What is selective mutism?

Selective mutism

Selective mutism :  is a disorder that usually occurs during childhood. It is when the child does not to speak in at least one social setting. However, the child can speak in other situations. Selective mutism typically occurs before a child is 5 years old and is usually first noticed when the child starts school.


  • consistent failure to speak in specific social situations (in which there is an expectation for speaking, such as at school) despite speaking in other situations.
  • not speaking interferes with school or work, or with social communication.
  • lasts at least 1 month (not limited to the first month of school).
  • failure to speak is not due to a lack of knowledge of, or comfort, with the spoken language required in the social situation
  • not due to a communication disorder (e.g., stuttering). It does not occur exclusively during the course of a pervasive developmental disorder (PPD), schizophrenia, or other psychotic disorder.

Selective mutism is described in the 2000 edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR: pp.125-127).

Children with selective mutism may also show:

  • anxiety disorder (e.g., social phobia)
  • excessive shyness
  • fear of social embarrassment
  • social isolation and withdrawal

Causes :

Many times a child with selective mutism has or is experiencing:

  • an anxiety disorder
  • inner self/self-esteem issues
  • a speech, language, or hearing problem
  • trauma

Prevalance: Current rates are estimated to be between 3 and 8 in 10,000. Some researchers state that the occurrence of SM is probably more frequent than this estimate. Reasons for this assumption focus mainly on the possibility of underreporting which could be due to families living in isolation, a family not recognizing SM as a behavior problem that can be treated, or families being unaware of the problem altogether since it usually does not occur in the home


Prognosis: The prognosis for children and adolescents who are treated for SM appears to be excellent. With appropriate treatment, SM is often overcome successfully. Without treatment, however, SM is more likely to persist and comorbid symptoms in addition to SM are common. Longitudinal studies showing the course of SM following treatment are needed, however, in clinical settings, most children with SM show significant improvement.

Professional Intervention:

  • A child with selective mutism should be seen by a speech-language pathologist (SLP), in addition to a pediatrician and a psychologist or psychiatrist. These professionals will work as a team with teachers, family, and the individual.
  • It is important that a complete background history is gathered, as well as an educational history review, hearing screening, oral-motor examination, parent/caregiver interview, and a speech and language evaluation.
  • Clinicians must be careful of labeling children with SM as having speech or language disorders, for this label can misdirect treatment away from the psychological problems underlying the failure to speak. The best treatments appear to be behavioral methods implemented in a multidisciplinary setting.

Parental intervention :

The home is a wonderful place to learn about social interactions and rules of behavior.

  • Provide a safe and loving environment for the child.
  • Accept the child for who they are.
  • Do not use threats or punishments to get the child to talk.
  • Be understanding and provide a secure environment for the child.
  • Instill hope in the child, reassuring them that there is help and they can overcome their situation.
  • Foster self-esteem and empowerment.
  • Provide the child with plenty of opportunities to explore extra-curricular activities, such as swimming, gymnastics, art, theater or dance. This will allow them to find pleasure in activities, practice their strengths and foster self-esteem.
  • Provide opportunities for after-school play-dates. Invite a peer that the child likes to the home, allow them free time to play and interact. Once the child talks to this peer freely, take them to the park or outdoors to promote communication outside the home.
  • Keep bringing different peers into the home (one or two at a time) and follow steps above to generalize communication to other places and people. Once a peer group has been established, consider having the play-dates at the other child’s home.
  • When taking the child to social activities, such as birthdays, school plays etc., arrive early, allow the child time to “check out the environment”, feel comfortable, and slowly warm up. Do not force them to interact or play.
  • The biggest challenge as a parent is knowing when to “push the child” and “when to let go”. You want to provide opportunities for socialization and not reward isolation and withdrawal. This is done in a slow and caring manner.
  • Role-play situations that are anxiety provoking at home. This will help you understand their difficulty as well as giving them social skills.
  • Provide plenty of praise and social rewards for communication.
  • Seek advice and help form professionals in your area.
  • If family conflict, trauma or dysfunction is present, consult a professional and attend family therapy.
  • Establish a support network for you as a parent. Children perceive their parents anxiety and frustration. Take care of yourself so you can care for your child.

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