Selective Mutism

Selective Mutism

Periods of shyness are common in children: they might get very quiet and withdrawn in a new place, when meeting new people or starting school. However, when a child is talkative and behaves normally in familiar surroundings such as their own home, but refuses to speak or has serious difficulty communicating in certain social situations, it may be selective mutism.

Often considered a severe form of social anxiety, selective mutism usually develops in early childhood, often before the age of five. The inability or refusal to speak is not due to a lack of knowledge or comfort with language or due to another communication disorder such as stuttering. Children with Selective Mutism have a fear of social interactions where speaking to others and communicating is expected. Parents frequently first learn about a child’s difficulty from a teacher or other school figure, because the behavior is not apparent when the child is in a comfortable setting or environment.


Symptoms of selective mutism

  • “Freezing” in place: standing motionless
  • Blank facial expression
  • Twirling or chewing hair
  • Head turning
  • Avoiding eye contact
  • Withdrawing into a corner to avoid interaction

Treating Children

Studies on treating childhood anxiety disorders have found that cognitive behavioral therapy can effectively treat anxiety disorders in children. Also, educating children about the nature of anxiety, ways to identify, evaluate and change anxious thoughts plus training in relaxation strategies have all been used with some success. Children are also taught to learn to recognize the physiological symptoms of anxiety and are taught to use positive “self-talk” rather than negative self-talk.

Techniques commonly used include relaxation training, use of imagery techniques, token reinforcement implemented by parents (e.g. praise, sticker charts), and careful self-monitoring of positive behaviors. Through exposure therapy, children are also taught ways to gradually face situations that they formerly avoided due to fear. Exposure therapy should be implemented by a trained therapist.

How Parents Can Help

Recent research suggests that parental involvement in treatment can enhance treatment effectiveness. By learning new ways to interact with their child, the child’s fears are not inadvertently reinforced. Parents can provide praise and positive reinforcement for brave behavior as well as implement and practice new coping skills with their children between sessions. Because children’s anxiety symptoms have been found to have significant impact on the family, many clinicians incorporate family therapy into their treatment protocol.