Introduction

Selective Mutism is a severe childhood anxiety disorder that affects a child’s ability to speak and communicate effectively in certain social situations, such as school or social gatherings, despite being able to talk comfortably in other settings. Children with the condition may avoid eye contact and may be perceived as being shy or uninterested in social interactions, but in reality, they experience high levels of anxiety and fear when they need to speak.

The condition usually starts in early childhood, between the ages of two and four, and can persist into adulthood if left untreated. The main warning sign is the marked contrast in the child’s ability to engage with different people, characterised by a sudden stillness and frozen facial expression when they’re expected to talk to someone outside their comfort zone^[1].

Selective mutism is often first noticed when a child starts school or enters a social setting where communication is expected, and they fail to participate in conversations. It is more common in girls than boys. While the cause of selective mutism is unknown, it is believed to be related to an anxiety disorder or social phobia, and it can be exacerbated by stressful or overwhelming situations.

Picture Credit: “Muted Playtime” by kellinahandbasket is licensed under CC BY 2.0.

Cause and Statistics
Experts regard selective mutism as a fear or phobia of talking to certain people in certain situations. The etiology is not always clear, but it’s known to be associated with anxiety. Usually, the child tends to be anxious and has difficulty taking everyday events in their stride.

Anxiety seems to be the root of the problem and may cause a child to clam up and avoid a situation they recognise as being uncomfortable. The good news is that there is help available, and many organisations exist that specialise in speech therapy. In Britain, the Royal College of Speech and Language Therapists^[2], and the Association of Speech and Language Therapists in Independent Practice^[3] can help people find speech therapy professionals.

The exact causes of selective mutism are unknown, but most experts believe it involves a combination of genetic, environmental and psychological factors^[4]. Some possible causes or risk factors include:

• Having another anxiety condition, like separation anxiety or social anxiety.^[5]
• Having autism spectrum disorder (ASD) or other developmental delays^[6].
• Having language problems or speech difficulties^[7].
• Having a history of trauma or abuse^[8].
• Having a family history of selective mutism or anxiety disorders^[9].

More than 10% of all children have some form of speech, language or communication needs. Speech and language therapy provides treatment, support and care for children (and adults, too) who have some difficulties in speech communication. The statistics are confusing. Some say selective mutism affects about one in every 1,000 school-age children, but other statistics suggest it is much higher^[10]. A fairly constant statistic is that girls with the problem outweigh boys by a factor of 2 to 1.

Citation: “A sad lonely child sits on her bed, anxiety, illustration” is licensed under CC BY-NC 4.0.

It’s not unusual for children from bilingual or multilingual family backgrounds or who have learned another language early on in life (typically between two and four years old) to suffer from the problem^[11]. It should be noted that according to the Wikipedia web page^[12], selective mutism can occur at any age, not only between two and four years old. But, on the other hand, there is no evidence that selective mutism is related to abuse, neglect or trauma, which, at first, seems rather odd as it might be expected in those circumstances.

According to the NHS^[13], selective mutism is not a phobia of talking to certain people but is an anxiety disorder that causes a person to freeze when exposed to specific triggers.

History
In 1877, German physician Adolph Kussmaul described children who could speak normally but often refused to do so as having a disorder he named aphasia voluntaria.^[14] Now an obsolete term, it was part of an early effort to describe the concept now called selective mutism. In 1980, a study by Torey Hayden identified four “subtypes” of elective mutism (as it was called then), although this set of subtypes is not in current diagnostic use.^[15] These subtypes are no longer recognised, though “speech phobia” is sometimes used to describe a selectively mute person who appears not to have any symptoms of social anxiety.

The Diagnostic and Statistical Manual of Mental Disorders (DSM), first published in 1952, first included selective mutism in its third edition, published in 1980. Selective mutism was described as “a continuous refusal to speak in almost all social situations” despite having a normal speaking ability. While “excessive shyness” and other anxiety-related traits were listed as associated features, predisposing factors included “maternal overprotection“, “mental retardation“, and trauma. Elective mutism in the third edition revised (DSM III-R) is described similarly to the third edition except for specifying that the disorder is unrelated to social phobia.

