Selective Mutism (SM) is an anxiety disorder that makes a person unable to speak in specific social situations. SM will usually start in one’s childhood and, if left untreated, can carry on and persist into adulthood.
People with SM do not choose or refuse to speak at certain times. Those with SM cannot talk during certain social situations, whether they want to or not.
For those with SM, the expectation to talk to certain people can trigger a freeze response with feelings of panic. Similar to a bad case of stage fright, which makes talking impossible. People with SM will learn, over time, to anticipate the situations that cause this reaction and avoid them.
They will also find that they can generally speak to some close people like family and friends when there is nobody else around to trigger the response.
Signs of Selective Mutism
Selective Mutism(SM) usually starts in early childhood. It’s commonly first noticed when the child starts interacting with people outside their family, such as when they start going to nursery.
The main warning sign is a considerable difference in the child’s ability to engage with different people. Those with SM can usually be characterized by a sudden stillness and frozen facial expressions when talking to someone outside their comfort zone.
When interacting with those they are not comfortable with, people with SM may also:
- appear nervous, uneasy or socially awkward
- seem rude, disinterested or sulky
- cling to those they are comfortable with
- appear shy and withdrawn
- be stiff, tense or poorly co-ordinated
- act stubborn, aggressive or irritable
Those with SM who are more confident can communicate through gestures like nodding their head for yes and shaking it for no.
However, those more severely affected tend to avoid all forms of communication with those they are not comfortable with, whether that communication is spoken, written or gestured.
Some 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 (SM) as a phobia (fear) of interacting with certain people. Like those they do not know or are not comfortable around. The cause of SM is not always clear, like lots of phobias and phycological disorders. Still, it’s known to be associated with anxiety.
The people who develop SM will usually tend to have anxiety.
Children may become unable to speak due to distress when their parents are not there. These children will transfer this anxiety to the people, usually adults, who try to settle them.
Suppose a child has a hearing problem or speech and language disorder. In that case, it can make speaking more stressful, as they can find it uncomfortable. Some children have a condition known as sensory integration dysfunction, which causes them to have problems when processing sensory information, such as loud noise and jostling from crowds. This condition can make them unable to speak and “shut down” when overwhelmed in a busy environment.
While some people assume children with SM are more likely to have experienced abuse, neglect or trauma than any other child, there is no evidence to suggest that. While SM can occur as a symptom of post-traumatic stress, it follows a very different pattern. The child will suddenly be unable to interact in environments they previously had no difficulty interacting in. This type of speech withdrawal can lead to SM if not appropriately managed, and the child develops more general anxiety about communication.
Other misconceptions about those with SM include:
- that a child with SM is controlling or manipulative or
- Those with SM have autism. Although they may have both, there’s no relationship between selective Mutism and autism.
- They are not interacting because they don’t want to
Diagnosing Selective Mutism
When Left untreated, selective Mutism can lead to those with it being isolated and developing low self-esteem or social anxiety disorder. It can also continue into adolescence and adulthood if left untreated. So it is crucial to try to diagnose it as early as possible. This is why many cases of SM are diagnosed and treated in childhood. When diagnosing SM, there are many things to account for, for example, if the child or adult has any other conditions or how their emotional well-being is.
Treating Selective Mutism
Most people with Selective Mutism (SM) are able to overcome it in childhood with the proper treatment and handling of the condition. But if they are diagnosed later in adolescence or adulthood, treating it will take longer and probably be more difficult.
The treatment’s effectiveness will depend on:
- whether or not they have additional circumstances that can complicate treatment like communication or learning difficulties, or anxieties
- how long the person has had SM
- whether the cooperation of everyone involved with the patient’s education and family life is assured
The treatment does not focus on speaking itself but on the anxiety associated with speaking.
This treatment usually begins by removing pressure on the patient to speak. They should gradually progress from relaxing in their social setting, like school or nursery. After being relaxed in their social setting, they should eventually begin to say single words and sentences to one person. Finally, they should eventually be able to speak freely and interact with all people in all settings.
Preventing the need for treatment
Children can avoid the need for treatment if family and other adults, such as staff in early years settings, combine their efforts and join forces to reduce their anxiety by creating a suitable environment.
This means:
- When you are anxious, do not let the child know.
- reinforcing the idea that they’ll be able to speak when they’re ready
- focussing on having fun
- giving praise to the child for all efforts they make to join in and interact with others, such as sharing toys, nodding and pointing
- Not being surprised or showing surprise whenever the child speaks but responding warmly to them.
These environmental changes are to help younger children. However, older children may need individual support to help overcome their anxiety.
The most effective types of treatment are cognitive behavioural therapy (CBT) and behavioural therapy.
Getting help and support
People with selective Mutism that are adults or teenagers can find information and support online at iSpeak and the Facebook group SM SpaceCafe.
The Selective Mutism Information and Research Association (SMIRA) is another good source of information for people affected by Selective Mutism. They also have a SMiRA Facebook page to provide a place you can feel comfortable.
If you need help finding professional help with Selective Mutism, contact the Association of Speech and Language Therapists in Independent Practice or The Royal College of Speech and Language Therapists. They can help you find experienced professionals in your area who have treated Selective Mutism.
