Anxiety in Children

Selective Mutism

What is Selective Mutism?

Selective mutism is characterised by a child’s inability to communicate effectively or speak in social situations. Selective mutism closely mimics the symptoms of social anxiety, as children with selective mutism hold an intense fear of certain social situations and communicating where there is an expectation to speak, due to a fear of being judged negatively or embarrassed. However, these children are capable of speaking and communicating in situations where they feel comfortable, relaxed, and secure.

Not all children with selective mutism will present in the same way; some children may be completely mute and unable to speak to anyone in social situations, while other children may be able to speak or whisper to a select few people. Some children with selective mutism may freeze and become expressionless when faced with their feared social situation, while others may appear relaxed, carefree, and capable of socialising with a small number of peers.

Most children with selective mutism tend to be diagnosed between the ages of 3 and 8 years. Often these children have a history of being temperamentally inhibited, and severely anxious in social settings. Many of them would have also experienced some separation anxiety.

Symptom Checklist

If your child exhibits any of the following symptoms, this should be brought to the attention of a trained health professional:

  • Inability to communicate and/or ineffective communication to others, including verbal conversation and non-verbal body language
  • “Freezing” in particular social settings and becoming motionless, expressionless, or appearing emotionless
  • Difficulties making eye contact with others
  • Poor body language when communicating with others
  • Being unable to talk at all, or speaking only very few words in a hushed whisper
  • Extremely shy behaviour (e.g., clinging to parents or tantrums when having to separate from caregivers) and an inability to communicate properly around others apart from limited few (e.g., family or people the child feels comfortable around)
  • Fear of and inability to speak in particular social settings such as: school, day care, birthday parties, play dates, or extended family gatherings or celebrations
  • Social withdrawal
  • School refusal
  • Blushing, looking down, freezing, or exhibiting other symptoms of extreme distress when confronted with speaking in social situations

What Treatments are Recommended for Selective Mutism?

Treatment for Selective Mutism involves Cognitive Behavioural Therapy (CBT), where a psychologist experienced in the field guides both the child and their parents through the steps in identifying the child’s negative thoughts and beliefs causing their mutism behaviours. The child is then re-educated on alternative ways of thinking to replace their old unhelpful and negative thoughts with new, more helpful and realistic ones. A big part of CBT for selective mutism involves GRADUAL exposure therapy, where the child’s fears are tested in real life, in order to prove to them that their engrained, negative thoughts are incorrect and do not result in the predicted negative outcomes they have come to expect over time.

It is also essential that school teachers are kept informed and made aware of the situation so that they can facilitate and support the child’s treatment plan. Teachers should be made aware that punishing the child for their mutism behaviours will only serve to exacerbate the problem. Instead, teachers should try to encourage communication opportunities in the classroom, by prompting more conversational and open-ended questions with the child, aiming to prevent short one worded answers.

Sources and Useful Resources