Selective mutism
There might be many reasons why people don’t want to talk: some people are shy, overwhelmed or might not see the point in talking. All of these are different from selective mutism, which is a severe anxiety disorder where a person finds it impossible to speak in specific situations. This might happen when they feel pressured to talk to certain people outside of their comfort zone, causing them to freeze up and make speech seem impossible.
Misunderstandings about selective mutism can lead to isolation and increased anxiety for those dealing with it. Selective mutism usually occurs between ages three and six and is typically diagnosed when a child goes to school, but can continue into later years.
While the condition that affects 1 in 140 younger people, it’s not well-known and can often be misunderstood. Therefore, gaining a better understanding of selective mutism is crucial to fighting against stigma and providing support to those affected by this condition.
Common myths
selective mutism
is just shyness
While introversion is a common personality trait characterised by discomfort in social situations, selective mutism is a clinically recognised anxiety disorder. Those with selective mutism experience extreme levels of anxiety that go beyond typical shyness. Selective mutism is also not a personality disorder.
selective mutism
is a choice
Selective mutism is a condition that’s completely out of an individual’s control. This anxiety becomes so oppressive that speaking becomes impossible even when they genuinely wish to communicate.
you can grow out of it
If left untreated, it can persist into adolescence and even adulthood. Early intervention and appropriate therapeutic support are crucial in helping individuals with selective mutism overcome their challenges.
Symptoms of selective mutism
Common indicators of selective mutism include:
- Stillness
- Frozen facial expressions
- Struggling to make eye contact when uncomfortable
- Speaking through a trusted individual. For example, whispering an answer to a question to a parent or friend at school
- Relying on nonverbal communication (like pointing, nodding, writing) to answer questions
- Being paralysed with fear or shutting down completely when unable to communicate
- Reluctance to engage in communication in certain situations.
Causes of selective mutism
The causes of selective mutism are complex and multifactorial. Below we explain some factors that might contribute to the condition:
Connection to Other Mental Health Conditions
Selective mutism is often associated with other psychological or developmental conditions that may contribute to its onset:
- Anxiety Disorders
Selective mutism is most closely linked to social anxiety. Individuals may experience intense fear in social situations where speech is expected. This fear can escalate to a phobia of speaking in certain contexts or around specific individuals.
- Speech, Language and Communication Disorders
Children with underlying speech and language difficulties, such as expressive/receptive language delays or communication disorders, may feel increased stress or self-consciousness when speaking. This can reinforce avoidant behaviours in social settings.
- Neurodivergence
While selective mutism and autism are distinct conditions, they often co-occur, especially in children with high levels of social anxiety or communication challenges.
Personality and Temperament
Certain personality traits may predispose individuals to develop selective mutism:
- Inhibited or Avoidant Temperament
Some children have a naturally shy, cautious or withdrawn temperament. When speaking situations cause anxiety, avoidance can quickly become a habitual coping mechanism.
- Perfectionism and Sensitivity
Many children with selective mutism are highly sensitive, perfectionistic and have a strong need to ‘get things right’. This fear of making mistakes, combined with discomfort in unfamiliar situations, can contribute to persistent silence.
Trauma and Stressful Events
Although rare, traumatic or highly stressful experiences can be linked to the onset of selective mutism in some cases. These might include sudden changes in environment (e.g., starting school, relocation) or witnessing distressing events. This might be connected with Post-Traumatic Stress Disorder (PTSD). However, most individuals with selective mutism do not report any traumatic triggers, highlighting that trauma is not a necessary cause.
“From a personal point of view, selective mutism feels like I am being strangled from the inside out. It feels like someone is trying to pull the tightest knot right in the middle of my throat. Whilst all of that is happening, there are a million words of what I want to say racing through my head in a matter of split seconds.”
Milo talks about their experience of selective mutism. Read more on Milo’s story here.
Treatment
There are multiple forms of treatment available for selective mutism, which mostly include forms of talking therapy:
Behavioural Therapy
These sorts of therapies, such as Cognitive Behavioural Therapy (CBT), is a crucial treatment approach. It helps people gradually overcome their fear of speaking by setting achievable goals.
Family Involvement
Parents and friends play a pivotal role in the treatment process. They work closely with therapists to support their child’s progress and create a comfortable and encouraging environment at home.
Speech and Language Therapy
Speech therapy is essential, especially for people with speech and language issues. It focuses on improving communication skills, helping the child express themselves more effectively.
School Support
Collaboration with educators and school staff is essential. Teachers can implement strategies to foster communication and school accommodations may be needed to facilitate the child’s progress in social situations.
support
Our Young People’s Programmes offer resilience training in schools (Bloom) and non-educational settings (Your Resilience) to help staff develop their skills and confidence in having open conversations about mental health and supporting young people. Learn more about our different Young People’s Programmes and contact us for more details.
Our National Advice and Support Service can help you and people you care for with mental health concerns and money worries.
We can link and signpost you to relevant local and national support, including our own Change Mental Health services, as well supporting with debt, grants and benefits.
The service is open Monday to Friday, 10am to 4pm (closed for lunch between 12.30pm to 1.30pm). Contact 0808 8010 515, email advice@changemh.org or fill in the form on the service webpage.
For full details about the service, visit the National Advice and Support Service webpage.
Other support
SMIRA is a UK charity supporting individuals with selective mutism, their families and professionals in health and education.
