Quick Guide to Selective Mutism

The main signs that a child might have selective mutism are: 

• Talking a normal amount at home, but not speaking at all in other situations, like at school or around strangers 
• Speaking only in a whisper or to a parent outside of the home
• Seeming paralyzed with fear when expected to speak 

Some kids with selective mutism use hand gestures or nodding to get by. Others do not use even these kinds of nonverbal communication. Some children also have trouble speaking at home if someone new is there. 

Selective mutism is a type of anxiety disorder. Children with selective mutism are talkative at home but have significant difficulties speaking in other places like school or around strangers. Parents and teachers may think the child is just shy or refusing to speak, but that is not the case. Kids with selective mutism feel that they cannot speak, even if they want to. Some can’t speak even if they are in pain or have to go to the bathroom. Selective mutism often causes kids a lot of distress and gets in their way at school and in social situations. 

Selective mutism usually shows up when children are three or four years old but may not really be noticed as a problem until they start school.  

For more, read our Complete Guide to Selective Mutism.

A mental health professional will rule out other causes or disorders that may have similar symptoms. Because kids with selective mutism have a hard time talking to strangers, the professional will ask parents and other adults in the child’s life to describe how the child speaks at home and at school. 

To be diagnosed with selective mutism, a child must be able to speak in some places but not in others. The condition must have lasted for a month that is not the first month of school, since many kids are shy at the start of a new school year. The child’s trouble speaking must also get in the way of school and social activities. 

The best treatment for selective mutism is a behavioral therapy, including a specific treatment called PCIT-SM for younger children:  

• The therapist works with the child and their parents to get more comfortable speaking in one situation at a time.  
• The child is never made to speak when they don’t want to. 
• The child is always encouraged and rewarded so that they build confidence in each speaking situation. 
• Special tools are used to help the child move from easier speaking situations to more challenging ones. 
• The therapist teaches parents and child how to use these tools in real-life situations.  

Some studies show that using this method in a short-term, intensive way can be most helpful. That often means having several sessions close together instead of weekly meetings with a therapist. 

Older kids and teens with SM may benefit from CBT to address anxious thoughts in addition to exposure techniques to build confidence in talking to new people and in new situations.

Medication is sometimes given to children who are so anxious that therapy by itself is too hard. It also helps when the child has had selective mutism for a long time or has a more severe case. The medications most often used for selective mutism are SSRIs (selective serotonin reuptake inhibitors), a kind of antidepressant. A doctor should always monitor the child for any side effects. 

Kids with selective mutism may also have other kinds of anxiety disorders like separation anxiety, social anxiety and specific phobias. Some are also diagnosed with mood disorders or learning disorders.