Disclaimer: I am not a doctor or health professional and know others may have different opinions than my own. This beginner’s guide to Selective Mutism (SM) was gathered from my knowledge and experience helping my oldest son overcome Selective Mutism.  

What is Selective Mutism?

Selective Mutism (SM), is an anxiety disorder characterized as a child’s inability to speak and communicate effectively in one or more select social settings.  

It is important to understand that Selective Mutism is not a speech disorder.  Many children with SM have an average to an above average vocabulary and are able to communicate properly where they feel comfortable.

SM is directly related to anxiety and it is situational.

A child with SM will vary in their level of communication from setting to setting depending on the anxiety felt in the specific environment. While children and teens with SM may be unable to speak in certain settings like school, they are able to speak in situations where they feel comfortable and secure.  Understanding this helps rule out other diagnoses. If a child is nonverbal in every situation, this is not Selective Mutism.

What causes Selective Mutism?

According to the Selective Mutism Anxiety Research and Treatment Center (SMart Center), the majority of children with Selective Mutism have a genetic predisposition to anxiety. Typically at least one of the child’s parents or family members has struggled with anxiety in their own childhood.

There are many different factors that can contribute to SM.  These can include timid temperament, sensory difficulties, and speech and/or language abnormalities.   Bilingual challenges and increased expectation may also be contributing factors.  

What does not cause SM?

Studies have shown no evidence that Selective Mutism is caused by a traumatic event, abuse or neglect.  While any of these negative experiences could potentially lead to someone being mute, it is not what causes Selective Mutism.

If a child experienced a traumatic event and became mute as a result, they would most likely be nonverbal in all situations and environments. If someone has Selective Mutism, their level of communication varies from setting to setting depending on the anxiety felt in the specific situation.

How common is it?

Selective Mutism is often referred to as a “rare” condition.  It is said to be slightly more common in females than males.   Studies on Selective Mutism are few and far between however. Published information about SM is limited and unfortunately sometimes inaccurate.  In my opinion SM is not as uncommon as it seems. I believe that misunderstandings of the subject leads to misdiagnoses.

Due to a lack of studies and treatment professionals that truly understand Selective Mutism, misunderstanding arise. People with SM are often assumed to just be extremely shy.  They may also be misdiagnosed with conditions like Autism, Oppositional Defiant Disorder (ODD), or speech/severe learning disorders.  This unfortunately leads to the wrong treatment path and can reinforce muteness.

What are some of the signs of SM in a child?

Selective Mutism can present in many different ways.  There is not an official Selective Mutism test or checklist; however there are certain characteristics and behaviors that are frequently seen in a child with SM.  

The main and consistent sign is being unable to speak and communicate effectively in one or more select social settings.  Children with SM frequently have social anxiety symptoms as well. 

Some other red flags include:

• Shutting down or freezing with fear when uncomfortable
• Having an expressionless or “Deer in the headlights” look in specific situations
• Being unable to initiate conversation or to ask for help in anxiety-provoking environments
• Responding only with nonverbal gestures or not at all when addressed in certain environments
• Trouble joining in and interacting with peers
• Withdrawing or refusing to participate in activities in the classroom or other environments where they feel anxious
• Difficulty answering open-ended questions
• Unable to eat or ask to go to the bathroom in public places when they feel anxious
• Being unable to ask for help when they are hurt or in need in specific environments
• Appearing oppositional or defiant  (When really they are terrified and dealing with paralyzing anxiety.)

Selective Mutism can become very clear in a classroom setting.  Parents are often unaware of the disorder until their child enters school.  It can become quite noticeable when there is an expectation to interact with teachers and peers.

This is how it became apparent to us.   

I am compiling our story and tips into a book that will be published in 2020.  If interested, I am posting book updates and answering parents questions about SM leading up to the launch here.

Is Selective Mutism a form of Autism?

No.  Selective Mutism and Autism are two different things.  It is understandable why someone who has little to no knowledge of Selective Mutism could think this.  On the surface there are some similarities.

Children with Autism may have a delay or lack of verbal language. They may have trouble interacting socially with peers and/or adults and often avoid eye contact. An appearance of looking shut down or a blank expression can also occur.

When a child with SM is anxious, they typically exhibit these same behaviors.  

The HUGE difference between Autism and Selective Mutism is that SM is SITUATIONAL.

A child with autism will consistently exhibit these types of behavior no matter the setting.  A child with SM however can be fully verbal and as socially appropriate as any other child when in a comfortable environment.  

How is Selective Mutism diagnosed?

If you suspect that your child has Selective Mutism, it is very important to go to a professional who has an excellent understanding of this disorder and experience treating it.

