What is Selective Mutism?
Selective Mutism (SM) is an anxiety disorder that affects a child’s ability to talk in certain social situations, such as school or public places. This can happen even though the child may talk just fine in other situations, like at home. Usually, a child with SM has a few “safe people” with whom they talk freely, such as parents or siblings. When expected to talk with someone who they are not comfortable with, children with SM “freeze” due to anxiety. SM gets worse when others “rescue” the child by answering for them when they are anxious. This teaches the child that they can continue being silent because someone will answer for them.
What Does SM Look Like?
While SM is usually first noticed when the child enters school, difficulties often start much earlier, around ages 2 to 4. An SM diagnosis is only appropriate if concerns have been continuing for at least one month. If concerns only occur during the first month of school, it is not considered to be SM.
During social activities, the child with SM may be shy, cling to their “safe person” or whisper their answer in their “safe person’s” ear, rather than talking directly to a new person. Some children with SM may use body language to communicate with others (e.g., pointing, nodding). But, some children may be too anxious to even use body language. Some children with SM are so anxious they may not be able to tell their teacher when they have hurt themselves!
SM is common in bilingual children, but SM is not due to a lack of understanding of or discomfort with a child’s spoken language. Some bilingual children feel worried about other people judging them about their accents or how they say things differently. In addition, about 38% of children with SM also have a speech and language disorder that may make their fear of speaking worse.
Some Common Misunderstandings
SM is no longer seen as defiance. Children with SM are anxious about being expected to talk to people who they are not comfortable with. Mutism can occur as a symptom of post-traumatic stress; however children with trauma-related mutism show a drastic change in their willingness to talk to people who they used to be able to speak with. Lastly, while some symptoms of Autism Spectrum Disorder (ASD) and SM overlap (e.g., difficulties with communication), the symptoms for SM are due to anxiety, rather than an inability to communicate. Children with SM can speak effectively when they choose to, but children with ASD and communication problems may struggle to communicate with anyone.
Recommendations for Caregivers
- Encourage bravery! The opposite of anxiety is bravery and, as “brave muscles” start to build, anxiety decreases. Whenever you see your child being brave, let them know by saying EXACTLY what they have done well like “I love how brave you are at this new playground!”
- Model bravery yourself! Talk to others when you are out (e.g., restaurants, grocery stores). Ask for help even if you don’t need it to show that talking to others can be helpful. If ready, have your child finish the sentence for you as if you forgot mid-question.
- Practice new activities at home. This can be from activities like ordering at a restaurant (e.g., look at the menu before going) to joining sports teams or classes.
- When going to new places, schedule 10-15 minutes as a “warm up” time. This should include seeing the space and doing fun activities with the child’s “safe person” like Legos or coloring. The time is focused on just getting comfortable in their space without the expectation to talk, answer questions, say “hi” or use manners.
- When introducing new people, the same recommendations apply. After their 10-15 minute “warm up” time, introduce the new person to the fun activity and start slowly! Play without asking questions or telling them what to do. Focus on the play (including playing with them, not just watching them play) and providing praise for what they are doing well (e.g., “you’re playing so creatively with the toys”, “you made such a cool castle”). As caregivers, you might need to educate others about not expecting your child to talk at first.
- Start with simple expectations where the answer is in the question (e.g., “would you like blue or pink?”). With success, move to hard questions (e.g., “what color would you like?”). Always allow at least 5 seconds for the child to answer before trying again. If there is no response after the second time asking, go back to the most successful response before trying again. You can also step away to practice before trying again.
- Set specific bravery goals that can result in prizes! This can include bravery stickers that then result in a toy after a child earns a certain number of stickers. It can also be a natural reward like if your child can order their ice cream, then they get ice cream! It is important that these rewards are ONLY given if the goal is met.
Seeking Professional Help
Professional treatment options include Parent Child Interaction Therapy – Selective Mutism (PCIT-SM) and Cognitive Behavioral Therapy (CBT). PCIT-SM focuses on parental coaching and CBT includes learning about thoughts that increase anxiety and avoidance. Usually, CBT is used with older children who have more insight into their own thoughts and feelings. Summer camps (Mighty Mouth Camp) have also shown to be very effective!
Anxiety medication is a choice to reduce the intensity of anxiety and allowing for an easier time engaging in exposure activities. Medication is not a permanent solution and should always include behavioral treatment!
Citations and more information are available at the below websites:
- https://childmind.org/guide/parents-guide-how-to-help-a-child-with-selective-mutism/#block_b9c16966-caba-4383-bebc-38ed03c93dfe
- https://www.kurtzpsychology.com/selective-mutism/what-is-selective-mutism-2/
- https://www.abct.org/fact-sheets/selective-mutism/
- Selective Mutism University (An e-learning website for parents, other caregivers, educators, and therapists): https://selectivemutismuniversity.thinkific.com/
Proper Citation for this blog post:
Buhr, N. & Bater, L. (2024, November 25th). Beyond Typical Shyness… Understanding the Selectively Mute Child. Retrieved from https://infoaboutkids.org/blog/beyond-typical-shyness-understanding-the-selectively-mute-child.
