Selective mutism (SM) is a newer form of anxiety disorder, first becoming part of the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1980. The NHS defines Selective Mutism as a mental health disorder, part of the Anxiety Disorder Cluster, whose primary symptom is the inability to talk in certain situations. 

People with Selective Mutism can talk, and freely do so in perceived safe environments (like their home, or with people they closely know and feel relaxed around). Their difficulties happen in situations and circumstances that they deem anxious and uncertain, for example, at school. In these triggering situations, people with Selective Mutism don’t initiate conversation or don’t respond when talked to. 

Is Selective Mutism A Disability? 

SMIRA (Selective Mutism Information and Research Association) explains that Selective Mutism is a form of disability. People with SM don’t stay silent on purpose or because they want to be mean or left alone. Instead, as the SMIRA explains, they have a form of social phobia which prevents them from talking when they feel exposed, unsafe, or in new, uncertain situations. 

People with Selective Mutism describe the experience as being paralysed, frozen, or tight in their throat. Often, their inability to speak is also accompanied by other cues like: 

• Difficulty looking people in the eyes.
• Have scarce facial expressions.
• Look stiff or tense in their body posture.
• Be slow to respond to questions.
• Be more sensitive to touch, sound, or crowded areas.
• Be highly perceptive of things around them.
• Be sensitive to the thoughts, actions, and emotions of those around them.
• Have difficulty expressing their thoughts and emotions.

Selective Mutism Symptoms

Selective mutism is mainly prevalent in children. If untreated, it may persist and continue well into adulthood and cause significant difficulties in everyday life and engagements. 

Selective mutism in children is usually diagnosed after their 5th year of life. As the ASHA (American Speech-Language-Hearing Association) explains, the diagnostic criteria for diagnosing SM are as follows: 

• Criterion A – Consistent inability to talk in certain social situations, in which it is expected to talk, while the general ability to talk is uncompromised.
• Criterion B – The condition interferes with educational and occupational achievements and social interactions.
• Criterion C – The disturbance lasts at least 1 month, but it is not the same month as the first time starting at school. 
• Criterion D – The failure to speak is not attributed to lack of knowledge or comfort of speaking the language.
• Criterion E – The disorder is not better explained by other disorders (like autism or childhood-onset fluency disorder).

The criteria are the same for diagnosing selective mutism in adults, too.

Selective Mutism Causes

There isn’t any one particular cause of Selective mutism. In essence, selective mutism is an anxiety disorder, which means that it is present in people who tend to be anxious. The HSE (Health Service Executive) explains that the trigger is a phobia (fear) of talking in some situations. They further note that selective mutism in children is more common in girls, and that it is present in around 1 child in 140. The HSE lists possibilities that may increase the risk of Selective Mutism in children: 

• Children who have speech or language difficulties, or need to communicate in a second language they don’t fully know.
• Children who come from ethnic or minority populations.
• Children who have sensory processing difficulties, like sensitivity to sounds.
• Children who come from families that have a history of anxiety disorders or depression.
• Children who are more sensitive, shy, anxious, or perfectionistic.
• Children who have low self-esteem or depression. 

Selective Mutism Triggers

The HSE continues to name some of the most triggering situations for people with Selective Mutism, especially children. 

• Unfamiliar settings in which they are coming in for the first time.
• Separation anxiety, i.e., being afraid to spend time alone, away from their parents or primary caregivers. 
• Loud and busy places with a lot of people.
• Being bullied, teased, or pressured into talking.
• Overwhelming situations.
• Being afraid to make a mistake or be embarrassed in front of others.

Selective Mutism Treatment

The Priory Group explains that timely diagnosis and treatment are imperative for selective mutism in children. If untreated, selective mutism can continue into adulthood and create significant difficulties in everyday life, both personally and professionally. 

They underline the importance of holistic support, in which a personalised plan is created for treating the anxiety underlying the disorder, as well as treating any co-occurring condition like depression. They name some of the most effective treatments for selective mutism: 

• Cognitive Behavioural Therapy
• Desensitization
• Graded exposure
• Stimulus fading
• Shaping 
• Positive Reinforcement

For selective mutism in adults and older children, the mental health professionals often also prescribe anxiety medication like antidepressants.

How To Get A Child With Selective Mutism To Talk

The Child Mind Institute underlines that it is never good to push children into doing something they are not comfortable with. This is why their treatment needs to be gradual, with small steps forward and a significant amount of praise for successful interactions. They further give the following directions to support children talking: 

• Learn specific ways to encourage speech and help children build positive talking experiences. 
• Giving the child more time to answer a question and not letting someone else answer it for them.
• Use labelled, specific praise for the things they do and communicate. 
• Ask open-ended questions where the child needs to communicate with a full sentence, instead of just yes or no.
• Repeat what the child is saying to let them know that you hear and understand them. 
• Do a recap of what the child is doing to show interest, and also to continue using conversation in situations where they are nonverbal.  

Selective mutism treatment should be holistic and include both medication and a support system from the child’s community. The given tips work best when practised by numerous important people in the life of the child, including their parents, relatives, and school teachers.  

Conclusion

Selective mutism is mainly prevalent in children. If untreated, it may continue into adulthood. It’s  a form of anxiety disorder characterised by a phobia of talking in anxious or triggering situations. 

Before labelling nonverbal children as uncooperative, dismissive, or disinterested, it’s important to understand that selective mutism is not an unwillingness to talk; it’s a disability in which the child feels paralysed and unable to speak due to overwhelming fear. 

Thankfully, with timely diagnosis and appropriate treatment, selective mutism is highly treatable. Understanding what this mental health condition entails, what its symptoms are, and the available treatment options can help parents and teachers understand this disorder and help children manage and reduce their anxiety and selective mutism symptoms.