Selective Mutism

Selective Mutism

Select mutism is an anxiety disorder that affects a child’s ability to to speak and communicate in social situations like school, playdates, or family gatherings. There are no physical causes of select mutism, and children who suffer from it are perfectly capable of speaking and communicating when they are in a safe, relaxed environment. In simple terms, select mutism is an extreme form of shyness.


In the overwhelming majority of cases, children with select mutism will have some form of social anxiety that renders them incapable of speaking in new or public settings. There are degrees of select mutism, and some children may fare better than others if the new group is small, or if there are familiar faces, but most of them will have trouble responding or initiating a conversation with new people.


As there are degrees to this condition, different children will react differently to intimidating social settings. Some may avoid contact but be able to whisper, others may make eye contact but not speak, and others may find themselves paralysed with fear and be completely unresponsive to any attempts by others to interact. However, unlike other conditions that may manifest in similar ways, such as autism, children with select mutism almost always have the desire to interact and make friends, but find themselves unable to do so.


Although the majority of children with select mutism have been found to be genetically predisposed to anxiety disorders, there are other reasons an individual may develop the condition. For example, if the amygdala, the part of the brain that deals with emotional behaviour, has a lower-than-average threshold, social situations can trigger a fear response and cause the child to retreat. Alternatively, select mutism can be brought on by Sensory Integration Dysfunction (DSI), which means they can be overwhelmed by one or more of their senses, and triggers such as lights or sounds could cause them to “shut down” socially. In some cases, children may develop select mutism due to a speech impediment or learning disability, which causes them to become too self-conscious to communicate.


Most diagnoses of select mutism take place between the ages of 3 and 8, as this is the period when most parents leave their children in a creche or at school, where the inability to socialise becomes clear. At this point, a doctor will speak with the parents and identify which of the aforementioned causes is behind the condition, although treatment will remain largely the same regardless.


The main priority of the treatment will be to lower anxiety levels, since this is the root of the problem in almost all cases. This will involve the use of one or more types of therapy, such as Cognitive Behavioral Therapy (CBT), Psychotherapy, or the specifically designed Social Communication Anxiety Therapy. This will involve helping the child in a number of different areas, such as building their confidence, helping them identify what causes their fear, and teaching them coping techniques. In some cases, anti-anxiety medications such as Prozac or Zoloft may be prescribed to help formulate a two-pronged approach, and tackle anxiety on a chemical level as well as a cognitive one.


In the end, the bulk of the treatment for select mutism is to properly and thoughtfully teach the child how to integrate with people. Although it may sound like an outdated approach, studies have shown that the most effective way to treat select mutism is to put them in social situations. This will require the involvement of people from all areas of the child’s life, such as extended family, neighbours, teachers, and friends.


The child’s reaction will vary depending on the combination of people and places, so one person interacting with the child may receive a different response in another setting. Furthermore, different people will find that different techniques work to help them interact with the child, and so each person involved in their life will start to build their own unique relationship with the child. This treatment does require a strong support base, and there will certainly be a learning curve for many involved, but if the time is taken and the effort put in, the majority of children with select mutism will be able to conquer their anxiety.

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