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May 2, 2024 · Selective mutism is a mental health condition that involves not speaking in certain environments or social settings despite the ability to speak. For example, people with selective mutism may be very vocal at home or with trusted friends and family members but not speak in large groups.
- Overview
- What is selective mutism?
- Signs and symptoms
- Causes
- Is selective mutism a sign of autism?
- Diagnosis
- Treatment
- Helping someone with selective mutism
- Summary
Selective mutism is a condition in which a person can speak in some situations but not in others. For example, a child with selective mutism may speak at home but not at preschool or around strangers.
Selective mutism is different than conditions that cause a physical or cognitive inability to speak. People with the condition are able to talk, but they find it difficult due to anxiety. For this reason, many doctors and advocacy groups define selective mutism as an anxiety disorder.
Selective mutism is a rare condition that causes difficulty speaking in certain situations but not in others. Some refer to it as a phobia of talking.
People with selective mutism can be confident communicators in many contexts but then struggle in settings that are unfamiliar or public.
For example, in children, selective mutism often begins when the child starts attending school or entering other public settings for the first time. These settings could include daycare, a church, playdates, or music lessons.
The average age of onset for selective mutism is 5 years, although this may be because this is the age at which many children begin going to school. Most studies suggest that selective mutism affects less than 1% of children. Sometimes, selective mutism persists into adulthood.
The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) states that to meet the criteria for selective mutism, a person must have:
•consistent difficulty speaking in situations where talking is expected, such as at school, despite having the ability to talk in other situations
•difficulty speaking that is not due to a lack of knowledge of or comfort with the language someone is speaking
•difficulty speaking that is more likely due to another condition, such as a communication disorder
•symptoms that last for at least 1 month and interfere with school, work, or socializing
For example, a person may speak only when at home or with a select group of people.
Selective mutism is not the result of defiance or disobedience. Instead, people with selective mutism feel unable to speak due to intense anxiety and shyness. They may fear others judging, ridiculing, or ignoring them.
The condition has no single cause. Instead, many factors can contribute to someone developing selective mutism. These factors include:
•Significant transitions: Going to school can cause anxiety in children. This is especially true if they have had few opportunities to socialize before or they are second-language learners. Bilingual children are overrepresented in studies on selective mutism, which suggests that anxiety about communicating could contribute to the condition.
•Home environment: Children who observe anxious or avoidant behavior at home may learn to behave in a similar way. This may lead to them avoiding situations that make them nervous, such as social situations. This avoidance can, in turn, reinforce a fear of talking.
•Genetics: Selective mutism tends to run in families, and researchers have identified at least one gene that appears to elevate the chances of developing it.
•Other anxiety disorders: Having other anxiety disorders may play a role in the development of selective mutism. Some examples include separation anxiety, social anxiety, and obsessive-compulsive disorder.
The DSM-5 defines selective mutism as an anxiety disorder. It specifically notes that doctors should not diagnose selective mutism when another diagnosis, such as autism spectrum disorder (ASD), better explains the symptoms.
According to current diagnostic criteria, therefore, selective mutism and ASD cannot coexist.
This definition is controversial. Some researchers argue that selective mutism may be a symptom of ASD or a diagnosis that commonly occurs alongside ASD. For example, a 2018 study of 97 children with a selective mutism diagnosis found that 63% were also autistic.
Whether selective mutism and ASD are related continues to be a subject of debate. However, parents and caregivers can seek expert help and advice from a knowledgeable pediatrician or mental health professional.
Diagnosing selective mutism involves a comprehensive assessment, which may involve:
•a speech and language evaluation
•interviews with parents, caregivers, or teachers
•collaboration with a variety of specialists, possibly including a pediatrician, child psychologist, behavior analyst, guidance counselor, or social worker
The speech and language evaluation can screen for any other conditions that might cause difficulty with speech, such as a speech delay or hearing impairment. Then, interviews with family members can help specialists get a sense of:
•when the symptoms began
Once a medical team has reached a diagnosis of selective mutism, treatment can begin. Although the treatment approach can vary, the goals center on:
•reducing anxiety in social settings
•helping the person practice speaking
•reinforcing nonavoidant behavior
The emphasis is on making the person with selective mutism feel safe but gradually more confident. Some examples of treatments for selective mutism include:
•Augmentative and alternative communication (AAL): AAL involves temporarily giving people an alternative way of communicating that they find less stressful. For example, a child may learn to use gestures or point to symbols. In the short term, this can help a child communicate at school, but it is not a long-term solution.
