Silent Childhood Anxiety:  Selective Mutism

Childhood anxiety affects a great number of children for various reasons, but Selective Mutism only affects about 1/8 of children and approximately 2% of adults.  More research is being done on this disorder and support is growing in the way of support groups and more mental health professionals treating it.

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Selective Mutism: What does it Mean?

Selective Mutism is a disorder that manifests in children and is classified under a severe anxiety disorder that is characterized by the inability to speak and communicate in certain social settings, like school. Selective Mutism occurs when a child is experiencing severe anxiety in a social situation.  This may be at school, a group setting where there are people they are not familiar with, and other settings where the child may feel anxious when attempting to talk to others.  These children are afraid to speak to people that goes beyond normal fears.    Selective Mutism is a diagnosis classified in the DSM 5 as a mental health diagnosis, and is not a result of a child just being stubborn.  Selective Mutism is not a result of trauma but instead is related to severe anxiety.  20-30% of children with Selective Mutism also have speech and language issues and that could be treated with the help of a Speech Pathologist.

Definition of Selective

The word selective refers to how the mutism is only at “selective” times, meaning at school, or on the playground.  It does not mean the child chooses these places, rather these are the places that cause the most anxiety.

Stats: How Many Suffer from this Disorder?

8 out of 10,000 children in the United States are affected by Selective Mutism, it typically affects children between the ages of 3 and 8 years old.  This disorder is slightly more prevalent in girls.  Often times you will see the first signs when children enter school age.  

What Causes Selective Mutism?

Most children with Selective Mutism have inherited anxiety from a person in their family.  This does not mean that another family member has ever had Selective Mutism, but instead it means that a family member has had anxiety that has been passed to the child and is now manifesting in the child as Selective Mutism.  Children with Selective Mutism often have a temperament that is reserved, withdrawn and/or subdued.  Often times these children show symptoms early in infancy, such as having tantrums, sleep issues, extreme shyness, excessive crying and separation anxiety.  

Sign and Symptoms

Some symptoms of children with Selective Mutism are: 

-being afraid to eat in front of others

-not wanting to bring attention to themselves 

-may appear “frozen” when faced in a social situation where they feel uncomfortable 

-may have communication difficulties or Sensory Processing Disorder where they are unable to process the many things around them such as bright lights, loud sounds, textures, etc…

What are the Common Behaviors/Characteristics?

Children with Selective Mutism are usually on the extreme side of shyness. They tend to isolate themselves in social situations where they may be expected to talk to other people, however they may be able to talk when they feel comfortable or relaxed at home.

Testing:  What are the the Diagnostic Criteria Per the DSM 5?

The DSM 5 has identified  these criteria for a diagnosis of Selective Mutism:

  • Consistent failure to speak in specific social situations (in which there is an expectation for speaking, e.g., at school) despite speaking in other situations.
  • The disturbance interferes with educational or occupational achievement or with social communication.
  • The duration of the disturbance is at least 1 month (not limited to the first month of school).
  • The failure to speak is not due to a lack of knowledge of, or comfort with, the spoken language required in the social situation.
  • The disturbance is not better accounted for by a Communication Disorder (e.g., stuttering) and does not occur exclusively during a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder.

Selective Mutism and other Conditions

There are children that have been diagnosed with PDD-NOS, Autism, and Developmental Disorders that have also had select mutism in social situations but this differs from Selective Mutism and other disorders should be ruled out before seeking treatment.

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Selective Mutism vs Social Anxiety

Most children with Selective Mutism are also given a diagnosis of Anxiety, more specifically Social Phobia.  The difference between the two diagnoses are that people with Social Phobia do not become mute to avoid talking with people.  Instead they may avoid social situations altogether or have physical symptoms such as sweating, rapid heart beat, and an overwhelming feeling of panic when in a social situation.

Selective Mutism in Adults/Children

While Selective Mutism is mostly seen in children, there are adults who have Selective Mutism as well.  Just like in children, adults have Selective Mutism due to high social anxiety.  Another cause can be an undiagnosed speech impairment and sometimes extreme low self esteem.  

Example Case of Selective Mutism

4 year old Jenny who has been home for most of her young life, enters into preschool and begins to show signs of withdrawal, isolating, not speaking or communicating with her teacher or other children.  When she goes home, she talks to her parents and siblings and appears to be comfortable and relaxed.  This continues daily, but only at school.  The school believes she has a speech delay and begins to take steps to have her evaluated for a speech and language delay.  The child may or may not talk with the speech therapist to have an evaluation.  Her parents tell the speech therapist that she talks at home and has good vocabulary.  The speech therapist asks the parents to video their child at home so that she can evaluate her speech patterns and communication.  The parents are then referred to their pediatrician or a psychologist who can further evaluate and discuss the possibility that she may have Selective Mutism.

