Selective or situational mutism

Information and signposting for parents of children that have or are suspected of having selective mutism.

What is selective mutism?

Selective mutism is an anxiety disorder where a person is unable to speak in certain social situations, such as with classmates at school or to relatives they do not see very often.

A child or adult with selective mutism does not refuse or choose not to speak at certain times, they are unable to speak.

The expectation to talk to certain people triggers a freeze response with feelings of anxiety and panic, and talking becomes impossible.

Selective mutism affects about 1 in 140 children. It’s more common in girls and children who have recently migrated from their country of birth

A word about language

Selective or situational?  They mean the same thing, but many people now prefer to use situational mutism. We will continue to use selective mutism for now, as it is the term you will find in medical definitions, assessments and guidelines. Until this changes, it may help to use selective mutism when seeking support. See our page on Amaze’s use of language for more information on how we make choices around disability language.

Characteristics of selective mutism

Selective or situational mutism is an anxiety-based mental health condition. It can start at any age, but most often starts in early childhood. It’s usually first noticed when a child starts to interact with people outside their family, such as when they begin nursery or school.

People with selective mutism will speak in some situations but remain consistently silent in others. This can be characterised by a sudden stillness and frozen facial expression when they’re expected to speak.

They may avoid eye contact and seem nervous or shy and withdrawn. They might be uneasy or struggle in social situations. Some children with selective mutism may be stiff, tense or have co-ordination issues.

Selective mutism will fluctuate depending on where a child is and who they are interacting with. It may vary from day to day too. For example, if a child or young person is very distressed or dysregulated, they may not be able to communicate in any form; spoken, written or gestured.

Getting a diagnosis of selective mutism

If you are concerned that your child is experiencing selective mutism, speak to your GP, health visitor, school nurse or other staff at their education setting. They may refer your child for further assessment and advice. This could include an appointment with a paediatrician, a speech and language therapist or a mental health professional.

Specialist clinicians may explore the following in relation to your child’s communication:

  • they do not speak in specific situations, such as during lessons or when they can be overheard in public
  • they can speak normally in situations where they feel comfortable, such as when they’re at home with their family
  • it has persisted for at least one month (two months in a new setting)
  • it interferes with their ability to function in a particular setting, for example their education is suffering
  • it is not better explained by another behavioural, developmental or communication disorder
  • it is not caused by a lack of knowledge of the language

The Selective Mutism Information and Research Association (SMiRA) has more information about diagnosis and getting help.

Supporting your child or young person with selective mutism

With the right help and support most children with selective mutism recover well.

There are things you (and the people that work with your child) can do immediately to help.

Dos

  • let them know you understand that they are scared to speak at times and that it’s OK
  • reassure them that they’ll be able to speak when they’re ready
  • let them know that non-verbal communication, such as smiling, waving or pointing, is fine until they feel better about talking
  • focus on making sure they feel valued and secure
  • find out about approaches that can help like the small-steps, “sliding in” approach
  • ask friends and relatives to give your child time to warm up at their own pace
  • praise the non-verbal things your child does to join in, such as passing and taking toys, nodding and pointing

Don’ts

  • don’t pressurise or bribe your child to encourage them to speak
  • don’t take over all their communication for them
  • try not to let your child know that you are anxious
  • don’t praise them publicly for speaking, wait till you are home
  • don’t show surprise when your child speaks, just respond as you would to any other child
  • don’t avoid social situations but think about changes you could make to make so they feel more comfortable

Treatments for selective mutism

In addition to adopting the kind of strategies we’ve outlined in our dos and don’ts and ensuring that home and school are working jointly on this, your child may be offered therapies to help with their social anxiety or gradually change their behaviour. This might be a course of cognitive behavioural therapy or a talking therapy such as counselling.

Therapists and school settings may work with your child on certain techniques that increase the child’s communication in small steps, such as desensitisation, graded exposure and stimulus fading.

  • graded exposure – working on situations that cause the least anxiety first
  • shaping – moving in small steps from non-verbal communication such as gestures or writing, to eye contact, to short words, then longer sentences, and finally two-way conversations.
  • stimulus fading – getting the child to communicate with someone close like their parent, then gradually introducing another person and, once they’re included in talking, the parent withdraws.
  • desensitisation – reducing the child’s sensitivity to people hearing their voice by recording and sharing their voice. For example, texting could progress to an exchange of voice notes, then more direct communication, such as telephone or video conversations.

You can find out more about treatments and techniques on the NHS website page on selective mutism – NHS (www.nhs.uk)

The Selective Mutism Information and Research Association (SMiRA) is another great place for information about selective mutism. There’s also a SMiRA Facebook page.

Further information

Organisations specifically for selective mutism

Videos and podcasts

Online or printed resources

Social media