What is selective mutism?
Selective mutism is a consistent failure to speak in specific social situations despite being able to speak. The word "selective" invites the misconception that the child chooses not to talk; in fact anxiety blocks speech. DSM-5 (2013) classifies it as an anxiety disorder.
DSM-5 criteria (summary)
- Consistent failure to speak in specific social situations where speaking is expected (e.g., school), despite speaking elsewhere.
- The disturbance interferes with educational or occupational achievement or social communication.
- Duration of at least one month (not limited to the first month of school).
- Not due to lack of knowledge of, or comfort with, the language.
- Not better explained by a communication disorder and not occurring exclusively during autism spectrum disorder or a psychotic disorder.
Prevalence and causes
- Prevalence estimates range from about 0.03% to 1%; a US school sample (Bergman et al., 2002) found about 0.7%.
- Behaviorally inhibited temperament, family anxiety and co-occurring social anxiety are common.
- It is reported more often in immigrant bilingual children, but must be distinguished from the normal silent period of second-language learning.
Shyness vs selective mutism
| Shyness | Selective mutism | |
|---|---|---|
| Course | Speaks after warming up | Consistently silent for a month or more |
| Extent | Answers, perhaps quietly | Little or no speech in certain settings |
| Impact | Little impairment | Impairs schooling and peer relations |
Treatment
- Behavioral therapy: stimulus fading gradually adds new people or places to situations where the child already talks, combined with graded exposure and reinforcement of speech attempts.
- Cognitive behavioral therapy: anxiety-management skills and stepwise goals.
- Medication: small studies support SSRIs such as fluoxetine in severe cases.
- School-based work and parent involvement improve results; treatment choices should follow evidence-based practice.
Tips for parents and teachers
- Do not pressure the child to speak with demands, bribes or punishment.
- Accept nonverbal communication first: nodding, writing, picture cards.
- Offer choice questions rather than open questions.
- Praise small attempts specifically.
This is general information; consult a child mental health professional if you are concerned.
References
- American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). APA.
- Bergman, R. L., Piacentini, J., & McCracken, J. T. (2002). Prevalence and description of selective mutism in a school-based sample. Journal of the American Academy of Child & Adolescent Psychiatry, 41(8), 938-946.
- Black, B., & Uhde, T. W. (1995). Psychiatric characteristics of children with selective mutism: A pilot study. Journal of the American Academy of Child & Adolescent Psychiatry, 34(7), 847-856.
- Muris, P., & Ollendick, T. H. (2015). Children who are anxious in silence: A review on selective mutism. Clinical Child and Family Psychology Review, 18(2), 151-169.
- Bergman, R. L., Gonzalez, A., Piacentini, J., & Keller, M. L. (2013). Integrated behavior therapy for selective mutism: A randomized controlled pilot study. Behaviour Research and Therapy, 51(10), 680-689.