Treatment
The primary treatment for selective mutism is behavioural therapy, including cognitive-behavioural therapy (CBT), which helps children manage their anxiety and build communication skills. Family therapy may also be helpful, as parents and siblings can play an important role in creating a supportive environment and encouraging the child’s communication. In some cases, medication may also be prescribed to manage anxiety and reduce symptoms of selective mutism. Early intervention is important for successful treatment, so a parent who suspects their child may be experiencing selective mutism should seek professional help as soon as possible.

Selective Mutism is a complicated condition of children who are otherwise well-developed but do not speak or communicate in certain situations, such as with classmates or with relatives they don’t see very often. It usually starts in childhood, but if untreated or treated incorrectly, it can persist into adulthood. Nearly all children with the problem also have social phobia or social anxiety and may only whisper or not speak at all. Many children become too distressed to speak when parted from their parents.

The main treatment for selective mutism is behaviour therapy, which involves gradually exposing a child to increasingly complex speaking tasks in the company of a supportive relationship. The idea that a child will outgrow selective mutism over time without treatment is usually not true. The prognosis for Selective Mutism is good. It has been known to disappear suddenly on its own, although this is not often. It is very treatable with the right therapy and understanding.

The treatment for selective mutism depends on the individual needs and circumstances of each person. However, some common approaches include the following^[16]:

• Cognitive-behavioural therapy (CBT) helps people identify and challenge their negative thoughts and beliefs about speaking and social situations.
• Exposure therapy, which gradually exposes the person to their feared situations and helps them practice speaking skills and coping strategies.
• Family therapy, which involves working with the parents and siblings to create a supportive and consistent environment for the person with selective mutism.
• Medication, such as antidepressants or anti-anxiety drugs, may be used in combination with psychotherapy to reduce symptoms of anxiety and depression.

Characteristics
The characteristics of selective mutism are numerous: Often, but not always, the children do not smile and have stiff, clumsy or awkward body language, particularly when they are in new situations or are uncomfortable and seem to prefer to play alone and not with their contemporaries. They do not like to be embarrassed or teased. They are stubborn and moody and may have bladder and bowel problems, and they are notoriously fussy or, do you say, picky eaters – they like what they like and little else.

Citation: “A sad lonely child plays alone, anxiety, illustration” is licensed under CC BY-NC 4.0.

Children with selective mutism stay silent even when the consequences of their silence include shame, embarrassment, ridicule, social ostracism, or punishment. A child or adult with selective mutism doesn’t refuse or choose not to speak; they are just unable to speak. It’s almost as if an expectation to talk triggers a freeze response with feelings of panic, and talking is impossible. Children who suffer from selective mutism usually speak in at least one setting, at school or at home, in a crowd or one-to-one.

Meeting strangers is usually a difficult hurdle. But they are rarely mute in all environments. Children with mutism brought on by trauma usually develop selective mutism suddenly in all situations. One example would be a child who witnesses the death of a parent or grandparent or another traumatic event such as a road or other serious accident, and selective mutism is likely to be their way of coping with the situation.

Scientific studies are few and far between. What selective mutism is not, although some specialists have misdiagnosed the problem to the contrary, is a variant of autism or an indicator of learning disabilities. Treatment should have as its main goals to lower anxiety, increase self-esteem and increase social confidence and communication but never on getting a child to talk.’

Besides lack of speech, other common behaviours and characteristics displayed by selectively mute people, according to findings^[17] by Dr Elisa Shipon-Blum, include:

• Shyness, social anxiety, fear of embarrassment or social isolation and withdrawal.
• Difficulty maintaining eye contact.
• Blank expression and reluctance to smile or incessant smiling.
• Difficulty expressing feelings, even to family members.
• Tendency to worry more than most people of the same age.
• Sensitivity to noise and crowds.

On the flip side, there are some positive traits observed in many cases:

• Above-average intelligence, inquisitiveness, or perception.
• A strong sense of right and wrong.
• Creativity.
• Love for the arts.
• Empathy.
• Sensitivity for other people.

Effects
The effect of selective mutism on a person’s life can vary depending on the severity and duration of the condition. Some possible effects include the following:

• Impaired academic performance and social development.
• Low self-esteem and confidence.
• Isolation and loneliness.
• Depression and suicidal thoughts.
• Difficulty finding employment or maintaining relationships.

