What is Selective Mutism? Definition, Signs, Causes & Recommendations

We’ve all experienced a time in ours lives when we didn’t feel like talking at all. It could have happened because we felt physically ill, or simply because we were emotionally drained at didn’t feel like interacting much. Regardless of the reasons, most likely after a couple of hours, days, or even weeks, we felt better and just went ahead carrying our social lives. Life revolves around social events that requires us to verbally communicate our thoughts (e.g. job interview, school presentation, asking for directions). However, in some cases, both children and adults can be affected by something called Selective Mutism, a severe type of anxiety disorder that prevents them from communicating effectively in specific social settings.

In this blog, we will talk more about what selective mutism is, signs, causes, and recommendations.

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What is Selective Mutism?

According to the National Health Service (NHS) in England, selective mutism in children is a severe anxiety disorder where a person is unable to speak in certain situations. These individuals can speak normally in social settings where they feel comfortable such as when talking to their parents, or when alone in their bedroom. However, when exposed to other social settings (e.g. classroom, lunch break), or to certain people (e.g. talks only to family members), they are unable to express themselves.

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) (published by the American Psychiatric Association), considers selective mutism as an anxiety disorder. Typically, selective mutism has an onset between 2 and 5 years of age, but it is usually not recognised until the child is exposed to other social settings aside from home (e.g. school) (Oerbeck B et al., 2019).

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What are the signs of Selective Mutism

According to the DSM-5, the criteria to identify someone with selective mutism includes (DSM-5; APA, 2013, p. 195):

• The child shows 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 attributable to a lack of knowledge of, or comfort with, the spoken language required in the social situation.
• Is selective mutism a form of autism? The disturbance is not better explained by a communication disorder (e.g. child-onset fluency disorder) and does not occur exclusively during the course of autism and selective mutism, schizophrenia, or another psychotic disorder.

Often these individuals might exhibit symptoms such as:

• Frequent tantrums
• Crying
• Moodiness
• Inflexibility
• Sleeping problems
• Extreme shyness
• Clinging to parents
• Freezing

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What causes Selective Mutism?

No single cause has been associated with the onset of selective mutism. However, other conditions have been associated with it. A metanalysis conducted by Driessen et al (2020) reviewed 22 studies compromising a total of 837 children diagnosed with selective mutism. Results of this study indicated that 80% of these children were additionally diagnosed with at least one comorbid anxiety disorder. Social phobia (i.e., social anxiety disorder) was found in 69% of the children, making it the most diagnosed comorbid anxiety disorder. Social phobia was followed by specific phobia (19%), separation anxiety disorder (18%), generalised anxiety disorder (6%), and obsessive-compulsive disorder (6%)

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Is selective mutism just shyness?

It is important to understand the differences between selective vs traumatic mutism. As previously mentioned, some signs need to be present for a child to be diagnosed with selective mutism. On the other hand, a child with traumatic mutism, is unable to speak specifically as a result of a traumatic event (e.g. witnessed the death of a family member).

Other diagnosis that should NOT be confused with selective mutism include:

• Speech and Language Disorders
• Childhood Onset Fluency Disorder
• Pragmatic Communication Disorder
• Neurodevelopmental Disorders
• Schizophrenia
• Psychotic Disorders

Is selective mutism part of ADHD?

Of note, "The main differential symptom between selective mutism and other anxiety disorders, developmental disorders, ADHD, or language-based disorders is that the child with selective mutism CAN talk in certain situations, but is not able to use that same quality/consistency/volume of speech in other situations due to anxiety" (Kotrba, 2015).

How to help a child with Selective Mutism

If you suspect that your child has selective mutism, you can request a formal speech and language assessment. If the speech provider determines that the child does not have a communication disorder, they can certainly refer the child to another qualified specialist (e.g. behavioural health professional) to identify strategies to support the child in desensitising them to the experience of communicating in uncomfortable settings. It takes a multidisciplinary approach to treat this condition. Speech providers will be able to offer best practices on how to get a child with selective mutism to talk.

Speech and language providers can also identify alternative communication systems to support the child, such as AAC boards, non-verbal communication (e.g. pointing, writing, drawing), non-verbal activities that the child can complete to boost his confidence, and decreasing social expectations in the environment.

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References

• ‍American Speech-Language-Hearing Association. (n.d.). Selective Mutism (Practice Portal). ‍
• American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-5) 5. Washington, DC: American Psychiatric Association; 2013.
• Driessen, J., Blom, J. D., Muris, P., Blashfield, R. K., & Molendijk, M. L. (2020). Anxiety in children with selective mutism: A meta-analysis. Child Psychiatry & Human Development, 51(2), 330-341.
• Kotrba, A. (2015). Selective mutism: A guide for therapists, educators, and parents. Eau Claire, WI: PESI Publishing and Media.
• Oerbeck B, Manassis K, Overgaard KR, Kristensen H. Selective mutism. In Rey JM, Martin A (eds), JM Rey’s IACAPAP e-Textbook of Child and Adolescent Mental Health. Geneva: International Association for Child and Adolescent Psychiatry and Allied Professions 2019.