Selective Mutism

What is Selective Mutism?

There is a range of behaviour that extends from “being shy” to “selective mutism”. Selective mutism is the result of an anxiety about being seen or heard talking. A child who has selective mutism talks normally in some situations, such as at home with familiar people, and does not speak in other situations, such as at school, with unfamiliar people, or in social settings.

Selective mutism occurs in 1 in 143 children. There may be a history of shyness or anxiety in family members, particularly in those that started that way as children.There may also be other symptoms such as separation anxiety, moodiness, inflexibility, clinginess, problems with sleeping or toileting, frequent crying or tantrums, and extreme shyness noticed even as a baby or toddler. Most parents report that their child showed signs of shyness and anxiety from infancy, but the diagnosis may not be given until preschool or early school-age, ages 3 to 8 years. Selective mutism often occurs with other disorders, such as other anxieties or developmental issues.

About 30% of children with selective mutism also have a speech and language problem. The difference between being shy and having selective mutism depends on how severe the symptoms are for the child. Selective mutism needs to be treated because it can affect how a child does in school, how they feel about themselves, and their ability to develop relationships with friends.

When should parents/caregivers get help?

Parents/caregivers should ask for help for school-age children if they are showing symptoms that last more than one month (but not the first month that they are in a new school). Preschool children, if they are not talking in preschool after 3 months, should be referred to a professional. For example, if they started in September, refer by January if they are not yet talking. For preschool children who have two languages, it may take a bit longer for a child to talk in the school setting. A bilingual child or a child learning English as a second language may take longer to start to talk in a new place compared to other children because there is both a new language and a new culture at the preschool.

Deciding when to get professional help also depends on how severe the symptoms are for the child. If it is impacting them socially or if the behaviour is difficult to manage, parents/caregivers should ask for a referral from a pediatrician or family doctor.

Consider what is driving the behaviour of selective mutism. Parents/caregivers should ask themselves if the child is anxious about starting a new school or anxious because there is a new language/culture. Support and encouragement are helpful, and they should continue to monitor how the child is doing over time. If the main reason was a traumatic experience, then a referral to psychology or psychiatry should be made right away.

Excessive shyness and difficulty with social interaction are behaviours, and they need to be assessed by someone who specializes in behaviour. This is a psychologist or psychiatrist, and he/she is the person who can make the diagnosis. Parents/caregivers may need to first get a referral to a pediatrician who can help get a referral to the psychologist or psychiatrist. Check with a family doctor to get started.

What can Professionals do to help?

The child with suspected selective mutism should be referred to a speech-language pathologist (SLP), who can determine if a speech or language difficulty is contributing to the problem. If it is not part of what is happening, the psychologist or psychiatrist will be the key person on the team to provide help.

If the child does have a speech and language problem with selective mutism, the SLP is then a key member of the team in assessing the child’s language skills and in developing treatment. The SLP will talk to parents about the child’s history, discuss the child’s communication skills at home and at school, and determine ways to make the assessment comfortable for the child. The SLP will also observe and assess the child to learn more about their language skills and social interaction. The SLP may also be involved in the treatment of selective mutism, either as a consultant to the team or with the child individually. This includes creating trust with new people and places, reducing pressure to speak, and building communication and participation with teachers and peers.

The psychologist or psychiatrist and the SLP will help make sure that the right people are involved in working with the child. Often there is therapy for behaviour and for language to build confidence and social skills.These professionals will work together to determine which treatment should be first or if they should happen at the same time. The best treatment happens when a team works together with the child and his/her family as well as the child’s teacher.