Well-Known People who may have suffered from Selective Mutism

• James Earl Jones, the actor who voiced Darth Vader in Star Wars, suffered as a child from a stutter. It made him mute for eight years as a child. He overcame his stutter by reciting poetry and performing in school plays^[18].
• Emily Dickinson, the poet who wrote over 1,800 poems, was very shy and reclusive as a child and adult and rarely spoke to anyone outside her family. She didn’t leave the family property for the last two decades of her life.
• Albert Einstein, the physicist who developed the theory of relativity. He was slow to talk and did not speak until he was four years old. He was considered a “slow learner” in his early school years.
• Maya Angelou^[19], the award-winning author, poet, civil rights activist, college professor and screenwriter, had selective mutism due to a psychological trauma she suffered as a child.
• Charles Darwin was a quiet and reserved child, and it is said that he had difficulty speaking in certain social situations.
• Mahatma Gandhi, the leader of India’s independence movement and renowned advocate for nonviolent civil disobedience, Gandhi reportedly suffered from selective mutism as a child.
• Aesop, the ancient Greek storyteller and creator of Aesop’s fables, is believed to have been afflicted with selective mutism as a child. His famous tales were said to have been a way of communicating his thoughts and ideas without speaking.

Although few people have heard of selective mutism, Paul McCartney (not a sufferer) knew all about it and wrote a song about it. Check out the lyrics to “She’s Given Up Talking” from his 2001 album Driving Rain.^[20] The lyrics are at: https://genius.com/Paul-mccartney-shes-given-up-talking-lyrics

Sources of Information and Support
Sources of information about selective mutism include:

• Selective Mutism Information & Research Association (SMIRA), a UK-based charity providing support, advice and resources for people with selective mutism, their families and professionals. Visit their website at http://www.selectivemutism.org.uk/
• NHS at: https://www.nhs.uk/mental-health/conditions/selective-mutism
• Child Mind Institute at: https://childmind.org/guide/parents-guide-how-to-help-a-child-with-selective-mutism/

Healthcare Professionals
The different types of healthcare professionals who may be involved in treating selective mutism are:

• Speech-language pathologists (SLPs), also known as speech therapists, may work with individuals with selective mutism to develop communication strategies and improve language skills.
• Clinical psychologists or behavioural therapists may also work with individuals with selective mutism, using techniques such as cognitive-behavioural therapy (CBT) to help them overcome anxiety and increase their ability to speak in social situations.
• In some cases, a psychiatrist may also be involved in the treatment of selective mutism, particularly if medication is being used to address any co-occurring mental health conditions.

Useful Reading about Selective Mutism

• Charli’s Choices by Marian B. Moldan and Tobby Allen. This story is about a girl with selective mutism and how her mother teaches her how to communicate successfully with others during a play date. The book was published by Archway Publishing in 2014 and has 30 pages. The ISBN is 9781480805075. Available at: https://www.amazon.co.uk/Charlis-Choices-LCSW-R-Marian-Moldan/dp/1480805076
• Mason and the Quiet Lion by Aspen M. Laboy. This story is about a young lion with selective mutism and how he finds his voice with the help of a friendly lioness. The book was published by Aspen M Laboy in 2018 and has 32 pages. The ISBN is 9780692085264. Available at: https://www.amazon.co.uk/Quiet-Lion-Aspen-M-Laboy/dp/0692085262
• Lola’s Words Disappeared by Elaheh Bos. This story is about a little girl who loves to talk but suddenly loses her words when she starts school. The book was published by CreateSpace Independent Publishing Platform in 2013 and has 50 pages. ISBN-10: ‎1484043332. Available at: https://www.amazon.co.uk/Lolas-words-disappeared-Elaheh-Bos/dp/1484043332
• Chasing Fireflies: A Novel of Discovery by Charles Martin. This (fiction) book is about a journalist who tries to uncover the identity and history of a six-year-old boy who has selective mutism and was found near a burning car with a dead woman. The book was published by Thomas Nelson in 2008 and has 352 pages. The ISBN is 9781595540560. Available at: https://www.amazon.co.uk/Chasing-Fireflies-Discovery-Neta-Jackson/dp/1595543252
• Selective Mutism: A Guide for Therapists, Educators, and Parents by Aimee Kotrba. This non-fiction book provides an effective, research-based behavioural intervention plan to treat selective mutism successfully. The book was published by Pesi Publishing & Media in 2014 and has 146 pages. The ISBN is 1559570067. Available at: https://www.amazon.co.uk/Selective-Mutism-Assessment-Intervention-Therapists/dp/1559570067/
• Selective Mutism In Our Own Words: Experiences in Childhood and Adulthood by Carl Sutton and Cheryl Forrester. This non-fiction book features personal stories from people who have experienced selective mutism, either as children or adults. The book was published by Jessica Kingsley Publishers in 2015 and has 272 pages. The ISBN (13) is 9781785920175. Available at: https://www.amazon.co.uk/Selective-Mutism-Our-Own-Words/dp/1849056366/

