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Selective Mutism in Children and Youth: Information for Parents and Caregivers

Summary: It is normal for many people to be shy, but when that shyness is so extreme that it stops a person from speaking outside the home (e.g. at school, or other public situations), then it may be condition known as selective mutism. People with selective mutism are not choosing to be difficult, or oppositional; they simply have nervous systems that are wired to be extremely hypersensitive. The good news, is that many things can be done to help their nervous systems feel safer, and thus help them to speak.
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“She won't speak to anyone…”

Fatima is a 7 year old girl who plays soccer with her brothers and talks excitedly about her favorite World Cup team. Yet, at recess time, she stands alone watching the other kids play soccer and doesn’t speak when her classmates ask her if she wants to play. And despite the school year being half over, she has not spoken a single word in her classroom.  

Fatima's parents have tried everything to get her to talk. They've tried talking to her about her feelings, and asking if she's been bulied. They've tried positive consequences such as rewards for being able to speak. They've tried punishing her for not talking. But nothing seems to work! What would you recommend?

Introduction 

It is normal that everyone can be shy from time to time. In fact, having just enough shyness can be helpful because it can protect us from doing things that may be embarrassing or awkward. But when one's shyness is so severe that it keeps them from actually speaking, then it may be a condition called selective mutism.

What is Selective Mutism?

Selective mutism is an anxiety disorder where: 

  • On one hand, when the person is with safe people (typically mom or dad) or safe places (typically home), the person is able to talk normally. With safe people and safe places, one might not even suspect that the person has any issues.
  • On the other hand, when outside the home (typically at school or public places such as stores or restaurants), or with people outside of the immediate family, the person is unable to speak. 

Hence the name "selective mutism", whereby they are mute in a selection of places, and with a selection of people. 

Note:

  • People with selective mutism are not being mute ‘on purpose’. They are not trying to ‘control’ a situation by being mute. Their inability to speak is due to severe anxiety, an anxiety so severe, that even talking is overwhelming. 

Signs and Symptoms of Selective Mutism 

When in comfortable situations such as at home, most children with selective mutism look and act like any other child.

 

However, in certain situations such as school, or in public, their anxiety prevents them from being able to speak and they may: 

  • Be unable to talk with other relatives outside the immediate family; 
  • Be unable to talk at school with teachers, classmates; 
  • Be unable to talk in public such as with store clerks or restaurant staff; 
  • Avoid situations that make them anxious, e.g. refuse to go out with family for shopping or other activities;
  • Have physical symptoms of anxiety such as stomach aches or headaches. 
  • Appear rude, because they avoid eye contact, or are unable to say hi or goodbye to people.

Other Issues Often Seen 

Children with selective mutism may also have:

  • Other anxiety problems such as
    • Social anxiety disorder (9 out of 10 children with selective mutism meet criteria for social anxiety disorder)
    • Difficulty being away from parents (separation anxiety)
  • Some form of speech or language problems

What Causes Selective Mutism?

Factors that contribute to selective mutism may include:

  • Genetics: Children with selective mutism have a sensitive "alarm system". Humans all have an "alarm system" that activates when we perceive danger. It allows us to be ready to ‘fight’ or flee danger. It is this alarm that allowed us to survive as hunter gatherers, and be able to survive physical threats such as being attacked by deadly sabre tooth tigers. In children with selective mutism, the alarm system is overly sensitive, and is triggered by social situations.  
  • Environment and experience: Children with selective mutism may also be mute in certain situations, perhaps because they have learned that this is a way to self-regulate their distress. When children feel a social situation is ‘dangerous’, they stay quiet, hide behind their parents or try to avoid the situation in other ways. When others respond by speaking for them or moving on, they feel less anxious. So these children learn that not speaking or avoiding social interaction helps them feel less anxious, and this behaviour becomes a pattern.

