My niece refuses to speak around adults, but with kids she's the leader of the group. Could she have SM?

Thank you for seeking advice on behalf of your niece. An inability to speak in certain social situations and comfortably speaking with immediate family members at home, difficulty initiating social interactions, and behavioral inhibition (i.e., looking frozen), are features that are often associated with selective mutism (SM). All our research studies on SM have now led us to better understand SM as an anxiety disorder. You mention that she’s so shy that she refuses even to eat and move around people other than her parents and grandparents, which really points to the high level of anxiety she’s experiencing. For many kids with SM, their anxiety goes beyond the ability to speak and even affects their ability to nonverbally engage with other people.

Many parents of children who have an SM diagnosis describe feeling puzzled by what appears to be a random variation of who they speak to or not. When providing psychoeducation to parents about SM at the Child Mind Institute, we typically list three variables that can affect a child’s ability to speak — people, places, and situations — and explain that kids with SM will verbalize to different degrees across these three variables. We then help the child, family members, and often collaborate with the school to gradually and systematically help the child practice “brave talking” with the individuals in their life who are important and whom they are not currently speaking to.

I understand your surprise that she becomes the leader of the pack when she’s with a group of kids. But just because she feels comfortable socializing when she’s around people her own age does not rule out SM.

Taken together, then, I recommend that your niece seek an evaluation from a mental health professional who can properly assess her, determine a diagnosis, and initiate treatment. The good news is that behavioral treatment, as I partially described above, is very effective in treating children with SM. It is important to note that research indicates the earlier the intervention is provided the better response a child is likely to have to treatment.