Selective Mutism: Helping Kids Find Their Voices

Anxiety makes kids unable to speak in some settings, usually outside the home

Clinical Expert: Rachel Busman, PsyD, ABPP

en Español

Selective mutism is an anxiety disorder that renders children who are talkative at home — even fabulous little chatter boxes — speechless in situations such as school, at church or temple, at the playground and when ordering ice cream. SM is an anxiety disorder and not a refusal to speak. A child who has selective mutism can’t speak in these various situations.

Parents may start to notice symptoms when their children are three or four, as they start to go on play dates or go to the park and are inhibited or too shy. When these children enter preschool, teachers report that they are unable to talk in their setting — even ask for help, ask to use the bathroom, and other things like that.

How common is selective mutism? Our best estimates are that one in 140 children ages 3 to 8 have SM. When you compare this with 1 in 20 children who have ADHD, it may seem that selective mutism is extremely rare. And while it certainly is less frequent, it is extremely debilitating as a child has to go to school every day and interact with teachers and other children. And when they’re unable to speak, they not only are missing opportunities to connect with others, but they’re unable to meet very important milestones for social development. And they can’t ask for help when necessary.

The good news is there is excellent evidence-based treatment available for children with selective mutism. This involves a robust behavioral intervention program that helps children learn skills to face people, places, and situations where they were previously nonverbal. The treatment encourages kids to flex what we call “brave muscles” to gradually increase speaking in a variety of settings. They are never pressured to talk, but are praised for “brave talk.”

Good treatment should involve parents and should teach them the same skills the children learn so that they can best support their kids when they’re not in session. Parents help kids practice brave talking in situations like school, at the ice cream store or the library.