Selective Mutism (SM)
Selective mutism (SM) is a severe anxiety disorder characterised by an inability to speak in certain situations. Children who display selective mutism do not speak out of choice or to be difficult. Instead, their inability to speak is because they are literally unable to do so, due to a freeze response associated with feelings of panic that makes talking impossible in certain situations. They are however able to talk freely to certain people e.g., close family or friends and when no one else is around to trigger the freeze response.
Selective mutism affects approximately one in 140 children. It usually starts between the ages of two and four and tends to be noticed when the child starts to interact with people outside of the family e.g., starting school or nursery.
SM is more common in girls and with children who are learning a second language.
SM is distinguishable by the marked contrast in the child’s ability to engage with different people. When SM is triggered, the child will often appear still, frozen facially, and will avoid eye contact. Other behaviours that can be associated with SM include: – being nervous/and uneasy; rude, distant and sulky behaviours; clinginess; being shy and withdrawn; appearing still, tense and poorly coordinated; and stubborn and aggressive behaviour e.g. temper tantrums after the child gets home from school.
Some children with SM who are more confident can use gestures or manage a few words or whisper. Some children are completely mute in stress inducing situations.
The causes of selective mutism are to some extent unknown. It is however strongly associated with anxiety and is a phobia of talking with certain people. Selective mutism is not in and itself linked to trauma, although it can be a symptom of post-traumatic stress, especially if the child suddenly stops talking in environments where they previously had no difficulties. SM appears to be more common if there is a history of anxiety disorders in the family.
Assessment (e.g. by a Speech Therapist), early diagnosis and treatment are essential. Carers and educators will require support and up-to-date information on how to best help children with SM. All pressure to speak needs to be removed from the child. Informal noisy play can be helpful to instill confidence and build trust. Sometimes a referral to CAMHS is necessary if there are other complex issues and difficulties.