Selective mutism is an anxiety disorder, so putting pressure on someone to speak will only create more stress and fear. In fact, repeatedly encouraging a child to “talk” or “speak” may mean that they develop negative associations with those words over time.
Instead, people can help those with selective mutism by creating a safe space. It is also important neither to force people with the condition to interact if they do not want to nor to try to treat the condition at home. Selective mutism requires professional treatment.
People can help create a supportive environment for children with selective mutism by following the tips below:
•Positive reinforcement: It is important to praise the child when they try to communicate aloud, even when it is not perfect. However, this should be in a private setting to avoid causing embarrassment.
•Patience: It may take longer for a child with selective mutism to respond to questions. Try to be patient and give them time to choose their words, and encourage others to do the same.
•Environmental adjustments: It is important not to avoid all sources of stress when a child has selective mutism, as this can reinforce avoidance. However, changing the environment can help make things easier. For example, instead of avoiding family gatherings entirely, consider introducing children to family members individually and giving them time to feel comfortable around each person.
Selective mutism is an anxiety disorder that affects communication. People with the condition find that they can talk in some situations but not in others. This behavior is an involuntary response to stress rather than a choice.
Treatment for selective mutism can involve behavioral therapies, psychotherapy, or both. Due to the impact that the condition has on people’s lives, it is important for family members, teachers, and peers to treat those with selective mutism with compassion and understanding.
Selective mutism is a childhood anxiety disorder characterized by a person being unable to speak in certain social situations. But they’re able to communicate...
Jul 7, 2021 · Selective mutism is a rare childhood anxiety disorder in which a child experiences a trigger response and is unable to speak in certain situations or to certain people. It is not a form...
- SymptomsThe onset of selective mutism is usually between the ages of 3 and 6. Most children who develop selective mutism also suffer from social anxiety ,...
- What are some signs of selective mutism?Children who suffer selective mutism may appear: Shy, socially awkward, anxious , insecure and clingy, embarrassed, rude, indifferent or aloof, st...
- CausesChildren with selective mutism often have a family history of anxiety disorders. The neurological basis for selective mutism is thought to be a cas...
- Can selective mutism lead to mood disorders?Selectively mute teens may also experience mood disorders like depression , and they can suffer conditions such as agoraphobia, a fear of leaving...
- Are selective mutism and autism spectrum related?Individuals on the autism spectrum have problems with social skills and communication abilities; while they do feel empathy for others, they do n...
- TreatmentIt is best to seek behavioral therapy or family therapy as early as possible for a child with selective mutism because the condition may not go awa...
- What happens when selective mutism is left untreated?If untreated, selective mutism can in some cases follow a child into adulthood. It will affect school, family, social life , and work. All of whic...
- How can schools and teachers help a child with selective mutism?Schools and teachers can help a child in various ways: • Do not pressure the child to speak • Allow time for counseling and speech therapy • Allow...
Selective mutism is when a child can’t speak in certain settings, but can speak fine in others. For example, a child may not be able to speak at school, but can speak with no problem at home. It is called selective mutism because the child is only mute in select situations.
Dec 30, 2022 · Selective mutism (SM) is a rare anxiety disorder where an individual cannot speak at school or other specific social situations but have no trouble speaking in different, presumably more comfortable settings. The condition typically affects children and is considered a childhood anxiety disorder, but can also affect older individuals.
Policy. If your child appears to be a completely different person at home than they are in other social settings, they may have selective mutism. Selective mutism is often misunderstood and can be misdiagnosed, but early detection and treatment are crucial for better outcomes down the road.
