Shy girl covering her face with her hands

Selective Mutism in Children

Do you feel that your child’s refusal to speak outside of the home setting or beyond immediate family members is more than just “shyness”?

Selective Mutism is a child anxiety disorder that is characterized by a consistent failure to speak in specific social situations where there is an expectation to speak, despite speaking in other settings. Children with Selective Mutism are capable of speaking and understanding language, but because of their anxiety, they will not speak in certain situations (e.g., daycare or school, public places, or social gatherings). For example, a child may not be able to speak at school, but can speak with no problem at home. About 90% of children with Selective Mutism also have more general difficulties with social anxiety (e.g., fear of being embarrassed and focused on; DSM-5).

Selective Mutism begins in early childhood and is more common in girls than in boys. It may be misinterpreted as shyness, stubbornness and attention seeking behavior, which can delay proper assessment and intervention and can lead to social and academic concerns. Children with Selective Mutism are much more than “shy”; they freeze with anxiety and take much, much longer to “warm up” in social situations. Too much pressure to speak can shut children with Selective Mutism down further and entrench the behavior over time.

The symptoms of Selective Mutism vary in severity and may include:

  • Consistent failure to communicate verbally in certain social situations (e.g., talking freely at home, but becomes nonverbal at school or around unfamiliar others)
  • Inability to speak even to familiar adults (such as parents) in the presence of others
  • Extreme reluctance to participate in social activities
  • Freezes, shuts downs, or clings to a parent in social situations
  • May struggle with non-verbal communication in certain social situations, or may use gestures in place of verbal communication (but has appropriate non-verbal communication skills when anxiety is low)
  • Avoidance of situations that trigger anxiety
  • Physical symptoms such as sweating, trembling or stomachaches

If you are concerned that your child may have Selective Mutism, a comprehensive assessment can help to clarify a diagnosis. This assessment should explore the circumstances in which your child is verbal and non-verbal and rule out other difficulties (e.g., a communication or language disorder), which could also be limiting your child’s speech. These assessments are helpful to obtain necessary supports in daycare and school settings.

Therapy sessions will also be an important part of your child’s growth and improvement. Cognitive-behavioral therapy (CBT) is the most common type of therapy used to treat Selective Mutism. CBT helps children to understand and manage their anxiety by teaching them coping and relaxation skills and gradually exposing them to feared situations in a step-by-step way. In therapy sessions, a careful progression of challenges that prompt your child’s speech will be implemented to help your child gain confidence with communication over time. Those skills are then generalized to other situations that are currently challenging for your child.

For younger children (ages 3-7), a skilled Psychologist can integrate CBT with play therapy to ensure that sessions are developmentally appropriate for your child. Involvement of parents and other key caregivers (e.g., daycare and school teachers) should also be integral to your child’s treatment plan. Speech therapy may also be beneficial. With appropriate intervention supports in place, children with Selective Mutism can learn to manage their anxiety and develop appropriate communication skills across environments.

To determine whether an assessment and/or therapy may be helpful for your child, please contact us to discuss further. We have a team of seasoned Registered Psychologists who specialize in child assessment and therapy (ages 3+) in the greater Edmonton area.