What is it?

Selective mutism is a childhood anxiety disorder characterised by an inability to speak or communicate in certain social settings, such as at school or in the community. The condition is usually first diagnosed in childhood.

What causes selective mutism in children?

The condition tends to be quite rare, so risk factors for the condition are not fully understood. It was once believed that selective mutism was the result of childhood abuse, trauma, or upheaval.

Research now suggests that the disorder is related to extreme social anxiety and that genetic predisposition is likely. Like all mental disorders, it is unlikely that there is one single cause.

Children who develop the condition:

• Tend to be very shy
• May have an anxiety disorder
• Fear embarrassing themselves in front of others

Other potential causes include temperament and the environment. Children who are behaviorally inhibited or who have language difficulties may be more prone to developing the condition. Parents who have social anxiety and model inhibited behaviors may also play a role.

What are the symptoms of selective mutism in a child?

Children suffering from selective mutism may show the following symptoms:

• Expression of a desire to speak that is held back by anxiousness, fear, or embarrassment
• Fidgeting, eye contact avoidance, lack of movement or lack of expression when in feared situations
• Inability to speak in school and other specific social situations
• Use of nonverbal communication to express needs (e.g., nodding head, pointing)
• Shyness, fear of people, and reluctance to speak between 2 and 4 years of age
• Speaking easily in certain situations (e.g., at home or with familiar people), but not others (e.g., at school or with unfamiliar people)

While these behaviors are self-protective, other children and adults may often perceive them as deliberate and defiant.

Key points about selective mutism in children

• Selective mutism is a type of mental health problem. 
• The cause of selective mutism is not fully known as it is so rare.
• Symptoms of selective mutism are usually diagnosed in childhood and can start as early as 2 years old.
• Symptoms can be seen as defiant to people who do not understand.
• Symptoms of selective mutism must have been present for at least one month, and not simply the first month of school.
• A symptom of selective mutism must have been present for at least one month, and not simply the first month of school.
• A child must understand spoken language and be able to speak in some situations to be diagnosed
• Treatment includes psychotherapy and medicines.