Self-Help Strategies for Selective Mutism 

Do’s

  • Do help the person feel more comfortable and safe. Because anxiety is at the root of selective mutism, it is helping them feel safe, which reduces anxiety, that helps them speak in social situations. 
  • Strengthen your relationship with your child with regular, quality time. Human beings are a social species, and at an extremely deep level, are wired to feel safer when they have a close connection with others. Ways to do this include: 
    • Set aside some special time each day where your sensitive child has 1:1 time with you, even if it is only 10-15 minutes every day. Make this special time longer on weekends or whenever possible. 
    • During this special time, ensure that you act in a way that sends the message that you accept your child no matter what.  
    • Avoid giving commands, asking questions or criticizing during special time. 
    • Consider using PRIDE skills during this time. PRIDE is a mnemonic for ways to build a deeper connection with your child, from parent child interaction therapy (PCIT), a type of treatment used for selective mutism.
P)ositive Reinforcement
  • Show gratitude towards your child. No matter what your child is doing, you can always find a way to say thank you, whether it is
    • "Thank you for being in my life." "Thank you for being my child." 
    • "Thank you for spending time with me today."
    • "Thank you for letting the server know what you wanted."
    • Even if your child is refusing to talk, you can still say, "Thanks for trying. I know its not easy talking with others."
R)eflect
  • Reflecting back the person's behaviours, thoughts, feelings is a way of letting them know that we acknowledge them and accept them.
    • Child is happy, and playing with a train at home. Parent: "You like playing with trains."
    • Child is unable to talk in a restaurant. Parent: "Its can be hard talking in a restaurant, especially if its busy."
  • Reflecting back a person's feelings without judgment, without telling them what to do or change, is a form of empathy and acceptance.
  • Validation is when we add something such as:
    • "You're not alone. When I was your age, I also found it hard to talk in restaurants." or "Other people might find this hard too."
I)mitate
  • When we follow the child's lead, and copy or imitate their appropriate behaviours, it increases the connection and gives your child a sense of control.
  • Child draws a sun in their drawing. Parent: "Thanks for giving me a great idea -- I'm going to draw a sun too!"
D)escribe
  • Describe the child's behaviours, in a way that is helpful and validating.
  • Is your child being inappropriate? Even so, you can probably look beneath the inappropriate behaviour and find something appropriate.
  • In a restaurant, child is unable to tell the server that they want spaghetti, but they are able to whisper "spaghetti" to the parent. Parent: "You want to be able to tell the server, "I'd like spaghetti!"
  • For example, if your child is frustrated and throws a toy, you can still start by validating the frustration. "I'm guessing you are feeling frustrated? Thanks for letting me know."
  • For example, if your child avoids, you can still validate that, "I'm guessing you are really scared / worried... Thanks for letting me know."
E)nthusiasm
  • Children want to have parents that are empathetic and validating, but also fun too. Show enthusiasm and match it to your child's energy level, e.g. Parent: "Awesome!" "Amazing!" Some children need more enthusiasm, others need less.
  • Make a Talking Map, which shows the people and environments where the child is able to speak. This helps you plan what areas to work on.

  • Make a Talking Map. This is a map that shows the different people and different places that your child is able to talk in. It gives you a quick way of seeing where to focus your efforts on helping your child, with which people and which places. 

    Example of a Talking Map

    HomeSchool Grandma's HouseStores, Restaurants
    Mom XXXX
    DadXXXX
    SiblingsX
    GrandmaX X
    Teacher
    Classmates
    Best friend xx
    Employees in store, restaurant server

    • Do practice communication skills in order to help your child climb the "Communication Ladder". 
      • The Communication Ladder is your child's ability to communicate. Easiest steps at the bottom, and harder steps at the top. Like climbing a ladder, we help the child start at the bottom, and work their way up step-by-step. 
      • For example:  
        • Using gestures
          • Example of an adult encouraging a child to use gestures with another person: "It would be really nice to wave hi to Jennifer! Please wave hello to Jennifer."
        • Whispering to a trusted adult
        • Whispering to a trusted adult, in front of a teacher 
        • Able to whisper to a teacher 
        • Able to talk out loud to a teacher one on one
          • Example of an adult encouraging a child: "I know Jennifer likes it when people say hi to her. Let's say hi to Jennifer."
        • Able to talk out loud to a teacher even with others around
      • Dr. Kirmayer (Child Mind Institute) recommends that after you have spent time building up a connection with your child through 10-15 minutes of positive quality time, this is a good time to practice communication skills through
        • Forced Choice: Ask a question, giving choices. E.g. "Its time for a snack. Would you like an apple, or a banana?"
        • Open-ended question: Ask a question that is open ended, e.g. "What did you do at school today?" 
        • Direct command for verbalization: Telling the child to say something, e.g. "Tell your dad what snack you want." "Can you please let Jenny know that it's snack time?"  
      • Games to help encourage your child to talk include: 
        • Go Fish
        • Zingo
        • Hangman
        • Headbandz
        • Guess Who
        • Surveys of Favorites
        • Spot It
        • Tell Tale 
      • Is your child easily able to do this with you at home?
        • Wonderful, then continue to work on 1) increasing the number of different places where your child can talk, and 2) the number of people with whom your child can talk to. 
        • Use the Talking Map to help guide you.
        • Example: 
          • If your child is able to talk with you, but not with grandma, then practice with grandma. 
          • If your child is able to talk with you in a normal voice at home, but not in a normal voice in public, then play a game in a public place.  

    Don’ts

    • Don’t force your child to speak. Don't get frustrated or upset if your child is unable to speak. This only makes your child more stressed, which makes it even harder for them to speak. 
    • Don't punish, pressure or make a child guilty for not speaking. These strategies increase anxiety, which only worsens the mutism.

    When and Where to Seek Help 

    Are your child's problems with talking not improving on their own?  If so, then get help, the earlier the better. Parents may hear that their child is just shy and will outgrow the selective mutism. But there are serious consequences for a child who can’t communicate or speak to others:

    • It can be hard to make friends. Not having friends or being isolated can put children at risk for teasing or bullying.
    • It can impact a child's learning. Your child won’t be able to ask questions or ask for help. Teachers can find it hard to assess your child’s learning needs. Your child will not be able to take part in group work or learn important presentation skills. Over time, problems at school can affect your child’s self esteem, make anxiety or depression worse or make your child feel isolated. Children in these situations sometimes refuse to go to school.

