It usually starts during childhood and, if left untreated, can persist into adulthood.
A child or adult with selective mutism does not refuse or choose not to speak at certain times, they're literally unable to speak.
The expectation to talk to certain people triggers a freeze response with feelings of anxiety and panic, and talking is impossible.
In time, the person may learn to anticipate the situations that provoke this distressing reaction and do all they can to avoid them.
However, people with selective mutism are able to speak freely to certain people, such as close family and friends, when nobody else is around to trigger the freeze response.
Selective mutism affects about 1 in 140 young children. It's more common in girls and children who have recently migrated from their country of birth.
Signs of selective mutism
Selective mutism can start at any age, but most often starts in early childhood, between age 2 and 4. It's often first noticed when the child starts to interact with people outside their family, such as when they begin nursery or school.
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 who's outside their comfort zone.
They may avoid eye contact and appear:
- nervous, uneasy or socially awkward
- rude, disinterested or sulky
- clingy
- shy and withdrawn
- stiff, tense or poorly co-ordinated
- stubborn or aggressive, having temper tantrums when they get home from school, or getting angry when questioned by parents
More confident children with selective mutism can use gestures to communicate – for example, they may nod for "yes" or shake their head for "no".
But more severely affected children tend to avoid any form of communication – spoken, written or gestured.
Some children may manage to respond with a few words, or they may speak in an altered voice, such as a whisper.
What causes selective mutism
Experts regard selective mutism as a fear (phobia) of talking to certain people. The cause is not always clear, but it's known to be associated with anxiety.
The child will usually have a tendency to anxiety and have difficulty taking everyday events in their stride.
Find out more about anxiety in children.
Many children become too distressed to speak when separated from their parents and transfer this anxiety to the adults who try to settle them.
If they have a speech and language disorder or hearing problem, it can make speaking even more stressful.
Some children have trouble processing sensory information such as loud noise and jostling from crowds – a condition known as sensory integration dysfunction.
This can make them "shut down" and be unable to speak when overwhelmed in a busy environment. Again, their anxiety can transfer to other people in that environment.
Diagnosing selective mutism
Left untreated, selective mutism can lead to isolation, low self-esteem and social anxiety disorder. It can continue into adolescence and adulthood if not managed.
Diagnosis in children
A child can successfully overcome selective mutism if it's diagnosed at an early age and appropriately managed.
It's important for selective mutism to be recognised early by families and schools so they can work together to reduce a child's anxiety. Staff in early years settings and schools may receive training so they're able to provide appropriate support.
Treating selective mutism
With appropriate handling and treatment, most children are able to overcome selective mutism. But the older they are when the condition is diagnosed, the longer it will take.
The effectiveness of treatment will depend on:
- how long the person has had selective mutism
- whether or not they have additional communication or learning difficulties or anxieties
- the co-operation of everyone involved with their education and family life
Treatment does not focus on the speaking itself, but reducing the anxiety associated with speaking.
This starts by removing pressure on the person to speak. They should then gradually progress from relaxing in their school, nursery or social setting, to saying single words and sentences to one person, before eventually being able to speak freely to all people in all settings.
The need for individual treatment can be avoided if family and staff in early years settings work together to reduce the child's anxiety by creating a positive environment for them.
This means:
- not letting the child know you're anxious
- reassuring them that they'll be able to speak when they're ready
- concentrating on having fun
- praising all efforts the child makes to join in and interact with others, such as passing and taking toys, nodding and pointing
- not showing surprise when the child speaks, but responding warmly as you would to any other child
As well as these environmental changes, older children may need individual support to overcome their anxiety.