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Table of Contents
Symptoms
Diagnosis
Causes
Complications
Treatment
Coping
FAQs
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It is estimated that less than 1% of children have selective mutism. The first described cases date back to 1877 when German physician Adolph Kussmaul labeled children who did not speak as having “aphasia voluntaria.”
Selective mutism can have a number of consequences, particularly if it goes untreated. It may lead to academic problems, low self-esteem, social isolation, and social anxiety.
How to Communicate With a Nonspeaking Autistic Person
Selective Mutism Symptoms
If you believe that your child may be struggling with selective mutism, look for the following symptoms:
While these behaviors are self-protective, other children and adults may often perceive them as deliberate and defiant.
Recognizing Symptoms of Anxiety in Children
Diagnosis of Selective Mutism
Although selective mutism is believed to have its roots in anxiety, it was not classified as an anxiety disorder until the fifth edition of theDiagnostic and Statistical Manual of Mental Disorders(DSM-5)published in 2013.
The use of the term “selective” was adopted in 1994, prior to which the disorder was known as “elective mutism.” The change was made to emphasize that children with selective mutism are not choosing to be silent, but rather are too afraid to speak.
Selective Mutism in Children
The primary criterion for a diagnosis of selective mutism is a consistent failure to speak in specific social situations in which there is an expectation of speaking (e.g., school), despite speaking in other situations.
In addition to this primary symptom, children must also display the following:
Children who stop talking temporarily after immigrating to a foreign country or experiencing a traumatic event would not be diagnosed with selective mutism.
Selective Mutism in Adults
In some cases, selective mutism persists from childhood to adolescence, and even into adulthood.
In order to be diagnosed with selective mutism as an adult, the following criteria are usually present:
Adults with selective mutism often display behaviors similar to those related to social anxiety disorder, such as fearing public spaces (i.e., restaurants) and/or speaking to unfamiliar people. Selective mutism (and social anxiety) may cause an individual to avoiding social situations or withdraw completely, leading to social isolation.
A health professional will likely ask questions related to these or other behaviors when considering selective mutism as a diagnosis.
Causes of Selective Mutism
Because the condition tends to be quite rare, risk factors for the condition are not fully understood. It was once believed that selective mutism was the result of childhood abuse, trauma, or upheaval.
Research now suggests that the disorder is related to extremesocial anxietyand that genetic predisposition is likely.Like all mental disorders, it is unlikely that there is one single cause.
Kids who develop the condition:
Other potential causes include temperament and the environment. Children who are behaviorally inhibited or who have language difficulties may be more prone to developing the condition. Parents who have social anxiety and model inhibited behaviors may also play a role.
Selective mutism also oftenco-occurs with other disordersincluding:
Complications of Selective Mutism
Unfortunately, selective mutism may worsen anxiety. For instance, a child with selective mutism may dread going to school, where their condition makes it hard for them to be accepted among their peers.
Selective mutism can lead to communication problems. An adult who has selective mutism may be perceived as judgmental or passive aggressive if people around them don’t understand their condition—an added layer that can make coping with the condition even more challenging.
Someone with selective mutism may withdraw from school, work, or everyday activities and socially isolate themselves. This may lead to low self-esteem and even depression.
If you or someone you know is experiencing the symptoms of depression, it’s important to seek help. It may be beneficial to confide in trusted loved ones about your challenges; in addition, a mental health professional can help you navigate the frustrations you’re experiencing.
Selective Mutism Treatment
Selective mutism is most receptive to treatment when it is caught early. If your child has been silent at school for two months or longer, it is important that treatment begin promptly.
When selective mutism is not caught early, there is a risk that your child will become used to not speaking, and as a result, being silent will become a way of life and more difficult to change.
Treatment for selective mutism may include therapy, medication, or a combination of the two.
Therapy
A common treatment for selective mutism is the use of behavior management programs.Such programs often base the treatment aroundcognitive behavioral therapy(CBT).
In a study examining children with selective mutism who received CBT for five years, researchers found that the majority were able to speak outside of the home and symptoms lessened of comorbid anxiety disorders.
Techniques used in cognitive behavioral therapy for individuals with selective mutism may include:
Medication
Medication may also be appropriate, particularly in severe or chronic cases, or when other methods have not resulted in improvement. The choice of whether to use medication should be made in consultation with a doctor who has experience prescribing anxiety medication for children.