    Where to find help? You can always start by seeing your family doctor or child's pediatrician. Or see a mental health professional (e.g. psychologist, speech/language therapist, psychiatrist).

    How is Selective Mutism Treated? 

    Health professionals who treat selective mutism may use treatments such as: 

    • Counseling / therapy
      • Usual goals include
        • Reducing the child's anxiety; 
        • Helping the child to be able to feel safe in a wider range of social situations, so that they can communicate, initially with non-verbal communication, and eventually verbally.
        • Increasing the number of people, settings and activities where the child can speak. 
    • Medications
      • If counseling/therapy has not been sufficiently helpful, then medications such as SSRIs (selective serotonin reuptake inhibitors) may be helpful.
      • Medications are prescribed by a doctor, such as a family physician, pediatrician or psychiatrist.

    Working with the School

    Meet with your child’s teacher, without the child around.  

     

    School staff who may be able to help include teacher(s), the school psychologist, guidance counsellor, etc. More and more educators have training and awareness about anxiety conditions and thus you will hopefully find that they are helpful. 

     

    In case they are not too familiar with selective mutism however, key messages for the school would be that the student:  

    • Is not being defiant or stubborn by not speaking.
    • Communicates better when she is feeling calm and less anxious. Blame, teasing, humiliation and coercion do not help her to speak.
    • May need to use non-verbal communication at first.

    Meeting with parents, teacher and the child  

    • It helps to introduce your child to the key adults at school (e.g. teacher) so that your child can start to form a connection and feel safe with that person. Many teachers have "Getting to know you" sheets where they ask students about themselves to get to know the student better, e.g. what are the student's favorite interests, hobbies, etc. It can be helpful as well for the teacher to also share a bit about themselves, such as the teacher's favorite interests, hobbies, to help the child feel more comfortable.  
    • If possible, it may be helpful for parents to meet the teacher first, without the child. This will give you a chance to get to know the teacher. You can then arrange a time to meet the teacher with your child. Then you can let your child know that you have already met the teacher, and that your child can feel comfortable with him. For example, you can say something like, "I'd like you to meet Mrs. So and So. You know what? She's really into dogs, just like you. In fact, she has a dog of her own. I think she's really nice, and I think you're going to get along with her."
    • Accommodations that schools may use may include
      • Creating a stronger connection with the teacher by asking if they can have a greeting ritual ("Good morning, hope you had a good evening last night!"), as well as a goodbye ritual at the end of the school day ("Have a great day, I'm looking forward to seeing you tomorrow!").
      • Educate other students (and school staff). Give the teacher permission to tell other students and staff about anxiety in general (or if you feel comfortable enough, your child's difficulties), at a time when your child is not in the classroom. The teacher might say something such as “Everyone has a bit of shyness. Some people are just a little bit shy, where some people are very shy. The good news is that there are things that all of us can do to help someone feel included, even if they are shy.
      • Agreeing on a system for communicating key requests 
        • For example, using the washroom: 
          • Give the child a "washroom card" that indicates the need to use the washroom (non-verbal communication);
          • Ask the child, "Would you like to use the bathroom?", to which the child can nod their head, or shake their head (non-verbal communication), or show a card, or write something down.  

    Authors

    Written by members of the Mental Health Information Committee at the Children’s Hospital of Eastern Ontario (CHEO).

    References

    Carpenter et al.: Extending Parent–Child Interaction Therapy for Early Childhood Internalizing Problems: New Advances for an Overlooked Population. Clinical Child and Family Psychology Review, 17, 340-356(2014). 
    https://link.springer.com/arti...

     

    Dr. Elisa Shipon-Blum: Understanding Selective Mutism: A Guide to Helping Our Teachers Understand, retrieved Aug 15, 2005 from http://www.selectivemutism.org/pdf/teachers.pdf

    Resources for Parents

    SelectiveMutism.org

    http://www.selectivemutism.org


    The Child Mind Institute has an excellent parent guide to Selective Mutism

    https://childmind.org/guide/parents-guide-to-sm/

     

    Selective Mutism University is an e-Learning website for parents and professionals with information about Selective Mutism, by Dr. Kurtz.  

    https://www.kurtzpsychology.co...

    License

    Under a Creative Commons License.  You are free to share, copy and distribute this work as in its entirety, with no alterations. This work may not be used for commercial purposes.

For the full license, visit http:// creativecommons.org/licenses.by-nc-nd/2.5/ca/

    Disclaimer

    Information in this fact sheet may or may not apply to your situation. Your health care provider is the best source of information about your situation.

    Date Posted: Nov 4, 2008
    Date of Last Revision: Jun 13, 2020

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