Selective Mutism

Definition -

Selective mutism is an anxiety disorder where a person is unable to speak in certain social situations, such as with classmates at school or to relatives they do not see very often. It can start at any age, but most often starts in early childhood, between age 2 and 4. It's often first noticed when the child starts to interact with people outside their family, such as when they begin nursery or school.

Usually starts during childhood and, if left untreated, can persist into adulthood. A person with selective mutism doesn’t refuse or choose not to speak at certain times, they're literally unable to speak. The expectation to talk to certain people triggers a freeze response with feelings of anxiety and panic, and talking is almost always impossible. Over time, the person may learn to anticipate the situations that provoke this distressing reaction and do all they can to avoid them. However, some people with selective mutism are able to speak freely to certain people, such as close family and friends, when nobody else is around to trigger the freeze response. 

Selective mutism can also be considered a phobia - fear of talking to people

Causes -

Causes of selective mutism can be when children become too distressed to speak when separated from their parents and transfer this anxiety to the adults who try to settle them. If they have a speech and language disorder or hearing problem, it can make speaking even more stressful. Some children have trouble processing sensory information such as loud noise from crowds. This can make them "shut down" and be unable to speak when overwhelmed in a busy environment. And their anxiety might transfer to other people in that environment.

When mutism occurs as a symptom of PTSD, it follows a very different pattern and the child suddenly stops talking in environments where they previously had no difficulty.

Symptoms -

Symptoms might include avoiding eye contact, clingy, rude, seeming disinterested, nervous, uneasy, and socially awkward at many times. Some confident children with selective mutism might answer questions if someone asks and use gestures instead of words to communicate such as nodding their heads for saying “yes” and shaking their heads for answering “no”. But more severely affected children tend to avoid any form of communication – spoken, written or gestured.

Common Misconceptions - 

A common misconception about mutism is that a child with selective mutism is controlling or manipulative, or has autism. However, studies have shown that there's no relationship between selective mutism and autism, although a child may have both.

Treatments -

To overcome/recover from mutism, a child can successfully overcome it if it's diagnosed at an early age and appropriately managed. It's important for selective mutism to be recognized early by families and schools so they can work together to reduce a child's anxiety. Staff in early years settings and schools may receive training so they're able to provide appropriate support. If you suspect your child has selective mutism and help is not available, or there are additional concerns – for example, the child struggles to understand instructions or follow routines – speak to a health professional and ask them to refer you to a local specialist service for a formal diagnosis.