Coping With Selective Mutism
In addition to seeking appropriate professional treatment, there are things that you can do to help your child manage their condition.
In general, there is a good prognosis for selective mutism. Unless there is another problem contributing to the condition, children generally function well in other areas and do not need to be placed in special education classes.
Although it is possible for this disorder to continue through to adulthood, it is rare and more likely thatsocial anxiety disorderwould develop.
Frequently Asked Questions
Being in public spaces or around less familiar people (such as classmates or co-workers) usually triggers selective mutism.
No. However, selective mutism and autism may co-occur in some individuals.
Selective mutism may not go away on its own; but, it can be overcome—it’s best to seek treatment to address any underlying anxiety.
10 Sources
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Kotrba A.Selective Mutism: A Guide for Therapists, Educators, and Parents.Eau Claire, WI: PESI Publishing and Media; 2015.Muris P, Ollendick TH.Selective mutism and its relations to social anxiety disorder and autism spectrum disorder.Clin Child Fam Psychol Rev. 2021;24(2):294-325. doi:10.1007/s10567-020-00342-0Hua A, Major N.Selective mutism.Curr Opin Pediatr. 2016;28(1):114‐120. doi:10.1097/MOP.0000000000000300American Speech-Language-Hearing Association (ASHA).Selective mutism.Wong P.Selective mutism: A review of etiology, comorbidities, and treatment.Psychiatry (Edgmont). 2010;7(3):23‐31.Steffenburg H, Steffenburg S, Gillberg C, Billstedt E.Children with autism spectrum disorders and selective mutism.Neuropsychiatr Dis Treat. 2018;14:1163-1169. doi:10.2147/NDT.S154966Oerbeck B, Overgaard KR, Stein MB, Pripp AH, Kristensen H.Treatment of selective mutism: a 5-year follow-up study.Eur Child Adolesc Psychiatry. 2018;27(8):997-1009. doi:10.1007/s00787-018-1110-7Bunnell BE, Mesa F, Beidel DC.A two-session hierarchy for shaping successive approximations of speech in selective mutism: Pilot study of mobile apps and mechanisms of behavior change.Behav Ther. 2018;49(6):966-980. doi:10.1016/j.beth.2018.02.003Muris P, Monait N, Weijsters L, Ollendick TH.Symptoms of selective mutism in non-clinical 3- to 6-year-old children: Relations with social anxiety, autistic features, and behavioral inhibition.Front Psychol.2021;12. doi:10.3389/fpsyg.2021.669907Cleveland Clinic.Is your child just shy—or is it selective mutism?
Kotrba A.Selective Mutism: A Guide for Therapists, Educators, and Parents.Eau Claire, WI: PESI Publishing and Media; 2015.
Muris P, Ollendick TH.Selective mutism and its relations to social anxiety disorder and autism spectrum disorder.Clin Child Fam Psychol Rev. 2021;24(2):294-325. doi:10.1007/s10567-020-00342-0
Hua A, Major N.Selective mutism.Curr Opin Pediatr. 2016;28(1):114‐120. doi:10.1097/MOP.0000000000000300
American Speech-Language-Hearing Association (ASHA).Selective mutism.
Wong P.Selective mutism: A review of etiology, comorbidities, and treatment.Psychiatry (Edgmont). 2010;7(3):23‐31.
Steffenburg H, Steffenburg S, Gillberg C, Billstedt E.Children with autism spectrum disorders and selective mutism.Neuropsychiatr Dis Treat. 2018;14:1163-1169. doi:10.2147/NDT.S154966
Oerbeck B, Overgaard KR, Stein MB, Pripp AH, Kristensen H.Treatment of selective mutism: a 5-year follow-up study.Eur Child Adolesc Psychiatry. 2018;27(8):997-1009. doi:10.1007/s00787-018-1110-7
Bunnell BE, Mesa F, Beidel DC.A two-session hierarchy for shaping successive approximations of speech in selective mutism: Pilot study of mobile apps and mechanisms of behavior change.Behav Ther. 2018;49(6):966-980. doi:10.1016/j.beth.2018.02.003
Muris P, Monait N, Weijsters L, Ollendick TH.Symptoms of selective mutism in non-clinical 3- to 6-year-old children: Relations with social anxiety, autistic features, and behavioral inhibition.Front Psychol.2021;12. doi:10.3389/fpsyg.2021.669907
Cleveland Clinic.Is your child just shy—or is it selective mutism?
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