Selective Mutism (A complete guide)

Selective Mutism, usually manifesting in childhood, is a complex diagnosis in which a child persistently fails to speak in specific social situations.

The child, however, is able to communicate in settings that they find to be more comfortable. 

In this blog post we will discuss what selective mutism is, etiology, signs/symptoms, diagnosis, and treatment. 

Table of Contents

What is Selective Mutism? 

Selective Mutism is described as a child’s failure to speak and communicate in select social settings in which they are expected to speak and communicate.

An example of such a social setting is school. The child is able to speak in other settings, however.

These other settings are often described as more comfortable or relaxed. An example of such a setting is the child’s home.

A diagnosis of selective mutism is given when the clinical picture cannot be explained by other communication disorders, other conditions such as Autism Spectrum Disorder, or the child’s lack of knowledge of a particular language.

The consistent failure to speak in certain social settings in Selective Mutism greatly interferes with the child’s social development, as well as with their education. 

Who is affected by Selective Mutism? 

Because Selective Mutism is not very common, an exact estimate of how many people are affected by it is difficult to ascertain.

Some research studies show that the prevalence of selective mutism is between 0.47% to 0.76%.

Higher prevalence has been shown in immigrant children and in language-minority children than in nonimmigrant children.

While some studies show that females are more likely affected than males, other studies show that both males and females are equally affected.

Selective Mutism affects children and most children develop it between the ages of 2 and 4 years old.

Selective mutism is usually detected a lot later, however. In fact, children with selective mutism are usually not identified until they begin school.

What causes Selective Mutism? 

Though Selective Mutism is relatively uncommon, there are a lot of things that can cause a child to develop it. 

Causes of Selective Mutism Include:

·      Underlying Anxiety Disorder

·      Sensory Processing Disorder

·      Anxiety from a Speech and/or Language delay and/or abnormality

The most common cause of Selective Mutism is an underlying anxiety disorder.

Though it seems strange for a child to develop an anxiety disorder, it is indeed very possible and common.

Children, especially children with anxiety, have a difficult time expressing their anxiety. Therefore, their anxiety often manifests in different ways than anxiety would manifest in adults.

Furthermore, anxiety can be genetic. If parents have an anxiety disorder, their child might be at higher genetic predisposition to develop an anxiety disorder as well.

Again, this anxiety disorder can then manifest as Selective Mutism.

In fact, some studies show that there is a 90% overlap between social anxiety disorder and selective mutism. 

Another cause of selective mutism can be sensory issues, specifically sensory processing disorder.

Having a sensory processing disorder means it is difficult for the child to take in sensory information such as sounds, visuals, etc.

This creates difficulty for them when they try to interact with their environment, once again causing anxiety and eventually selective mutism. 

Yet another cause of selective mutism can be speech and language delays and abnormalities.

Though the abnormalities themselves don’t create selective mutism, the anxiety the child experiences from dealing with the speech and language delay can eventually lead them to withdraw and develop selective mutism. 

What are the symptoms of Selective Mutism? 

The most pronounced symptoms of selective mutism are:

·      Inability to communicate while in specific social settings (ex. School)

·      Ability to communicate in other settings that are more familiar or relaxed (ex. Home)

There are several signs and symptoms of Selective Mutism.

The most important sign, however, is the inability of the child to speak/communicate in a social setting such as school.

The parents will often describe that the child is able to speak/communicate in a setting which is more comfortable and relaxed, such as home.

This distinction is important since it shows that the issue at play is not an underlying communication disorder.

The child is able to communicate, but only in specific settings. 

Parents often note some physical symptoms associated with Selective Mutism.

These physical symptoms often manifest prior to entering an uncomfortable social setting.

For instance, the child may have tantrums prior to school or birthday parties.

This is the child’s way of explaining that they are uncomfortable. Their anxiety resurfaces through physical symptoms.

Some physical symptoms of selective mutism are:

·      Nausea/vomiting

·      Headaches

·      Joint pains

·      Abdominal pain 

While in an uncomfortable social setting, in addition to not speaking, the child may have a certain appearance that gives hindsight into their anxiety. These include:

·      blank stares

·      awkward body language

·      expressionless face 

Children with Selective Mutism also exhibit certain behavioral issues. These include:

·      mood swings

·      inflexible 

·      domineering while at home

How is Selective Mutism diagnosed?

Certain criteria are required to meet a Selective Mutism diagnosis. These include:

·      Consistent failure to speak in specific social situations in which there is an expectation to speak, despite speaking in other situations

·      Disturbance interferes with education or with social growth

·      Duration of disturbance is at least one month

·      Failure to speak is not due to lack of comfort with language

·      Disturbance is not better explained by another communication disorder or autism spectrum disorder

If your child is showing any of these symptoms, speak to their pediatrician.

The pediatrician may suggest further observation or may recommend a session with a speech therapist, psychologist, or psychiatrist.

This team of health professionals can work with you to gather all the symptoms your child is exhibiting.

Once they make a formal diagnosis, they can provide you with different treatment options.

