Selective Mutism · What Is It, Symptoms, Treatment, and More

The main symptom of selective mutism is the individual’s failure to speak in specific settings, such as when meeting new people, despite having the ability to speak in other, presumably more comfortable situations. Instead of communicating verbally, individuals may communicate by gestures, nodding, head-shaking, or sometimes short monosyllabic words or whispering. In other cases, they may not communicate at all.

According to the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, or DSM-5, selective mutism is diagnosed when individuals persistently fail to speak in specific social situations but can speak freely in others. The failure to speak must last for at least one month, except for the first month of school, where hesitation to speak can be expected and may interfere with education or occupational attainment. To diagnose selective mutism, the failure to speak should not be attributable to a lack of knowledge or comfort with the spoken language or a communication disorder. 

Selective mutism is often diagnosed when the child first attends preschool or kindergarten. That is typically the first time children are expected to speak with someone other than their parents and family. In some cases, diagnosis may be delayed, as parents may believe the problem lies in the classroom, with the teacher or school climate, considering the child has no trouble speaking freely at home.

Treatments for selective mutism typically include cognitive-behavioral therapy (CBT), play therapy, and family therapy. One cognitive-behavioral therapy strategy is stimulus fading, which involves creating a relaxed situation with someone familiar to the child can talk to and gradually bringing someone new into the room. Play therapy is a unique type of psychotherapy where play is used as a means of helping children express or communicate their feelings. Family therapy, however, can allow parents to be closely involved with the child’s therapy and work on ways to improve communication together. 

Additionally, there are several ways teachers can make communication less stressful at school. Examples include establishing a relaxed atmosphere in the classroom; encouraging and accepting all attempts at communication (e.g., with gestures, pictures, objects, whispering); providing quiet spaces for children to sit and talk together; speaking or singing in unison, and planning activities requiring single words or short answers. 

In cases with significant anxiety that interferes with daily activities, medications like selective serotonin reuptake inhibitors or SSRIs (e.g., fluoxetine, paroxetine, sertraline, citalopram) might be recommended in combination with psychotherapy.