A lot of physicians and therapists will claim that they understand Selective Mutism and can help treat your child.  They often have some knowledge of this disorder, but they do not have a comprehensive understanding or experience to know how to best treat SM.  I learned this the hard way with our first pediatrician.

When selecting a professional to diagnose and treat your child, make sure that they have worked with SM cases in the past and have had proven success. Ask for testimonials and be sure to understand their approach.

A professional will rely heavily on parent reports when making a diagnosis, since a child who potentially has Selective Mutism will have difficulty participating in a traditional question/answer session. Be sure to fully educate yourself on SM and come prepared so that you can answer questions and feel confident that the provider is knowledgeable.

Be cautious of any medical professional who sees Selective Mutism as a choice, manipulating behavior, or heavily focuses on the child’s need to speak. Share on X

Can SM be Misdiagnosed?

Absolutely! Misdiagnoses can and do occur due to a lack of studies and treatment professionals who truly understand Selective Mutism.

People with SM are frequently assumed to be just extremely shy or misdiagnosed with the wrong disorder.  This unfortunately leads to the wrong treatment path and can reinforce muteness.  Educate yourself so that you can be the advocate your child needs.

For more information about SM falsehoods check out 8 Myths about Selective Mutism.

Want to know the top ten things that  helped my son become verbal in all settings?

Download my free printable & start helping your child today!

What is the treatment for Selective Mutism?

Proper treatment is key in helping a child overcome Selective Mutism.  This is one of the reasons that I am dedicated to raising awareness, clearing up misunderstandings and encouraging early treatment of SM.

So, how is SM treated?

According to the SMart Center, the main goals of Selective Mutism treatment should be to lower anxiety, increase self-esteem and increase social confidence and communication.

The treatment plan will vary for each individual case. Typically it will involve a combination of Cognitive Behavioral Therapy (CBT), positive reinforcement and desensitization.  It is a group effort that requires parental involvement and support from a child’s school and family as well.

First, you need to remove all pressure to speak. 

Make sure that this is communicated to family, school staff, treatment professionals and anyone else interacting with your child.  People without knowledge of SM tend to try and get a child to speak by whatever means necessary- bribing, threatening, etc.  This is a natural reaction, but it is the worst thing that they can do.  Pressure will just exacerbate the issue and reinforce muteness.

Do not bribe or force a child with Selective Mutism to talk. Expectation of speech and focusing on talking actually increases anxiety and reinforce muteness. Share on X

Anyone who regularly interacts with a child with SM should be educated to remove all pressure and expectation to speak.  This is a critical first step. Reducing anxiety and increasing the comfort level has to occur before the possibility of communication will take place.

The right treatment professional can also be an advocate for your child. They can help communicate your child’s needs to school staff, family members, etc. If there aren’t any treatment centers near you, do not get discouraged.  Many doctors offer teleconferences as an option, so it is worthwhile to research different treatment facilities that are of interest to you.

Is medication needed to treat SM?

Typically behavioral therapy is the first line of treatment prior to considering the need for medication.  For more information on this check out, When Should Medication Be Used to Treat Selective Mutism?

When should I seek treatment for my child?

Studies show that the sooner a child is treated for Selective Mutism, the quicker the response and the better the results. 

It is easier to treat a preschool child with SM than a teenager.  The younger the child, the less conditioned they are to avoid situations that involve talking.  This makes it much easier to change their behavior and mindset.   

As a child grows, they can begin to view being non-verbal as normal which can lead to a conditioned response.  In addition, peers and people they have regular interactions with will begin to perceive them as non-verbal as well, which can reinforce the habit. 

Can a child overcome SM?

Yes!  A child can overcome Selective Mutism with the right treatment and a lot of hard work.  They will however still likely have a disposition to anxiety throughout their life.

My son is now verbal in all areas and is thriving.  He still deals with anxiety, but it does not define him!  He is a highly sensitive child who is incredibly observant and feels things deeply.  Our son has to work harder at certain things than other children, but is a happy, child who has developed some amazing friendships.  

Moving Forward

I hope that you now have a better understanding of Selective Mutism and that I have answered the questions you had.  If you suspect that your child has Selective Mutism, I urge you to take action and be the advocate your child needs.  You can do this!  Your child can be helped!

Join the Selective Mutism Parenting Journey FB group to learn more about helping your child with SM and to get updates about my book launch detailing our SM journey and strategies.

Also check out my post, How to Help a Child with Selective Mutism to learn how to start taking action today!!!

Is your child struggling with Selective Mutism?  Are they currently being treated for the disorder? Have they overcome it?  I would love it if you would share your story with us in the comments below!  You never know who you may help!

Want to know the top ten things that  helped my son become verbal in all settings?

Download my free printable & start helping your child today!