Child holding hands over mouth

Children with selective mutism may want to speak, but feel too anxious to do so.

Children who suffer from selective mutism are able to speak and have a good understanding of language, but do not speak in specific situations or to specific people. Experts have found that children with selective mutism suffer from severe anxiety and it is this anxiety that prevents them from speaking – in essence the mutism is an avoidance strategy to help them cope with their anxiety in certain social settings. This disorder was originally called elective mutism, but was changed because it gave the impression that children did not want to speak, while in fact they often really want to but become anxious at the idea of speaking to others and simply cannot make themselves do it. It is very important to note that selective mutism is NOT the same as traumatic mutism is which children stop speaking after they have experienced a traumatic event.

Selectively mute children may never speak in specific situations such as in school or at parties, etc. but can then be real chatterboxes in situations where they feel comfortable, like at home or when they are with their parents for instance.  Children with selective mutism also realise that they are expected to speak in certain social situations but simply cannot make themselves speak, even if they want to.

Most children with selective mutism have a genetic predisposition for this disorder, meaning that they often have a parent or other family who also suffered from anxiety or selective mutism.  On a neurological level, scientist have found that people with selective mutism may have over-excitable amygdalas – the amygdala is responsible for giving an indication of possible threat and evokes the fight or flight response.

Selective mutism is a debilitating disorder and may have a very negative impact on a child’s daily functioning in social settings. Some may find it very difficult to participate in activities and may seem stiff or awkward in social settings.  They may be reluctant to smile or to show other facial expressions and may have a very strong fear of social embarrassment.  They tend to worry a lot more than other children of the same age and they may be sensitive to noises and crowds.  They need routine and may be easily upset by changes to this routine.  Some children with selective mutism may also have trouble processing sensory information and this may add to their anxiety and feelings of being overwhelmed in unfamiliar situations.

Because of this difficulty in social settings children with selective mutism are often misdiagnosed as being autistic especially because some of them may also find it difficult to make eye-contact.

Contrary to popular belief, selective mutism does NOT necessarily improve with age and needs to be addressed early on in a child’s life as it may lead to chronic depression and deepened anxiety and social / emotional issues if left untreated.    There is also the risk that the mutism may become self-reinforcing in that people will no longer come to expect a verbal response from the child and so may stop initiating conversations with them.

As frustrating as this disorder may be for parents and the children who suffer from it, it has generally been my experience that shaming, punishing, pressuring or trying to bribe the child to speak will not help as it will simply lead to increased levels of anxiety.

Children with selective mutism need a supportive environment – one in which they know they are expected to speak but where they are not made to feel anxious when they cannot speak . It is vital that they get therapeutic intervention to help build their confidence and self-esteem, decrease their anxiety, guide them in their social skills and teach them healthy coping mechanisms. Very often the extreme anxiety also needs to be treated by anti-anxiety medication, which may be stopped once the child has learned to cope in social settings.