Selective Mutism

girl against wallSelective mutism, formerly known as elective mutism, is an anxiety disorder in which children who are capable of speech in certain settings, have other environments in which speaking does not occur. Most children show significant improvement with early intervention and typically begin speaking in all settings within one year.

Selective mutism is not…

Selective mutism is not just shyness. Shyness is a normal trait that all individuals exhibit to some degree in different settings.

Selective mutism is not a child willfully refusing to speak. It is a failure to speak, not a refusal to speak. For this reason, the classification was changed from elective mutism to selective mutism. The updated term deemphasizes oppositional behavior. Rather than a child electing not to speak, there are select environments in which speaking does not occur.

Selective mutism is not usually a permanent condition. It is rare for selective mutism to continue into upper grades or adulthood. Most children with treatment show significant improvement and will begin speaking across settings.

What is selective mutism?

Selective mutism is associated with anxiety and may be related to an extreme form of social phobia. It is estimated that more than 90% of children with selective mutism also meet the DSM-IV criteria for social anxiety disorder. Extreme anxiety may force the child to remain silent despite a desire to participate in the environment.

Features of selective mutism include profound shyness, social isolation, little or fleeting eye contact, clinging behaviors, compulsive traits, and withdrawal. The average age of onset is around 5 years old when a child starts school. The American Psychological Association reported in 2000 that selective mutism occurs in approximately 1 in 1000 children. However, some studies have estimated its prevalence at 7 in 1000 children. Selective mutism is more common in females than in males.

Signs of selective mutism…

  • A failure to speak in specific social situations
  • Failure to speak interferes with school performance, work, or social interaction
  • Lasts at least one month…beyond the first month of school
  • Not due to a lack of knowledge or comfort with the spoken language
  • Not due to a communication disorder

What may be included in an evaluation for selective mutism?

An evaluation for selective mutism may include the following:

Speech and language testing to rule out problems with expressive language or other communication disorders

Physical exam to rule out hearing problems

Psychological assessment

Developmental screening

How is selective mutism treated?

Treatment for selective mutism varies. Sometimes medications are prescribed to help reduce anxiety. Anxiety occurs due to an imbalance of neurotransmitters (chemical messengers) in the brain. There are medications that can help to stabilize these neurotransmitters and reduce the effects of anxiety. Anti-anxiety medications may also be prescribed in conjunction with behavioral therapy.

According to the American Speech-Language Hearing Association (ASHA), effective behavioral treatment for selective mutism may include the following:

  • Stimulus Fading- The child is placed in a relaxed setting with someone she talks to. Gradually, a new person is introduced to the setting.
  • Shaping- All efforts by the child to communicate are reinforced in a structured manner
  • Self-modeling Technique- The child is shown a video of herself speaking to facilitate self-confidence. The video is shown in the setting where mutism occurs.

What can teachers and parents do to help a child with selective mutism?

The most important thing for teachers and parents to do in order to help a child with selective mutism is to remove all pressures and expectations for the child to speak. This allows the child to feel understood…which is the first step to overcoming selective mutism. Communicating with the child that it is sometimes scary to speak helps remove some of the isolation that she may be feeling.

In the classroom, it may be helpful for teachers to use small groups that are less intimidating to the child. Children with selective mutism can be given non-verbal methods of communication, such as signals or cards, to communicate in the classroom and with peers. The goal is to gradually fade non-verbal communication as speech emerges.

It is important for teachers to work together with families in order to consistently implement treatments for children with selective mutism. By working together as a team, speech will usually generalize into other settings.

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