Selective Mutism in Children: A Comprehensive Guide

What is Selective Mutism?

Selective mutism (SM) is an anxiety disorder that manifests in children who are unable to speak in certain social contexts, such as at school, or with anyone outside their family circle. Although they are able to speak normally in environments where they feel safe, such as at home, they are unable to do so in any other context, with the obvious serious consequences for their well-being and for their psycho-educational development process.

How to differentiate selective mutism and shyness

Selective mutism and shyness may seem similar at first sight, as both behaviours imply a reluctance to speak in certain social situations.

However, they are distinct conditions with their own characteristics. Shyness is manifested by a tendency to feel uncomfortable or nervous in social situations, especially with strangers. On the other hand, selective mutism prevents the person from speaking in specific situations, despite having the ability to speak in other contexts.

A key difference between the two conditions is that shyness generally decreases as the person becomes more familiar with the environment or people and gains confidence. In contrast, selective mutism persists even in familiar situations if they are within the context that triggers the anxiety. Furthermore, while a shy person may choose to remain silent in social gatherings, but is able to speak if necessary, a person with selective mutism will often find themselves unable to speak, regardless of their desire to do so.

Another important distinction is that shyness does not usually interfere significantly with a person’s daily life and is relatively common. Selective mutism, however, can be very limiting and affect a person’s ability to participate in educational, social and professional activities. It is less common than shyness and requires professional intervention for management and treatment.

It is crucial not to confuse shyness with selective mutism, as the latter may require specific attention to help the person overcome communication barriers and participate fully in everyday life.

Causes of Selective Mutism

The causes of selective mutism are multifactorial and may include biological, psychological and social factors. Genetic predisposition, early life experiences and family dynamics play an important role in the development of this disorder. Overprotection, high educational expectations and traumatic experiences may also contribute to its occurrence.

Psychological and Environmental Factors in selective mutism

Psychological factors, such as anxiety and extreme fear of social evaluation, play a crucial role in the development of selective mutism. Children may experience overwhelming anxiety that prevents them from speaking, especially in environments where they feel that their verbal skills or personality are being judged. This anxiety can be so intense that it overcomes the natural desire to communicate and connect with others.

The environment is also a significant factor. Children with MS can often speak fluently at home or in the presence of people with whom they feel comfortable. However, in less familiar surroundings or with unfamiliar people, they may withdraw and be unable to speak. This suggests that SM is not simply a conscious choice or an act of will, but an involuntary response to a stimulus perceived as threatening.

Family Influences and Dynamics in Selective Mutism

Family dynamics may influence the onset of SM. In some cases, communication patterns within the family or parental expectations may contribute to the development of the disorder. For example, if a child perceives that speaking in certain contexts brings negative consequences or if he/she faces conflicting pressures about when and how to communicate, he/she may choose silence as a defence mechanism.

 

Biological and Genetic Factors in Selective Mutism

Recent research suggests that there may be a genetic predisposition to selective mutism, although genetic factors alone are not sufficient to explain its occurrence. It is likely that a combination of biological predisposition and life experiences contribute to the development of the disorder. For example, a child with a natural tendency to be anxious may be more susceptible to SM if faced with stressful or traumatic situations.

 

Language Development

Difficulties in language and communication development may also be a contributing factor. Children who have problems processing linguistic information or who struggle with non-verbal communication skills may feel overwhelmed in social situations, leading to reluctance to speak.

 

Social and School Experiences and Selective Mutism

 

Negative experiences at school or with peers can reinforce non-speaking behaviour. If a child has had traumatic or embarrassing experiences with public speaking or has been teased or rejected, he or she may develop a persistent fear of speaking in similar situations.

Treatment for Selective Mutism

It is important to clarify that selective mutism is a disorder that can be successfully treated, although it is a complex and potentially lengthy treatment, especially when it is not diagnosed early. Of course, treatment is most effective when it is multidisciplinary, involving the child’s family, psychologists, speech therapists and educators. Interventions may include cognitive behavioural therapy, which helps children cope with and overcome their anxiety, and graded communication strategies that encourage verbal expression in safe “sliding in” environments.

How to support a child with selective mutism at school

Supporting a child with selective mutism at school requires a comprehensive strategy involving teachers, parents and therapists. It is essential to create a school environment that is safe and welcoming for the child, where the child feels free from anxiety and pressure. Educators must be informed about the disorder and trained to manage it appropriately, avoiding forcing the child to talk and instead encouraging participation through alternative methods of communication such as gestures, drawing or writing.

Collaboration with parents is key to ensuring consistency between home and school. Parents can share valuable information about the situations in which their child is most comfortable speaking and the strategies that have been effective at home. In addition, it is important for teachers to establish clear and regular communication with parents to monitor progress and adjust strategies as needed.

In the classroom, activities can be implemented that promote confidence and interaction without pressure to talk. For example, role-plays, small group activities and collaborative projects can help the child feel part of the group and eventually increase his or her comfort in communicating verbally. Assigning the child roles or responsibilities that do not require speaking, but still involve the child actively in the classroom, can also be beneficial.

It is crucial to avoid situations that may increase the child’s anxiety, such as calling on the child to respond loudly in front of the class. Instead, teachers can provide options for the child to demonstrate understanding and knowledge non-verbally or in a more private setting. In addition, classmates should be encouraged to be understanding and patient, promoting an inclusive and supportive environment.

Early intervention is important in addressing selective mutism. Specialists, such as speech-language pathologists or psychologists, can work with the child to develop communication skills and manage anxiety. Therapies may include gradual exposure to speaking situations and systematic desensitisation to reduce anxiety associated with verbal communication.

Finally, it is essential that the school and therapists work together to create an individualised treatment plan that is tailored to the child’s specific needs. This plan may include short- and long-term goals, specific classroom strategies and ways to measure progress. With a patient, understanding and consistent approach, children with selective mutism can begin to overcome communication barriers and participate more fully in their education.

The “Sliding In” technique is a step-by-step strategy used in the treatment of selective mutism (SM) that helps children to speak in situations where they were previously unable to speak.

Diagnosis of Selective Mutism

The diagnosis of selective mutism requires careful assessment by professionals. A clear distinction must be made between SM and other speech or developmental disorders, and the context in which the child is able or unable to speak must be considered. When the child is in school it is usually easier to diagnose, as it is in the second cycle of infant education (3-6 years in Spain), when it is possible to start detecting behaviours in the child that could mean selective mutism. A diagnosis in this phase allows a quicker and more successful treatment. However, a great number of cases are diagnosed and treated from the age of 6, when the child is already in the primary education cycle. In this case, the earlier the better, although the treatment of selective mutism can be successful at any age, it takes much longer when kids are older. A transparent school environment with good communication between teachers and parents is also important.

In Open Psychology we have a great experience in psychoeducational evaluations of children, including selective mutism, and we also have a professional –Lidia Budziszewska, who is specialised in the treatment of selective mutism.