What is Selective Mutism

Selective Mutism is an anxiety-disorder of childhood where a child demonstrates an inability to speak in certain social environments. A child may have difficulty speaking in one environment (speaks at home, but not at school) or multiple environments (does not speak at home or school). Selective Mutism is associated with functional impairments in educational, familial, social, or occupational settings. Left untreated, Selective Mutism may lead to increased stress within family units, decreased academic performance, and decreased socialization needed for appropriate development.


Symptoms of Selective Mutism include: difficulty speaking in at least one social situation, difficulty initiating relationships, withdrawal in social situations, slowness to respond to verbal and nonverbal communication, somatic symptoms (headaches, tummy aches), irritability in social situations, and/or stiff body language. Many times, parents are surprised to learn their child experiences Selective Mutism because they are talkative, energetic, and assertive at home. That is often because the child feels safe in that environment! If you suspect your child may be struggling with Selective Mutism, seek an assessment at our clinic today! There are highly effective, evidence-based treatments designed to treat Selective Mutism and allow your child and family to get back to optimal functioning!


What is the difference between a child who is shy and child with Selective Mutism?

Shyness is a developmentally-appropriate behavior for many children (and even adults). Most people demonstrate shyness in some capacity. Many children demonstrate shyness when presented with new situations (new school, new friends, change in family unit, etc.), however, there is only mild discomfort present and the child resumes typical behavior as they adjust to the new situation. Children with Selective Mutism demonstrate persistent symptoms that often worsen over time.


Do children with Selective Mutism understand language?

Yes. Children with Selective Mutism typically have the abilities (both cognitively and physically) to speak, however, anxiety overrides those abilities.


Is my child just being oppositional or defiant?

It is unlikely. There is a common misconception that children with Selective Mutism are demonstrating oppositional or defiant behavior (i.e., they are choosing not to speak). This view, unfortunately, tends to be accompanied by punitive consequences for the child which in turn increases anxiety. Instead, the inability to speak is theorized to be due to avoidance of anxiety. The child is seeking to decrease their anxiety in order to feel comfortable in the situation, and the quickest way to do so often involves some form of avoidance. 


What is treatment like for Selective Mutism?

Treatment for Selective Mutism is similar to treatment for other anxiety disorders, specifically social anxiety. Cognitive-Behavioral Therapy techniques have been found to be highly effective in treating Selective Mutism, particularly the use of controlled exposure. Exposure Therapy includes gradually exposing the individual to anxiety-provoking situations, with the assistance of the therapist and family. The therapist helps the child build coping skills and then guides the individual through exposure exercises in session with family members present. The individual and their family then engage in exposure exercises as “homework”. As the individual exposes themselves to anxiety-provoking situations while working toward speaking (often beginning with non-verbal communication), they experience small successes and the easier those situations become. As a result, the child’s brain learns that the previously avoided situations are indeed safe. It is sometimes helpful to use metaphors in treatment (i.e., taking steps like we do to learn to ride a bike or swim). The individual may also be taught cognitive restructuring skills such that they develop more helpful ways of thinking when approaching anxiety-provoking situations. It is helpful to accompany this treatment with positive reinforcement to increase the likelihood that the individual feels success, takes ownership of their hard work, and develops confidence to approach increasingly difficult situations. Adjunct treatments such as social skills training, relaxation training, and family therapy may also be beneficial. Parents of children with Selective Mutism may find comfort in joining a support group. 


Where can I go for more information?

Selective Mutism Association: www.selectivemutism.org

Anxiety and Depression Association of America: www.adaa.org

Association for Behavioral and Cognitive Therapies: www.abct.org


Where can I seek assessment and treatment for my child?

We have several therapists at Austin Anxiety & OCD Specialists who have extensive knowledge of and experience treating Selective Mutism. Please do not hesitate to call (512-246-7225) or e-mail ([email protected]) our office today!


Written by: Samantha Myhre, PhD

If you have any additional questions please contact us at 512-246-7225. If you are ready to get started, please visit our client portal.