YouTube Videos about Selective Mutism

• Understanding and Managing Selective Mutism by Anxiety Canada. This 1-hour video explains what selective mutism is, how it develops, and how to treat it using evidence-based strategies. You can watch it at: https://youtu.be/tAkIXpykB5U
• What is Selective Mutism? by WeAreTeachers. This video briefly overviews selective mutism and its impact on children’s learning and socialisation. You can watch it at: https://www.youtube.com/watch?v=K2VFx_iOnxQ
• Raising A Child With Selective Mutism | My Child Won’t Talk by Truly. This 23-minute documentary follows the lives of two families with children who have selective mutism and their challenges and successes in overcoming the condition. You can watch it at: https://www.youtube.com/watch?v=gONZsyo9Rdk
• Videos by Selective Mutism WA. This website lists several videos that may be helpful for sharing with others to explain selective mutism, such as a webinar by Danielle Cottam, a speech pathologist and founder of Selective Mutism Australia, and a 15-minute video with tips for families and teachers. You can access them at: https://www.selectivemutismwa.com/videos
• Silent Children: Approaches to Selective Mutism by SMiRA (Selective Mutism Information and Research Association). This 24-minute documentary features interviews with children, parents, teachers, and experts on selective mutism and how to help them overcome their anxiety and communicate effectively. You can watch it at: http://www.selectivemutism.org.uk/videos/
• What is Selective Mutism? Basics, Misconceptions, and Treatment Strategies by Child Mind Institute. This 1-hour webinar covers the definition, causes, symptoms, diagnosis, and treatment of selective mutism using cognitive-behavioural therapy (CBT) techniques. You can watch it at: https://www.weareteachers.com/selective-mutism/

Summary and Conclusion
Research is ongoing to better understand the causes and effective treatments for selective mutism. While the exact causes are not yet fully understood, some potential factors that have been identified include:

• Genetics: Selective mutism appears to run in families, suggesting that genetic factors may play a role.
• Temperament: Some children with selective mutism may have a naturally shy or anxious temperament.
• Environmental factors: Traumatic experiences, such as abuse or neglect, may increase the risk of developing selective mutism.
• Developmental factors: Some children with selective mutism may have delayed language development, which can contribute to their difficulty speaking in certain situations.

In terms of treatment, the most effective approach is typically a combination of behavioural therapy and medication. Some of the latest research in this area includes:

• Cognitive behavioural therapy (CBT): This type of therapy can help children with selective mutism to gradually become more comfortable speaking in different settings.
• Exposure therapy: in a safe and supportive environment, it involves gradually exposing the child to situations in which they may feel anxious about speaking.
• Medication: Some medications, such as selective serotonin reuptake inhibitors (SSRIs), may help reduce anxiety and improve communication skills.
• Parent involvement: Research suggests involving parents in the treatment process can improve outcomes.
• Virtual reality therapy: Some recent studies have explored the use of virtual reality technology as a tool for exposure therapy, with promising results.

