to speaking.

• Medication: Your child’s doctor or other medical providers may recommend medication, depending on your child’s symptoms and situation.

Self-strategies that may help

While professional support is important, there are also small strategies that can help children feel more comfortable speaking.

• Create low-pressure speaking opportunities. Encourage communication during relaxed activities like playing games or reading together.

• Practice gradual exposure. Slowly introduce new people or settings where speaking is expected, starting with situations that feel safer.

• Offer positive reinforcement. Celebrate small steps, like making eye contact or speaking a few words, to build confidence.

• Avoid pressure or punishment. Pressuring a child to speak can increase anxiety and make communication harder.

Clinician’s take

One common myth about selective mutism is that it’s simply a behavioral choice or a sign of stubbornness in children. In reality, it’s an anxiety disorder where children experience overwhelming fear and distress in specific social situations, making it crucial to provide compassionate support and intervention.

Brandy Chalmers, LPC

Clinical reviewer