Our guide to selective mutism

What is selective mutism?

Selective mutism (SM) is an anxiety It is best understood as a phobia of talking in certain situations.
A child with SM will speak happily and freely in some situations and environments, but will be unable to speak in specific situations. SM tends to be most notable in places like nursery, school or other public places but it may also happen around family members the child or young person does not see regularly.
The expectation to talk to certain people in certain situations results in feelings of panic, making it impossible for the child to speak at these times. When this happens repeatedly, the child learns to anticipate situations which trigger feelings of panic and anxiety, and then do all they can to avoid them. This is how phobias develop.

A marked change in a child’s ability to engage when they are expected to talk to someone who is outside their comfort zone.
An ongoing difficulty in a child or young person using their voice in a specific situation (for example, at nursery or school). This pattern is different for every child but is consistent and predictable.
The child is able to speak freely and confidently in other situations, most often at home.
The difficulty will have lasted for a period of 1 month or more.

Children with selective mutism may:

be totally silent in specific settings (for example, school).
avoid eye contact and seem shy, nervous, socially awkward or be described as seeming uninterested or withdrawn.
stare, have a fixed facial expression, look physically ‘frozen’ or appear poorly-co-ordinated when there is an expectation to speak to someone outside of their comfort zone.
struggle to separate from their parents/care givers.
be quiet and reserved at nursery/school but become dysregulated (for example, having ‘temper tantrums’) when they get home.
not be able to answer questions in class (even when they know the answers/how they should respond).
find it difficult to ask for help or start conversations with others.
struggle to ask to get a drink, use the toilet, or say they feel unwell at nursery or school. As a result, they might go for hours without using the toilet/having a drink, and some may have accidents as a result.
speak with a whispered voice when communicating with peers/adults in the affected setting.
use gestures to support their communication; for example, nodding for “yes”, shaking their head for “no” or using their hands to ‘describe’ an object or action. However, non-verbal communication (gestures/writing) can be difficult for many children with SM.
be described by others as being “stubborn”, “rude”, “controlling” or “manipulative”. This sort of terminology is unhelpful.

SM usually starts in childhood, between the ages of 2 and 4 years (for example, when the child starts nursery or school).
Prevalence statistics for SM vary. However, it is thought that SM affects around 1 in 140 children and young people. It is more common in girls than boys and affects more children who are learning a second language.
There is no evidence to suggest that children with SM are more likely to have experienced abuse, neglect or trauma than any other child. While it is important to be aware of possible safeguarding concerns for all children, the view that children may be mute because they have suffered trauma can hinder families from accessing support. When mutism happens in the context of  post-traumatic stress, it follows a different pattern to SM; i.e. the child will stop talking suddenly in environments where they were previously confident to speak.
There may also be concerns around autism. While there may be shared characteristics across SM and autism (for example, avoidance of eye contact and difficulties with social communication), characteristics will have very different root causes. It is possible, however, for a child to have both autism and SM.

A child can successfully overcome SM if it is identified at an early age and if appropriate support is implemented. Early intervention for children with SM is associated with better outcomes in a shorter time period.
If left unsupported, a child can continue to be affected by SM into teenage years and adulthood. If not addressed appropriately, SM can affect academic functioning and lead to low self-esteem, social withdrawal and other anxiety disorders.
A range of professionals can support children and young people who present with SM. Speech and language therapists have a key role in supporting early identification as well as in the management of SM. As children and young people get older, they are more likely to require a multidisciplinary approach to support wider needs.