Selective Mutism: Symptoms and Treatment

Selective mutism is a very complex childhood anxiety disorder characterized by the inability of a child to speak and communicate effectively in particular social settings, such as school.


Today we speak of a quite complex childhood disorder that is characterized by the inability of the child to communicate effectively in certain social environments. They are children who can speak in environments where they feel comfortable, but have many difficulties in initiating any type of verbal and non-verbal communication in other environments.

Actually, it is a childhood anxiety disorder – then, at the base is anxiety – where the social environment plays a modulating role. Interacting with others in environments where you do not feel safe, as school may initially be, can be overwhelming. Thus, many end up displaying a selective mutism that can be total or partial, depending on the child.

Unlike traumatic mutism, where the child completely loses speech after having experienced a traumatic event, children with selective mutism do not completely lose speech. The latter can talk and socialize in some environments and with some people. His silence is a means to avoid social anxiety.

How does it develop?

In a high percentage, in children suffering from selective mutism, there seems to be a genetic predisposition to suffer anxiety. They are children who show signs of severe anxiety and extreme shyness from a very young age.

Statistics also show that a high number of them have a temperament that favor this position so conservative, and in many cases incapacitating. Some hypotheses suggest that children who are so inhibited seem to have a low threshold of excitability of the amygdala. This would cause them to interpret events or circumstances as signs of potential danger, when they would not be.

Only 20-30% of them have a subtle anomaly of speech, language or learning. In these cases the additional stress makes the child feel much more anxious when there are circumstances where they must communicate.

There is a small proportion of these children with inhibited temperament who come from bilingual families or who have spent time in a foreign country and therefore exposed to another language during their language development (between 2-4 years)

The behavior of a child with selective mutism

It is important to know that a child suffering from selective mutism has a normal communicative attitude in environments in which he feels comfortable. The parents of these children often comment on how talkative, funny, curious and even stubborn they are when they are at home.

Symptoms of selective mutism

Almost all the symptoms of a child suffering from selective mutism can be attributed to anxiety. Some of them are:

  • Temperamental inhibition: timid behavior and extremely cautious in new or unknown situations. They are also often inflexible, moody and domineering at home. These children need control and internal order.
  • Social anxiety: more than 90% of children suffering from selective mutism have a high level of social anxiety, despite having appropriate social skills for their age, although they simply do not put them into play.
  • Various physical symptoms: in addition to mutism, these children recurrently experience stomach pains, nausea, vomiting, headaches and joints, shortness of breath, diarrhea and nervousness.
  • It is quite common that these children, in social situations that overwhelm them, show a neutral facial expression and that they do not smile. Even their non-verbal language becomes rigid, they avoid eye contact and seem more interested in playing alone. Some may show these symptoms in the presence of the group of children or the teacher, but they may interact in a normal way with only some of them.
  • They may also have problems with food intake, with bowel and bladder. Sensitivity to very bright lights or very loud sounds.
  • They may present difficulties with the sensations of touch. Label the clothes, be touched by others or brush their hair. They are children with very intensified senses, very sensitive and sensitive.
  • In the classroom, they tend to be isolated from others. They have difficulty following a series of instructions, they are easily distracted. Despite this, many children with selective mutism are very intelligent and focus on their studies as a way to escape from social interaction
  • Comorbid anxiety may appear: separation anxiety, obsessive-compulsive disorder OCD, trichotillomania (hair removal), specific phobias and panic disorders.

How is selective mutism treated?

Intervention therapies in children who suffer from selective mutism are focused on moving from non-verbal communication to verbal communication. The main objective is to reduce anxiety, increase self-esteem and develop social and communication skills. There are several approaches from which an intervention can be proposed:

  • Behavioral therapy: seeks, with positive reinforcement, to superimpose positive feelings or expectations on anxiety, indirectly blocking the avoidance response (mutism).
  • Game therapies: psychotherapy and other psychological approaches that help to eliminate the pressure to verbalize and help the child to relax.
  • Cognitive behavioral therapy: intervenes on those thoughts that produce anxiety. It is understood that by reducing the level of anxiety felt by the child, this will tend, in a natural way, to be more communicative.

In any case, whether it is a theoretical framework or another that supports the intervention, the solution does not require the child to speak. Rather, it is about transferring that feeling of security that enables you in certain environments to those in which you do not have such a high degree of knowledge or control, so that anxiety is reduced.