Selective mutism is a social anxiety disorder where the individual experiences fear and apprehension when in social situations.  The person may be quite capable of speech but is unable to speak in certain situations. The disorder used to be referred to as "elective mutism", but it is now recognised that the child does not choose not to speak. No single causes have been found for selective mutism, but most sufferers display similar traits. People who suffer from selective mutism describe symptoms such as a tight throat or paralysis when they have to talk in a certain situation. Selective mutism was formely described as elective mutism, indicating that individuals chose to to be silent in certain situations, while the truth is that they are forced by their extreme anxiety to remain silent. They want to speak, but just cannot get the words out.

Some children who start at a new school or classroom are often silent to begin with, especially if they do not speak the language, and other children choose not to speak to certain people. This is unlikely to be a selective mutism and more likely to be shyness or a lack of understanding of the language. There are a number of things you can do to include the child and increase their confidence. It is important to keep trying to converse with the child even if they do not respond (accept non-verbal responses) and include them in small groups or pair them with a buddy. Other children choose not to speak to certain people or in certain environments. This is unlikely to be a disorder, rather a choice of the individual for whatever reason. If the duration of the mutism continues for more than a month after measures have been taken to integrate the child, it is probably best to seek professional advice.

Characteristics of selective mutism

There are a number of characteristics that present with selective mutism:

• Consistent failure to speak in specific social situations or environments such as school or classroom, despite speaking in other situations. This has effects on progress at school, work and social situations.
• The failure to speak is not due to a lack of knowledge of the spoken language, autism, a communication disorder, or other psychiatric problem.
• At home where the child feels safe and confident to talk, he may be quite different and display moodiness, assertiveness, inflexibility, domination, extreme talkativeness, be easily upset and prone to crying.
• The child may be generally anxious, over sensetive and dislike crowds.
• The child may display blank facial expressions, lack eye contact and rarely smile.
• The child may have stiff or awkward body language.

Treatment and therapy will depend on the individual and the severity of the disorder. Forceful attempts, begging or bribery to make the child speak will not work and will possibly make the condition much worse.  Selective mutism does not necessarily get better as the child gets older so it is important to try and treat the disorder from an early age. Through treatment and speech therapy the condition can improve.  If left untreated the mutism can become more severe and people around the individual will have an expectation that no communicatuion will occur and may begin to stop intiating themselves because of the lack of response. A lack of treatment can also lead to depression, worsening anxiety and further withdrawal.

The goals of treatment for selective mutism are to reduce anxiety, increase self-esteem and increase confidence in communicative and social settings. The focus should not be about getting the child to talk, but reducing anxiety levels and developing confidence. If these process can be achieved verbalisation will eventually follow.

A common treatment for selective mutism is behaviour therapy through the use of stimulus fading. This involves a kind of de-sensitization of the individual in the presence of others. Initially the child will be brought to a controlled, safe environment with someone they are comfortable and can communicate with. Over time another person may be introduced.  Small steps are taken over a period of time to allow the individual to slowly overcome their anxieties. Another form of desensitization is to allow the individual to contact someone through non-direct means intially (e.g. email, text message etc) prior to actually meeting them. Combined with stimulus or desensitization therapy can be play therapy, psychotherapy or cognitive behavioural therapy. Parents may also need guidance to accept this disorder and learn how to react and respond.

Some practitioners advocate drug treatments such as anti-depressants to reduce anxiety, although this is quite a controversial area, with many differing views on the subject. However, some mute children have a biochemical imbalance and medication has been found to be successful.

Prior to any treatment other causes should be investigated including hearing impairment. Conversely, selective mutism should not be confused with another disorder such as autism.

For more information, books and resources about selective mutism and other speech and communication difficulties see our Resource Centre.