Overall, while there is still much to be learned about the causes and effective treatments for selective mutism, ongoing research is helping to expand our understanding of this condition and improve outcomes for affected individuals. In summary:

• Selective mutism is a complex anxiety disorder that affects a person’s ability to speak in certain situations.
• It can negatively impact a person’s social, academic, and emotional development.
• It can be treated with various interventions such as cognitive-behavioural therapy (CBT), medication, or environmental modifications.
• More research is needed to understand the causes and mechanisms of selective mutism.
• More awareness and support are needed for people with selective mutism and their families.

Picture Attribution: “Tímida” by Nando.uy is licensed under CC BY-NC-SA 2.0.

Sources and Further Reading

• Anxiety and Depression Association of America: Selective Mutism – https://adaa.org/understanding-anxiety/specific-phobias/selective-mutism
• ASHA (American Speech-Language-Hearing Association): Selective Mutism – https://www.asha.org/public/speech/disorders/selective-mutism/
• Beyond Shyness: Understanding Social Anxiety Disorder and Selective Mutism – https://beyondshynessandsocialanxiety.com/selective-mutism/
• British Stammering Association: Selective Mutism – https://stamma.org/condition/selective-mutism
• Child Mind Institute: Selective Mutism – https://childmind.org/guide/selective-mutism/
• Classification of Elective Mutism by Torey L. Hayden, at: https://www.torey-hayden.com/research/classification-of-elective-mutism.pdf
• Family Doctor: Selective Mutism in Children – https://familydoctor.org/condition/selective-mutism-in-children/
• Harvard Medical School: Selective Mutism – https://www.health.harvard.edu/mind-and-mood/selective-mutism
• Healthline: Selective Mutism – https://www.healthline.com/health/selective-mutism
• https://en.wikipedia.org/wiki/Selective_mutism
• https://www.healthline.com/health/anxiety/adult-selective-mutism
• https://www.healthline.com/health/anxiety/selective-mutism-symptoms
• https://www.verywellmind.com/what-is-selective-mutism-3024702
• https://www.verywellmind.com/what-is-selective-mutism-3024702
• Johns Hopkins Medicine: Selective Mutism – https://www.hopkinsmedicine.org/health/conditions-and-diseases/selective-mutism
• Mayo Clinic: Selective mutism – https://www.mayoclinic.org/diseases-conditions/selective-mutism/symptoms-causes/syc-20373861
• My Child Without Limits: Selective Mutism – https://www.mychildwithoutlimits.org/understand/selective-mutism/
• National Education Association: Understanding Selective Mutism – http://www.nea.org/tools/17049.htm
• National Institute of Mental Health: Selective Mutism – https://www.nimh.nih.gov/health/topics/selective-mutism/index.shtml
• NHS: Selective mutism – https://www.nhs.uk/conditions/selective-mutism/
• Psych Central: Selective Mutism – https://psychcentral.com/disorders/selective-mutism/
• Selective Mutism Anxiety Research and Treatment Center – https://www.selectivemutismcenter.org/
• Selective Mutism Anxiety Research and Treatment Center in the United States: https://selectivemutismcenter.org/
• Selective Mutism Foundation – https://selectivemutismfoundation.org/
• Selective Mutism Group – http://www.selectivemutism.org/
• Selective Mutism Network – https://www.selectivemutismnetwork.org/
• Selective Mutism Online Support Group – https://groups.yahoo.com/neo/groups/selectivemutism/info
• SMIRA (Selective Mutism Information & Research Association) – https://selectivemutism.org/
• The Mighty: Selective Mutism – https://themighty.com/selective-mutism/

Acknowledgement
Information provided via machine-based artificial intelligence has been incorporated into this paper, generated from the sources below, in response to questions and interrogation by me:

• https://chat.openai.com/chat
• https://www.bing.com/ (and click on ‘chat’)

CAUTION: This paper is compiled from the sources stated but has not been externally or medically reviewed. Parts of this paper include information provided via artificial intelligence which, although checked by the author, is not always accurate or reliable. Neither we nor any third parties provide any warranty or guarantee as to the accuracy, timeliness, performance, completeness or suitability of the information and materials covered in this paper for any particular purpose. Such information and materials may contain inaccuracies or errors and we expressly exclude liability for any such inaccuracies or errors to the fullest extent permitted by law. Your use of any information or materials on this website is entirely at your own risk, for which we shall not be liable. It shall be your own responsibility to ensure that any products, services or information available through this paper meet your specific requirements and you should neither take action nor exercise inaction without taking appropriate professional advice. The hyperlinks were current at the date of publication.