How to Deal/Coping With Selective Mutism

Teaching your child about Selective Mutism can help your child to understand this disorder and help them to know they are not alone.  Children may not know why they are reacting the way they are in social situations so education would be beneficial.  Offering your child support and patience can help them to overcome anxiety in social situations, just as assisting them with boosting their self esteem will also help.  Practicing what to say and role playing can be beneficial to a child and can help them gain the tools they need to be more confident.

Look Out for These Complications/Risk Factors

Pushing a child with Selective Mutism to speak in public may actually have a negative effect.  Children may become oppositional, develop more anxiety and lower self esteem.  These children may then have Selective Mutism that persists through adulthood and never truly gets treated.  Children with this disorder need lots of support, patience and understanding.  Seeking treatment from a professional can help a child overcome this and help them to lead a more normal life.  

Selective Mutism Treatment

Treatment for Selective Mutism include reducing the anxiety in children, increasing their self esteem, role playing, and observing them in their own environment to assess how to help the child.  These children often need help to learn how to socialize in a social situation so, although an office setting with a therapist is important, it is also important to help a child while in a social situation to overcome their anxiety.  Many children do well with behavior therapy, where they are given positive reinforcements.  Being involved in your child’s treatment and educating the school staff is key to treating a child with Selective Mutism so that they are given the support and patience that is needed. 

Possible Medications for Selective Mutism

Medications are also used in some children to assist them with reducing anxiety.  Medications such as SSRI’s can be useful in treating anxiety.  Those medications include Paxil, Prozac, Celexa, Zoloft and Luvox.  Other medications such as Buspar and Effexor have also been successful in treating Selective Mutism.  

Home Remedies to Help Selective Mutism

While there is no magic trick to treat Selective Mutism, there are things you can do at home to help your child gain more confidence and feel more comfortable.  Some things you can do are:

1.  Reward your child when they speak in a social setting.  Children respond well to rewards and this can boost their confidence so they can begin feeling better about themselves.

2.  Role play conversations and situations with your child so they can get an idea what it will be like when in that situation.  This will give them some prompts to work with when they are afraid to speak.

3.  Don’t push or get frustrated when they don’t talk.  This may push them further into anxiety and lengthen the time before they try to speak in social situations.  

4.  Offer support and patience.  The more you support them and get support for yourself, the more educated you and your child will be and the more you will both know you aren’t alone.  

Living with Selective Mutism

Getting a diagnosis of Selective Mutism can be overwhelming and discouraging, however with treatment and support, you child can overcome this disorder.  Sticking with the treatments is key to overcoming this.  

Insurance Coverage

Selective Mutism is a mental health disorder and therefore covered by most insurance that have behavior health coverage. Contact your insurance from the number on the back of your card or talk to your pediatrician about a referral.  Don’t be discouraged if your pediatrician is not familiar with this disorder, instead contact your insurance company and ask for a referral to a licensed mental health professional who treats Selective Mutism.

How to Find a Therapist

You can locate a Licensed Mental Health Professional who specialize in Selective Mutism by visiting  There you can locate therapists as well as support groups in your area.  You can also search Psychology Today in your area to find a mental health professional.  

Questions to Ask a Potential Therapist

1.  How many children with Selective Mutism have you treated?

2.  What is your approach to treatment?

3.  How can I participate in the treatment process?

4.  Will you be involved with my child’s school?

5.  What is your understanding of Selective Mutism.  Be cautious of therapists who view the behavior as “manipulative” or something that the child can control.  Selective Mutism does not come from a child who is being manipulative, but rather a child who is experiencing severe anxiety.

Selective Mutism Resources and Support Helpline

Resources for searching for help and support include:

1.  Here you can locate a licensed professional who can help to diagnose and treat your child if you suspect Selective Mutism.  This website also lists support groups in your area, a list of books on the subject, upcoming conferences and events as well as contact information to speak to someone who can help you to navigate  the resources.  

2.  Facebook:  You can join the facebook group, supportselectivemutism, which can offer support and resources from others who are going thru a similar situation.

3.  Here you can find videos on understanding Selective Mutism as well as contact information regarding support.  Their contact number is:  646-434-0977.

Selective Mutism is a mental health disorder that affect 8 out of 10,000 children in the United States.  Although it is not as prevalent as many other disorders, such as Autism or PDD-NOS, it is important to seek treatment as early as possible . Getting the proper treatment and support will increase your chances of success.  Do your research and visit the website for Selective Mutism to learn more about it and find support in your area.  Remember, these children need patience and support to help them to feel safe and confident.  Help is available! If think your child may have Selective Mutism, contact the Selective Mutism Association or go to their website for more information.

author avatar
Angel Rivera
I am a Bilingual (Spanish) Psychiatrist with a mixture of strong clinical skills including Emergency Psychiatry, Consultation Liaison, Forensic Psychiatry, Telepsychiatry and Geriatric Psychiatry training in treatment of the elderly. I have training in EMR records thus very comfortable in working with computers. I served the difficult to treat patients in challenging environments in outpatient and inpatient settings
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