Selective Mutism in Children

As children grow and develop essential language and communication skills, they typically learn to discuss their thoughts and feelings with others in a wide variety of settings. In some cases, children may speak comfortably and openly at home while completely freezing in community social settings. Selective mutism is an anxiety disorder characterized by lack of communication with others while speaking at a healthy function at home or with people they know best.

Since selective mutism causes a disruption in typical communication skills, speech therapy is a relevant and beneficial treatment commonly used to treat signs and symptoms and to help children improve their social participation. In this article, we will be discussing common causes of selective mutism, signs and symptoms, and how speech therapy can help. 

What might cause a child to develop selective mutism?

Although selective mutism is recognized as a diagnosable anxiety disorder, experts are still learning about it and how it affects children. There is no single cause for selective mutism, but here are few factors that may contribute to its development:

• Anxiety/ fear

Selective speaking may be heavily driven by fear or anxiety: fear of new or unfamiliar social situations, new people, etc.

• Lack of confidence

Some children may present with very limited self-esteem, which makes them feel less confident in managing in unfamiliar social situations. 

• Previous trauma

If a child has experienced something traumatic in life (i.e. the death of a loved one, abuse, etc.), this could result in some form of mutism: selective, reactive, or post-traumatic mutism. The child may opt to remain silent during all unfamiliar interactions, or just avoid talking about the traumatic experience itself. 

• Dysfunctional relationships at home

If the child has a rocky home life where healthy communication skills is not fostered, this could also result in symptoms of selective mutism or other communication deficits. 

• Problems with sound processing

Poor auditory processing can impact language development on a number of levels. If a child struggles with processing verbal communication, they may avoid interacting altogether in unfamiliar or new social circles. 

• Family history

A child who has a family history of anxiety disorders is predisposed to developing one themselves, but it’s not a sure thing. The same goes for selective mutism and having a  heightened risk of developing symptoms. 

What are the common symptoms of selective mutism in children?

In many cases, signs and symptoms of selective mutism start appearing around age 2; however, the symptoms may be more noticeable when a child begins school. There is a distinct difference between selective mutism and shyness. Let’s explore some of the common signs and symptoms that a child may exhibit:

• Avoiding eye contact

The child may want to look ANYWHERE but into someone else’s eyes. This can be awkward-looking to others, but very comfortable for the child. 

• Not responding to verbal cues

If spoken to, the child may not verbally respond. This can be a point of frustration for many people in the child’s lives, including teachers, friends, coaches, and other people they may come in contact with in their community. 

• Not speaking in certain situations

The child appears to avoid speaking in unfamiliar or uncomfortable social situations. This goes beyond avoiding public-speaking (which many typical children and adults avoid) and extends into other academic or casual interactions. 

• Appears “paralyzed” or shuts down in certain social situations

Some kiddos with selective mutism almost appear plagued by fear and emotionally shut down just to avoid adverse effects from speaking with others. 

• Relying on other communication strategies to converse

The child will rely on other forms of communication to describe their wants and needs. This includes written forms as well as relying on a trusted family member or friend to communicate for them. 

Some children with selective mutism may have another speech-related or developmental disorder simultaneously affecting their communication skills. It’s common for selective mutism to co-occur with other anxiety disorders, particularly social anxiety. 

How can speech therapy help treat selective mutism?

Speech therapy services are provided by a qualified and licensed speech-language pathologist (SLP). While speech therapy focuses on a multitude of conditions, including swallowing and cognitive disorders, one of the primary goals is to support and improve functional communication across the age span. Here’s a few ways that speech therapy may help a child living with selective mutism:

• Developing communication skills

The speech therapist will assess the child to develop a baseline for treatment. This includes learning their current levels for communicating in written, gestural, or oral formats and expanding on it to help them succeed at their appropriate age level. Communication interventions may focus on just the tiny pieces that make up language (articulation, speech production, etc.), especially if there are present language-processing issues. 

Learning how to build relationships and interact with others

Interventions may include: social stories, play therapy, adaptive strategies, and caregiver education to provide opportunities for healthy conversation with others. Treatments would include multiple environments that the child is expected to communicate in: home, school, extra-curricular activities or sports, church, etc. 

• Work on social skills

While it’s essential to have the child communicate speech patterns at an age-appropriate level, it’s equally important to help the child interact with others in a socially appropriate manner. This may include instructing the child in how to properly react to others thoughts and feelings and thereby fostering long-lasting friendships. 

• Increasing child’s comfort level to be able to speak in different situations

Speech therapy sessions may focus on providing the child with coping mechanism and strategies to reduce their fears or anxiety and promote their self-confidence in unfamiliar social situations. 

If the child’s situation calls for it, especially in cases where anxiety and other psychological factors are impacting the child’s communication, speech therapists may consult with and co-treat along with a licensed psychologist or psychiatrist. 

Conclusion

Selective mutism can be a debilitating disorder, affecting a child’s ability to expand their social skills in numerous settings. If parents are concerned and need professional guidance, The Therapy Place can provide evaluations for children  experiencing symptoms of selective mutism. Call us today for a free evaluation to see what your child needs and if speech therapy is an appropriate intervention tool.

Medically reviewed by Esti Schiff MS, CC-SLP, Director of Speech and Language Therapy