What is Selective Mutism?

Selective Mutism (SM) is an anxiety disorder that inhibits a person from speaking or participating in certain social settings. SM is most common among children under 5 years of age. Because it is not a biological or speech/language disorder, children with SM may be very talkative at home while completely silent at school or other social settings.

While some parents may initially believe their child’s lack of communication is a “choice,” the reality is often more complicated. Just as people suffering from generalized anxiety disorder don’t choose to be anxious, children with SM aren’t “choosing” to be silent. SM in children marks discomfort, low self-esteem, anxiety, and fear. Over 90% of children with selective mutism also suffer from social phobia and social anxiety. Some symptoms of SM are separation anxiety, tantrums, sleep problems, and mood swings.

How do I know if my child has SM or is just shy?

Selective mutism can manifest in different ways for each child. The child may feel uncomfortable speaking altogether, or speak to only a select few of his/her friends. Children with SM are extremely shy and withdrawn, not simply timid. These qualities interfere with their development and is socially debilitating.

How does Selective Mutism develop?

The cause of SM is not definite. However, one explanation suggests that children with SM have a “decreased threshold of excitability,” in the amygdala, which makes events such as birthday parties or answering a teacher’s question in class highly anxiety-provoking. Another explanation suggests that some children with SM might also suffer from Sensory Processing Disorder, a sensitivity to light, sound, touch, smell, or taste. This hinders their capacity for emotional regulation, and may lead to the misinterpretation of some social situations as threatening.

How is it treated at Union Square Practice?

An integrative approach drawing from tenets of behavioral therapy and cognitive behavioral therapy (CBT) orientations are used to treat selective mutism. Treatment is often coordinated among the therapist, caregivers, and the child’s school. Effective treatment draws on behavioral therapy strategies including modeling, practice/exposure, and contingency management.