A multi professional team who is familiar with Selective Mutism can help you on your child make significant progress.

What is the treatment for Selective Mutism? 

Early intervention is key for Selective Mutism.

Treatment can be broken up into two groups:

·      Behavioral  

·      Pharmacological

Behavioral: A therapist who is well versed in the treatment for selective mutism can offer the behavioral treatment approach.

This treatment is the most recommended treatment available. It consists of the therapist working closely with the child and the parents.

Over time, they expose the child to social settings in which the child usually does not speak. They never pressure the child, but only encourage them to speak with positive reinforcement.

Exposure is gradually increased in a systematic approach.

This allows the child to develop skills/tools that they can apply to any real life social situation.

Pharmacological: Medication for selective mutism is essentially an anti-anxiety medication called a selective serotonin reuptake inhibitor (SSRI).

That being said, not all children require the use of medication in their treatment.

The anti-anxiety medication is offered to children who have a very severe case, have been displaying symptoms for a long time, or who need something else in addition to the behavioral exposure treatment.

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Frequently asked questions (FAQs) about Selective Mutism:

1.    Who develops Selective Mutism?

Selective Mutism is a fairly uncommon diagnosis, but it usually affects young children.

Some reports say the average onset of symptoms is 5 years of age, though parents will often look back and say that the symptoms began much earlier, around 2-3 years.

Some studies say that selective mutism is slightly more common in females than in males.

Reports of older children or adolescents developing selective mutism are rare. 

2.    How common is Selective Mutism?

Selective Mutism is not very common, though experts believe the true prevalence of Selective Mutism is underestimated.

Being that it is not a very common diagnosis, selective mutism may sometimes be misdiagnosed as a different condition.

Certain reports say that selective mutism affects 1 in 1000 children referred for mental health treatment. 

Why does a child develop Selective Mutism?

There are many theories as to why a child may develop selective mutism.

Most children with selective mutism, also have an underlying anxiety disorder.

The children are also more likely to have a family member with an anxiety disorder.

A stressful environment can also be a risk factor in that it can trigger a child’s underlying anxiety disorder. 

4.    I, the parent, have an anxiety disorder, does this put my child at greater risk to develop Selective Mutism? 

Most children with Selective Mutism do have an underlying anxiety or social anxiety disorder.

There is some evidence that there is a genetic link between children with selective mutism and anxious parents or family, specifically parents who have social phobia, avoidant personality disorder, or selective mutism. 

5.    At what age does Selective Mutism usually develop?

Children usually develop Selective Mutism around the ages of 2-6 years old. 

6.    At what age is Selective Mutism usually diagnosed?

The average age of diagnosis is between 3-8 years, usually when the child begins school and the symptoms are more apparent.

7.    If Selective Mutism develops early on, why is it often not diagnosed until later?

Sometimes Selective Mutism is diagnosed later than when symptoms first appear.

This is because the symptoms become more apparent when the child begins school.

It is in school when the child feels more anxiety than at home, and the symptoms will manifest in a more pronounced manner.

After teachers reaffirm the parents’ initial mild concerns, a diagnostic workup will likely be prompted. 

8.    Is it important to diagnose Selective Mutism the earlier the better?

Yes. The earlier a child begins therapy, the better the results.

This is because the earlier you can intervene, the more likely you will be able to mold and change the child’s mutism patterns.

The later you intervene, the more accustomed the child becomes to their patterns.

9.    Is Selective Mutism the same thing as being shy? Can my child just outgrow it? 

Selective Mutism is not the same thing as being shy. Selective Mutism is a psychiatric disorder that requires a formal diagnosis and treatment. Shyness is not.

A child that is shy may withdraw in certain social situations, but once they assimilate they are able to communicate.

A child with selective mutism, however, feels like they are unable to communicate in any situation where they feel uncomfortable.

A child can outgrow being shy. A child cannot outgrow selective mutism without therapy and proper intervention. 

10.                  Is Selective Mutism a form of Autism Spectrum Disorder? 

Selective Mutism is not a form of Autism Spectrum Disorder.

They may appear to be similar due to the age on onset, and the behavior the child displays in certain social contexts.

These include blank stares, disinterest, lack of verbal communication.

The difference however is that children with Autism Spectrum Disorder can behave like this in all social contexts.

A child with Selective Mutism, however, can easily communicate and engage in social situations in which they are comfortable. 

11.  What is the prognosis of Selective Mutism?

A child who has been treated for selective mutism has an excellent prognosis.

Without treatment, selective mutism is likely to exist and result in difficulty with social and personal development. 

Want to learn more about Selective Mutism? Try this book! 

Can I Tell You About Selective Mutism? A Guide for Friends, Family, and Professionals

This illustrated book is narrated by a young girl with selective mutism and helps readers see it from her perspective.

She explores what it feels like to have selective mutism, and how those around her can help. 

Have more questions or comments about Selective Mutism? Post below! 

Resources

What is Selective Mutism?  SelectiveMutismCenter.org

Selective Mutism FAQ Selective Mutism Selective Mutism.org

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