Selective Mutism

Some children are shy and do not like to talk to people they don’t know. They usually start talking when they feel more comfortable. However, some children will not talk at certain times, no matter what. This is selective mutism. It is often frustrating for the child and others. Help is available.

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About Selective Mutism

Does your child talk at home or with friends but refuse to talk at school? A child with selective mutism will talk at some times and in some places, but not in others. This might start when your child goes to school. Sometimes, it starts when a child is younger.

Signs of Selective Mutism

If your child has selective mutism, you may notice that:

  • They will not speak at times when they should, like in school. This will happen all of the time in that situation. Your child will talk at other times and in other places.
  • Not speaking gets in the way of school, work, or friendships.
  • This behavior lasts for at least 1 month. This does not include the first month of school because children may be shy and not talk right away.
  • Your child can speak the language needed at that time. A child who does not know the language being used may not talk. This is not selective mutism.
  • Your child does not have a speech or language problem that might cause them to stop talking.

Causes of Selective Mutism

Selective mutism is in the Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition, or DSM-5. Doctors and others use the DSM-5 to help diagnose social and mental problems. In the DSM-5, a child with selective mutism may:

  • Have an anxiety disorder.
  • Be very shy.
  • Be afraid to embarrass themselves in public.
  • Want to be alone and not talk with friends or others.

Testing for Selective Mutism

Talk to your doctor if you have concerns about how and when your child talks. Your child should also see a psychologist or psychiatrist to see if they have a problem like anxiety. A speech-language pathologist, or SLP, can test your child's speech and language. These experts may work with your family and your child's teacher if there are problems at school.

Speech and language testing may include:

  • Talking with you about your child’s development and medical history.
  • Having your child’s hearing screened.
  • Seeing how well your child’s lips, jaw, and tongue move.
  • Seeing how well your child understands what others say to them.
  • Listening to how well they say words, answer questions, and talk about their ideas.

Some children will not talk to the SLP. If that happens, the SLP may ask if you have a video of your child talking.

Treatment for Selective Mutism

Each person with selective mutism needs to work on different skills. Your doctor may suggest medication, which works for some people. SLPs will work to get your child comfortable talking in all situations. Your child may need to work to change how they behave at those times when they won’t talk. Or, they may need to work on their speech and language.

To help change your child’s behavior, the SLP may use:

  • Stimulus fading. Your child may be with someone they talk to easily at first. Then, a new person may slowly join in. This will help your child get comfortable with new situations.
  • Shaping. The SLP will praise or give rewards to your child for trying to communicate. Your child may first only point or use other gestures. Then, they may mouth a word, which means saying it silently or whispering. The goal is for your child to speak in all situations.
  • Self-modeling technique. Your child may watch videos of themself talking in a comfortable situation, like at home. This may help them feel more confident about how they speak. They may then try speaking in other situations.

The SLP will also work with your child on any speech or language problems that they may have. This may include helping them say sounds clearly or helping them say words loudly. The SLP may also help them use words to ask questions or talk about their thoughts. Your child may be more willing to talk to others once they feel better about how they sound.

The SLP may also work with others in the places where your child has trouble. This may include your child’s teachers, counselors, coaches, or family members. The goal is for your child to be comfortable talking in any situation.

See ASHA information for professionals on the Practice Portal’s Selective Mutism page.

To find a speech-language pathologist near you, visit ProFind.

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