Selective Mutism

Selective Mutism (SM) is a childhood anxiety disorder defined by a child’s persistent inability to speak in certain social settings and with certain people. Children with SM are able to verbally communicate in settings where they feel secure, typically at home and around their parents and siblings. However, ‘‘they are unable speak at all or speak above a whisper in other social contexts, for example at school, in public or at extended family gatherings’’ (Child Mind Institute). It is important to note the inability to speak in specific contexts that characterises SM is explained independently from “an organic inability rooted in language ability, another communication disorder and concurrent diagnosis of pervasive development disorder” (DSM-IV-TR). The condition is termed as ‘selective’ to highlight the specific situations in which children fail to speak rather than the intentional withholding or reluctance to speak as previously conceptualized (Wong, 2010). The prevalence of SM is currently 0.7 – 2% of children and its onset is typically between the ages of three to six, as children are expected to verbally participate in school. It is common that children with SM report a history of being behaviourally inhibited and are also diagnosed with other impairing anxiety disorders such as social anxiety disorder, separation anxiety and phobias (e.g. Dummit et al., 1997).

Children with SM often appear to be ‘paralyzed with fear’ when unable to communicate verbally and at times even non-verbally. Others will compensate by using gestures, facial expressions, pointing and nodding as strategies to get by when unable to speak. These difficulties in speaking have to have occurred for more than the duration of one month, excluding the first month of school, and to reportedly impact upon the child’s life. The characteristics of SM consequently interfere with performance at school and engaging in social activities with peers. It can cause severe distress where children are unable to communicate if they are in pain or express their needs to use the bathroom.

For more information on the assessment of SM and our SM Program, please contact the CDT’s SM Program Director.

For more information on SM such as identifying symptoms and intervention methods, please refer to our information sheet below: