Every child has a unique personality: some are more outgoing; others are shy; and some are slow to warm up. But what about when kids look very different in different situations— talking like a chatterbox at home but not speaking at all at school or in public? They may go silent when someone asks them their name, freeze when the teacher calls on them, or get their parents to order for them at restaurants. Some kids have no trouble talking with their parents and siblings but are completely quiet around extended family members and new people. These speaking patterns are very common in selective mutism—or SM for short.
Selective mutism is diagnosed when children consistently do not speak in some social situations, such as at school, despite talking at home or in other situations. It is considered a social communication anxiety disorder. In other words, people with SM feel very anxious about communicating with other people. When they refrain from speaking, it is notthat they are being rude on purpose. Instead, they are often experiencing so much anxiety about talking that it feels paralyzing!
In order to be diagnosed with SM, this pattern of speaking needs to last at least one month and interfere with important areas of life like school or relationships. There are exceptions when children might not speak, but it is not due to SM. For example, children with developmental delays may have difficulty learning to understand and use language across contexts.Additionally, if children are not speaking in situations because they do not know the predominant language used—such as children who do not know how to speakEnglish as well as their peers but are in an English-speaking classroom—that would not necessarily be SM. However, if a child is comfortable using language in general but is only speaking in some situations, they may be experiencing selective mutism.
In general, it is estimated that SM affects between 1-2% of the population. It is most common among young children but can last into adolescence and adulthood. Individuals with selective mutism often experience co-occurring social anxiety, or fear of negative evaluation or rejection, and sometimes have a strong-willed temperament. Additionally, some research suggests that individuals who need to speak a non-native language are at greater risk for developing SM. Finally, even if SM improves over time, symptoms of social anxiety often remain. In other words, a young child with SM may speak at school and in public by the time they are a teenager but still worry a lot about what other people think of them.
So how is SM treated? The cycle of selective mutism is maintained by adults “rescuing” children in social situations. When a child with SM is prompted to speak, they may become very anxious and not respond.Because of this awkward silence, it is natural for the adult present—who may feel quite anxious themselves because their child is not answering!—to speak on behalf of the child. When the parent responds, both the child and adult feel less anxious because the awkward silence has ended. However, this short-term lowering of anxiety for both the child and parent actually maintains the SM cycle.The child learns that their parent will speak for them, and the parent feels less anxious because they avoid uncomfortable situations. If this pattern continues, it is likely the child will continue to avoid speaking!
In SM treatment, children work toward gradually speaking in new situations, with new people, and at higher volumes over time. As they engage in new speaking practices, they are rewarded for their bravery. Common goals for SM treatment include being able to ask for help, answer questions at school, and talk to peers in order to make and maintain friendships. The goal of treatment is not necessarily that the child will be the most talkative student in their class, but rather that they will talk enough indifferent contexts. In other words, they will be able speak when they want and need to. Importantly, the goal of treatment is not to help the child to feel completely relaxed all the time or avoid experiencing any anxiety or discomfort.Instead, we hope they will get comfortable being uncomfortable and tolerate strong emotions in order to do important things!
Because children with SM often speak using a whisper or very quiet speaking voice, increasing volume is encouraged over time. Ask a child to repeat what they said in a louder voice if you cannot hear their response. You may need to move closer to them at first and work on increasing distance overtime.
If you are a caregiver or teacher to a child with SM, there are many things you can do to help them! First, you can give them labeled praise when they speak in new situations. For example, let them know you are glad that they told you they were finished with their worksheet. If they are uncomfortable with praise at first, you can scale back your enthusiasm and quietly thank them for telling you.
You can also reflect back what they say to you. If they tell you which snack they want, reflect, “You told me you wanted grapes.” This shows that you are listening to them and able to hear what they say. You can also describe what a child is doing when you are interacting with them. If they are playing with blocks, you could say, “You put the green block on top of the blue one.” This lets them know that you are paying attention to them and gives them the opportunity to respond if they want to. You can also move from open-ended questions to forced choice ones if the former is too difficult.
Things to avoid include questions that can be answered non-verbally and trying to guess what the child wants without hearing it directly from them. Giving prompts to speak may also backfire, particularly for socially expected phrases like hello, goodbye, please, or thank you. You can work up to these over time in favor of using non-verbals such as waving initially. Finally, it’s important not to use negative talk about speaking such as, “Don’t be shy!” or “It’s rude not to say hello!”
It is important to consider school accommodations to support children with SM. For example, children can complete speaking practices with their teacher and parent before or after school when no other students are around.While a child is working on speaking, it is recommended they have non-verbal ways to communicate safety concerns, such as needing to use the bathroom or seethe nurse. There should also be regular communication between the school and parents about the child’s progress. A tracking sheet can be used to note when, where, and how often a child is speaking at school and reward them for progress. Finally, children with SM often benefit from meeting their teacher before the school year starts to practice speaking with them one-on-one.
Overcoming selective mutism is challenging but possible!While it can be stressful for both children and their families to work on speaking in new situations, it is very rewarding. Children learn that they can do hard things, and parents learn that they don’t have to “rescue” their child from uncomfortable situations. Facing their fears about speaking allows kids to feel more confident and do important things like engage at school, make friends, and do meaningful activities. It may be hard at times, but it is worth it!
