Overview:

Selective mutism (SM) is an anxiety disorder in which a child who is talkative at home is unable to speak in other settings, such as school. Parents often notice signs of SM when a child is 3 or 4 years old, and may spend a whole year in preschool without saying a word.

Symptoms:

  • Being freely verbal and even gregarious at home, but completely or mostly nonverbal at school or around strangers
  • Seeming “paralyzed” with fear, or “shut down” when unable to speak
  • Some use gestures, facial expressions, and nodding to get by; others have difficulty communicating even nonverbally

Causes:

Experts believe that the condition is familial and possibly genetic. Generally, at least one parent of a child with SM reports having problems with anxiety when he or she was young.

Treatment:

Selective mutism is treated with cognitive behavioral therapy. Pressure usually exacerbates the problem, so the therapist works gradually and systematically with the child, using positive reinforcement to build the his confidence and help him find his voice in the settings where he has trouble speaking. The therapist also works with parents to teach them how to apply these techniques in real-life settings. There is evidence that intensive treatments are most effective.

Some children may be also be prescribed anti-anxiety medication, if their selective mutism is severe, or medication may be added if they’re not making progress with behavioral therapy.