Selective mutism: Symptoms, causes, diagnosis, & treatment

Key Takeaways

Unlike a personality trait like shyness, selective mutism is an anxiety disorder. It typically manifests in childhood and requires professional help to overcome.
Children with selective mutism can speak in situations where they’re at ease, like at home. However, when they’re in uncomfortable scenarios, like at school or among strangers, they become nonverbal.
Selective mutism is a treatable condition. Many children can overcome their symptoms through cognitive behavioral therapy (CBT), speech therapy, and in some cases medication may be recommended.

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. However, 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.

What do selective mutism symptoms feel like?

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 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.

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

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

What causes 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-occuring conditions can make treatment more complex. But fortunately, there are complementary supports available for children and families affected by both selective mutism and autism.

How is selective mutism treated?

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.

Find care with Rula

Selective mutism can be confusing for both children and caregivers alike. For example, you may have a child who communicates freely at home. They may even be downright boisterous when they’re with their family. But at the same time, they may experience anxiety that’s so intense it prevents them from using their voice at school or with peers.

Rest assured that like other anxiety disorders, selective mutism is a treatable condition. With early detection and intervention, many children can overcome their symptoms entirely.

When you and your family need support, Rula can connect you with a behavioral therapist in just a few clicks who specializes in treating children. With our therapist-matching program, you can quickly and easily find a provider who takes your insurance and offers the specialized care your child needs to thrive. And thanks to our extensive network, you won’t have to wait weeks or months for an appointment. You can start the process today and your child can begin receiving care as soon as tomorrow.