This is an anxiety disorder in which people are unable to talk in certain social situations, but are able to speak at other times. It is usually first recognized between the ages of three and eight years.

What is it?

Selective mutism is associated with anxiety, and children who are affected by it struggle with excessive fears and worries. They are generally able to speak freely where they feel comfortable but are unable to talk in specific situations, when they do not engage, go still, or have a frozen facial expression when expected to talk. This inability to speak is not the result of a conscious decision or a refusal. The mutism can be triggered by
a stressful experience, or it can stem from a speech or language disorder, or hearing problem, that makes social situations involving communication particularly stressful. Whatever the cause, everyday activities are difficult, as are relationships within the family or school. Treating the condition can prevent it from persisting into adulthood—the younger the child is when diagnosed, the easier it is to treat. If symptoms persist for more
than a month, the child should be seen by a GP, who can refer them for speech and language therapy. A specialist asks whether there is a history of anxiety disorders, a likely stressor, or a hearing problem. Treatment depends on how long the child has had the condition, the presence of learning difficulties or anxieties, and the support that is available.

State of fear

TREATMENT

❯ Cognitive behavioral therapy using positive and negative reinforcements to build speech and language skills; graded exposure to specific situations to reduce anxiety, removing pressure on the child to speak.

❯ Psychoeducation can provide information and support for parents and caregivers, relieve general anxiety, and reduce chances of the disorder persisting

“It is a child suffering in silence.”

Dr. Elisa Shipon-Blum, American president of Selective Mutism Anxiety Research and Treatment Center