Selective mutism is an anxiety disorder found in children that is characterized by an inability to speak when asked due to fear. This mental illness typically co-exists with social anxiety and shyness. A child’s selective mutism may greatly impede on their ability to successfully coexist with their peers, as well as effectively engage with their teachers at school. This may also negatively affect their self-esteem as well.

For children suffering with this condition, they are fully capable of speaking to authoritative figures, but will often resist this as the expectation for them to speak when asked is enough to give them an influx of overwhelming anxiety at the mere thought of it. The feeling of expectation is very difficult for children suffering from this illness as they may find it very challenging with initiating conversation with others.

When encountering other individuals in social interactions, children with selective mutism do not initiate speech or reciprocally respond when spoken to by others. Lack of speech occurs in social interactions with children or adults.

Children with this condition will speak in their home in the presence of immediate family members but often not even in front of close friends or second-degree relatives, such as grandparents or cousins. The disturbance is often marked by high social anxiety.




Children with this disorder often refuse to speak at school, leading to academic or educational impairment, as teachers often find it difficult to assess skills such as reading. The lack of speech may interfere with social communication, although children with this disorder sometimes use non-spoken or nonverbal means (e.g., grunting, pointing, writing) to communicate and may be willing or eager to perform or engage in social encounters when speech is not required (American Psychiatric Association, 2013, p. 195).

Symptoms of Selective Mutism

Associated features of selective mutism may include excessive shyness, fear of social embarrassment, social isolation and withdrawal, clinging, compulsive traits, negativism, temper tantrums, or mild oppositional behavior.

Although children with this condition generally have normal language skills, there may occasionally be an associated communication disorder, although no particular association with specific communication disorder has been identified.

In clinical settings, children with this condition are almost always given an additional diagnosis of another anxiety disorder–most commonly, social anxiety disorder.

Selective mutism may result in social impairment, as children may be too anxious to engage in reciprocal social interaction with other children. As children with selective mutism mature, they may face increasing social isolation.

In school settings, these children may suffer academic impairment, because often they do not communicate with teachers regarding their academic or personal needs. Severe impairment in school and social functioning, including that resulting from teasing by peers, is common (American Psychiatric Association, 2013, pp. 195-197).

Additional symptoms of selective mutism:

  • Intense anxiety when asked to speak
  • Avoiding situations where they may be asked to speak
  • Avoiding certain people who may ask them to speak
  • Extreme shyness
  • Feeling pressured to speak or deliver
  • Quiet around certain individuals
  • Difficulty expressing themselves
  • Unable to cope with their anxiety
  • Shakiness, sweating, and increased heart rate




Causes of Selective Mutism

Temperamental. Temperamental risk factors for this condition are not well identified. Negative affectivity (neuroticism) or behavioral inhibition may play a role, as may parental history of shyness, social isolation, and social anxiety. Children with this condition may have subtle receptive language difficulties compared with their peers, although receptive language is still within the normal range.

Environmental. Social inhibition on the part of parents may serve as a model for social reticence and selective mutism in children. Furthermore, parents of children with selective mutism have been described as overprotective or more controlling than parents of children with other anxiety disorders or no disorder.

Genetic and physiological factors. Because of the significant overlap between selective mutism and social anxiety disorder, there may be shared genetic factors between these conditions.

The onset of this condition is usually before age 5 years, but the disturbance may not come to clinical attention until entry into school, where there is an increase in social interaction and performance tasks, such as reading aloud.

The persistence of the disorder is variable. Although clinical reports suggest that many individuals “outgrow” selective mutism, the longitudinal course of the disorder is unknown. In some cases, particularly in individuals with social anxiety disorder, selective mutism may disappear, but symptoms of social anxiety disorder remain (American Psychiatric Association, 2013, p. 196).

Genetics and one’s environment may both play significant roles in the development of this condition. This is typically the case with virtually every mental disorder. For instance, a child who has a family history of anxiety disorders may have an increased chance of developing this condition due to them possibly having a genetic predisposition for it.

Diagnostic Criteria

A. Consistent failure to speak in specific social situations in which there is an expectation for speaking (e.g., at school) despite speaking in other situations.

B. The disturbance interferes with educational or occupational achievement or with social communication.

C. The duration of the disturbance is at least 1 month (not limited to the first month of school).

D. The failure to speak is not attributable to a lack of knowledge of, or comfort with, the spoken language required in the social situation.

E. The disturbance is not better explained by a communication disorder (e.g., childhood-onset fluency disorder) and does not occur exclusively during the course of autism spectrum disorder, schizophrenia, or another psychotic disorder.

(American Psychiatric Association, 2013, p. 195)

Prevalence

Selective mutism is a relatively rare disorder and has not been included as a diagnostic category in epidemiological studies of prevalence of childhood disorders. Point prevalence using various clinical or school samples ranges between 0.03% and 1% depending on the setting (e.g., clinic vs. school vs. general population) and ages of the individuals in the sample. The prevalence of this disorder does not seem to vary by sex or race/ethnicity. The disorder is more likely to manifest in young children than in adolescents and adults (American Psychiatric Association, 2013, p. 196).

Comorbidity

The most common comorbid conditions are other anxiety disorders, most commonly social anxiety disorder, followed by separation anxiety disorder and specific phobia. Oppositional behaviors have been noted to occur in children with selective mutism, although oppositional behavior may be limited to situations requiring speech. Communication delays or disorders also may appear in some children with this condition (American Psychiatric Association, 2013, p. 197).

Selective Mutism Treatment

There are many different forms of treatment that may be advantageous for someone suffering with this illness. Some of these treatments include desensitization, self-modeling, stimulus fading, spacing, shaping, mystery motivators, as well as pharmacological treatment, among others. Cognitive behavioral therapy (CBT) may also be beneficial as well.

All of these different forms of treatment are meant to help the child feel more comfortable with speaking. Though some of them will give the child more acute anxiety, such as with desensitization for example, the goal will be for them to improve their ability to speak to others with much less stress and anxiety overtime.

A low dose of an anti-anxiety medication or an antidepressant may be able to help your child suffering from this condition also, but this is something that you will want to first discuss with your child’s doctor.

If you think you or your child may have this condition or is suffering from some of the symptoms outlined in this article, then you should talk to your doctor as soon as you can so that a proper diagnosis can be had and so that treatment can begin. Upon seeing your doctor or your child’s pediatrician, you may then be referred to see a specialist such as a talk therapist or a psychiatrist for further treatment.


References:

  • American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders, 5th Edition: DSM-5 (5th ed.). American Psychiatric Publishing.
  • American Speech-Language-Hearing Association. (n.d.). Selective Mutism. ASHA. Retrieved November 3, 2020, from https://www.asha.org/public/speech/disorders/selective-mutism/
  • Selective Mutism | Anxiety and Depression Association of America, ADAA. (n.d.). ADAA. Retrieved November 3, 2020, from https://adaa.org/living-with-anxiety/children/selective-mutism
  • Selective mutism. (n.d.). Medline Plus. Retrieved November 3, 2020, from https://medlineplus.gov/ency/article/001546.htm
  • Selective Mutism (SM) Basics. (2019, February 18). Child Mind Institute. https://childmind.org/guide/selective-mutism/
  • Shipon-Blum, E. (n.d.). What Is Selective Mutism. Selective Mutism Anxiety Research & Treatment Center | SMart Center. Retrieved November 3, 2020, from https://selectivemutismcenter.org/whatisselectivemutism/
  • Wong, P. (2010, March 7). Selective Mutism. NCBI. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2861522/