What is Selective Mutism and How is it Treated?

Selective mutism is a complex childhood anxiety disorder characterized by a child’s lack of verbal communication in select social environments, such as school. Children with selective mutism possess the ability to speak, but are selective of the settings in which they choose to speak. They will often speak in environments where they feel safe, relaxed, and calm with familiar people such as parents or siblings, but will choose not to speak in environments where they are less comfortable. A common misconception is that selective mutism is a form of autism. Children with selective mutism may demonstrate lack of appropriate social language use that mimics those on the autism spectrum, but selective mutism is not indicative of autism.

Possible causes of Selective Mutism

• Anxiety disorder
• Genetics
• Extreme feeling of embarrassment about speech (for example, stuttering, inability to produce certain sounds correctly)
• Feeling alone or isolated in a social setting with no sense of comfort

What does Selective Mutism look like?

Children with selective mutism have a fear of speaking in any social interaction setting which in turn can impact their learning or social involvement at school such as the ability to make friends or join in sports, clubs etc. Environments they may have a more difficult time in are school or other social settings such as the grocery store.  This disorder can be quite debilitating and stressful for children. Not all children will exhibit the same characteristics. These students will have a difficult time speaking in large groups or even one-on-one with a teacher. They may appear as shy, timid, expressionless, or unemotional. Those who are less severe may appear calmer and more relaxed. This type of child may sit in class quietly and follow the lead of their peers when directions are given. They may not display any behavior concerns and just come across as “shy”. It is important to build rapport with these students so that they feel safe and connected.

Treatment for Selective Mutism

Consult with your child’s pediatrician and express your concerns regarding where, when, and/or how your child talks and/or a child psychologist for anxiety concerns. A speech-language pathologist (SLP) can also assess and treat your child’s speech and language concern. Treatment would include gathering case history regarding developmental milestones or any relevant medical information, scheduling a hearing screening, assessing articulation (speech sound development), language (expressive, receptive, social) development, voice, and/or fluency (stuttering) concerns.

 It is important for the professionals to collaborate as a team. The team can include but is not limited to a pediatrician, behavioral health professionals, school teacher, parent, speech language pathologist, and social worker in order to help treat children with selective mutism.

Selective Mutism and the Speech Language Pathologist

The speech-language Pathologist (SLP) can screen individuals who demonstrate language and communication difficulties including selective mutism. They will provide comprehensive assessment, and aid in diagnosing selective mutism with an interdisciplinary team. The SLP will also refer to other professionals to rule out any other conditions. If deemed appropriate, the SLP will develop a treatment plan and monitor the child’s progress. The SLP is also able to counsel individuals and their family members, advocate for these individuals, and serve as an integral member on the interdisciplinary team.

Each person with selective mutism presents differently. However, there are some treatment options the speech language pathology can use. According to the American Speech-Language-Hearing Association, three types of treatment techniques the speech language pathologist can use to help your child feel more comfortable and lessen anxiety when speaking in different environments:

• Stimulus fading: Once your child is comfortable speaking to a certain individual, introduce a new person slowly.
  • For example, when playing a board game have the new person join in, interact, and take turns while playing the game.
• Shaping: provide positive reinforcement, or awards/praise, for communicating
  • First, this could start off as mouthing a word or pointing. Then working towards whispering, and eventually speaking.
• Self-modeling technique: record the child talking where she is comfortable speaking, like at home, and then have the child watch herself speak. This may help build confidence.

If you have questions or concerns about your child's speech or hearing development, please contact Cleveland Hearing & Speech Center.