Selective Mutism is a complex childhood anxiety disorder marked by a child’s inability to communicate properly in certain social circumstances, such as school. These kids can speak and converse in environments where they feel safe, secure, and relaxed. It usually begins in childhood and can last throughout adulthood if left untreated.


Selective mutism affects less than 1% of children, according to estimates. The first documented cases originate from 1877 when German physician Adolph Kussmaul diagnosed “aphasia voluntaria” in children who could not talk.
Selective Mutism is associated with social phobia or anxiety in more than 90% of children. Selective mutism is a condition in which a child or adult is unable to talk at some moments. They do not refuse or choose not to speak at particular times willingly, but they are really not capable to do so.
If left untreated, selective mutism can have a number of negative implications. Academic issues, low self-esteem, social isolation, and social anxiety are all possible outcomes of selective mutism disorder.

Selective Mutism

Symptoms of Selective Mutism

If you suspect your child is suffering from selective mutism, search for the following signs and symptoms:
• Expression of a wish to speak that is let down by fear, anxiety, or embarrassment
• In fearful situations, fidgeting, avoidance of eye contact, lack of movement, or lack of emotion
• Inability to communicate in some social circumstances, such as school.
• Using nonverbal communication to communicate requirements (e.g., nodding head, pointing)
• Between the ages of 2 and 4, shyness, fear of others, and a reluctance to talk
• In some contexts (e.g., at home or with known people), speaking is easy, but not in others (e.g., at school or with unfamiliar people)
While these behaviors are self-protective, they may appear to other children and adults as willful and disobedient.

Causes of Selective Mutism

According to new research, the disorder is linked to severe social anxiety, and a hereditary predisposition is likely. There is unlikely to be a singular cause for the disorder, as with all mental illnesses.
Children who develop the disorder include:
• Having a shy personality.
• Presence of an Anxiety disorder.
• The fear of being humiliated in front of others
Temperament and the surroundings are two more possible explanations. Children who are behaviorally constrained or have linguistic challenges are at a higher risk of having the disorder. Parents with social anxiety who model restricted behaviors could potentially be a factor.

Risk factors of Selective Mutism

Following are the factors which can increase the risk for the development of selective mutism:
• Anxiety problems

• Difficult familial relationships
• Psychological issues that have not been addressed
• Issues with self-esteem
• Issues with audio processing
• A problem with speech or language, such as stuttering
• Anxiety problems in the family
• A horrific encounter
Selective mutism can be passed down through generations.

Complications of Selective Mutism

If left untreated, selective mutism can lead to isolation, low self-esteem, and social anxiety disorder. It can continue into adolescence and adulthood if not managed.

Prevention of Selective Mutism

There is no sure way to prevent Selective Mutism, however there are some coping strategies to deal with the symptoms of the disorder.
• Inform your child’s teachers and others who work with him or her. Ascertain that your child’s instructor is aware that the behavior is not intentional. You and your child must work together to encourage him and provide praise and prizes for good behavior.
• Select activities that are appropriate for their current abilities. Don’t push your child into social situations or hobbies that demand verbal communication. Instead, engage in non-verbal pursuits such as reading, drawing, or puzzle solving.
• Encourage progress and don’t punish for shortcomings. Punishing silence is not a good thing in the same way that rewarding positive steps toward speaking are. If your child is terrified to talk, no amount of pressure or punishment will help them overcome their fear.
• Don’t put undue pressure on your child. Putting pressure on your child will just raise their nervousness and make it more difficult for them to talk. Concentrate on showing your child that you care and that you accept him or her.

Diagnosis of Selective Mutism

To be diagnosed with selective mutism, an individual must meet the following criteria, according to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition:
• Despite speaking in other settings, a consistent failure to speak in specific social situations where speech is expected (e.g., at school).
• The disruption impairs educational or occupational performance, as well as social communication.
• The disturbance has lasted at least one month (not limited to the first month of school).
• The failure to communicate is not due to a lack of familiarity with or knowledge of the spoken language required in the social environment.
• The symptom isn’t better described by a communication impairment (e.g., stuttering) and doesn’t happen just in people with autism spectrum disorder, schizophrenia, or another psychotic disorder.

Treatment of Selective Mutism

Psychotherapy, medicine, or a combination of the two may be used to treat selective mutism.


Behavior management programs are a typical treatment for selective mutism. Desensitization and positive reinforcement strategies are used in these programs, followed by Cognitive behavioral therapy (CBT), which is applied at home and at school under the supervision of a psychologist.


Medication may be necessary for some circumstances, particularly those that are severe or persistent, or when other techniques have failed to improve the situation. The decision to utilize medication should be made with the help of a doctor who has experienced prescription anxiety medication for children.