End Notes and Explanations

1. Source: https://www.nhs.uk/mental-health/conditions/selective-mutism/ ↑
2. At: https://www.rcslt.org/speech_and_language_therapy/how_to_find_an_slt/finding_an_SLT ↑
3. At: https://beta.helpwithtalking.com/ ↑
4. Source; https://www.healthline.com/health/anxiety/selective-mutism-symptoms ↑
5. Source: https://www.healthline.com/health/anxiety/adult-selective-mutism ↑
6. Source: https://www.verywellmind.com/what-is-selective-mutism-3024702 ↑
7. Source: https://www.healthline.com/health/anxiety/selective-mutism-symptoms ↑
8. Source: https://www.healthline.com/health/anxiety/adult-selective-mutism ↑
9. Source: https://www.healthline.com/health/anxiety/selective-mutism-symptoms ↑
10. Comment: NHS says: Selective mutism affects about 1 in 140 young children. It’s more common in girls and children who are learning a second language, such as those who’ve recently migrated from their country of birth. Source: https://www.nhs.uk/mental-health/conditions/selective-mutism/ ↑
11. See: Research at the Selective Mutism Anxiety Research and Treatment Center in the United States: https://selectivemutismcenter.org/ ↑
12. Source: https://en.wikipedia.org/wiki/Selective_mutism ↑
13. Source: https://www.nhs.uk/mental-health/conditions/selective-mutism/ ↑
14. Source: https://www.brighttots.com/Selective_Mutism.html Cited at: https://en.wikipedia.org/wiki/Selective_mutism ↑
15. Source: Classification of Elective Mutism by Torey L. Hayden. Abstract: In this study of 68 children displaying elective mutism, four types of mutism are distinguished: (a) symbiotic mutism, characterized by a symbiotic relationship with a caretaker and a submissive but manipulative relationship with others; (b) speech phobic mutism, characterized by fear of hearing one’s own voice and use of ritualistic behaviors; (c) reactive mutism, characterized by withdrawal and depression which apparently resulted from trauma and (d) passive-aggressive mutism, characterized by hostile use of silence as a weapon. The prevalence of physical and sexual child abuse in all four groups was high. The classification of elective mutism into subgroups is clinically relevant for a better understanding of the etiology and for devising appropriate intervention. Journal of the American Academy of Child Psychiatry, 19:118—133,1980. See: https://www.torey-hayden.com/research/classification-of-elective-mutism.pdf Cited at: https://en.wikipedia.org/wiki/Selective_mutism ↑
16. Source: https://www.verywellmind.com/what-is-selective-mutism-3024702 ↑
17. Sources: (i) Selective Mutism Symptoms. Theselectivemutism.info, (ii) Online Parent Support (2005-05-26). “Selective Mutism”. Myoutofcontrolteen.com. (iii) Moini, Jahangir (2021). Global emergency of mental disorders. Justin Koenitzer, Anthony LoGalbo. London. ISBN 978-0-323-85843-4.OCLC 1252050397. However, there are some positive features of selective mutism. These include above average intelligence, inquisitiveness, or perception; a strong sense of right and wrong; creativity; love for the arts; empathy; and sensitivity for other people, (iv) Perednik, Ruth (1 June 2012). “An interview with Ruth Perednik: treating selective mutism”. North American Journal of Psychology. 14 (2): 365.Gale A288873877 ProQuest 1013609961. Many are above average in intelligence, creative, and sensitive to others thoughts and feelings. Cited at: https://en.wikipedia.org/wiki/Selective_mutism ↑
18. Source: https://www.speechpathologygraduateprograms.org/2017/11/6-famous-people-you-never-knew-had-a-speech-disorder/ ↑
19. See: https://www.respectability.org/2018/02/maya-angelou-legendary-poet-civil-rights-activist-disability-inspires-generations/ for information about her life and works. ↑
20. Source: https://www.today.com/allday/paul-mccartney-selective-mutism-1C9385053 ↑