Selective Mutism

Selective mutism (se-LEK-tiv MU-ti-zum) is a condition in which children feel so inhibited and anxious that they do not speak in particular situations, most commonly in school. Children with selective mutism are capable of speaking and communicating normally and do so in other situations, for example, at home.

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What Is Selective Mutism?

Selective mutism is a condition in which children feel anxious and inhibited and do not speak in certain situations. Children with selective mutism are capable of speaking normally and do so in other situations where they feel more comfortable. These children often talk normally at home, but they may completely stop talking around teachers, other children, or other adults. Their behavior gets in the way of their making friends and doing well in school.

Selective mutism, once thought to be quite rare, was beginning to be more widely recognized in the early 2000s. It used to be called elective mutism, because researchers thought that children were purposely choosing not to talk. It was sometimes thought that a child's refusal to speak was a way to rebel against adults or a sign of anger. The problem affects at least one in 100 school-age children. Most children are diagnosed between three and eight years old, but selective mutism may not cause problems until children start school. The condition may last for just a few months, but in some cases, if left untreated, selective mutism can last for years. Some experts believe that untreated selective mutism in children leads to social anxiety disorders * in their adult years. Experts have concluded that selective mutism is an extreme form of social anxiety in a child. Social anxiety is an intense lasting fear or extreme discomfort in social situations, and usually leads to avoidance of many social situations. With selective mutism, children seem to feel so self-conscious or anxious in certain situations that they avoid talking altogether.

What Causes Selective Mutism?

There is no single cause of selective mutism. As with other forms of anxiety, some children may be more likely to have this problem if anxiety or extreme shyness runs in the family, or if they are born with a shy nature. Beyond genetics, in some families in which adults are anxious, children may learn to feel socially anxious by watching the way adults react and behave. Upsetting or stressful events like divorce, the death of a loved one, or frequent moves may trigger selective mutism in a child who is prone to anxiety.

What Are the Symptoms of Selective Mutism?

How Is Selective Mutism Diagnosed?

Some children with selective mutism will speak to a mental health professional, but others will not. Even if children are silent, a skilled professional therapist still can learn a lot by watching how they behave. The therapist can also talk to parents and teachers to find out more about the problem and possible factors that contribute to it. In addition, a number of tests may be used to exclude other possible causes for failing to speak. These include special medical tests to rule out brain damage, intelligence and academic tests to rule out learning problems, speech and language tests to rule out communication disorders * , and hearing tests to rule out hearing loss.

How Is Selective Mutism Treated?

Most children who have selective mutism want to feel comfortable talking. Although they resist efforts to help them talk at first, therapy can be effective in treating this problem. The most common treatment for selective mutism is behavioral therapy, which helps people gradually change specific unwanted types of behavior. For example, after the therapist helps the child to feel comfortable, the child might be rewarded for speaking softly and clearly into a tape recorder. Once they have succeeded at this several times, they can move on to being rewarded for speaking to one child at school. Children who are selectively mute may speak to specific children. They then might be invited to participate in a group with the children to whom the selectively mute child speaks.

Often, family therapy is added, which helps identify and change behavior patterns within the family that may play a role in maintaining mutism. When a child has selective mutism, it is common for the family members to speak for the child. Though they do this out of love and concern and the desire to be helpful, these patterns must be discontinued to help motivate reluctant children to begin to speak for themselves. Play therapy and drawing are often used to help these children express their feelings and worries. In addition, some children with selective mutism are prescribed medications used for treating anxiety. These medications help lessen the anxiety that plays an important role in the selectively mute child's behavior, allowing the child to take the risks involved in talking.

See also Anxiety and Anxiety Disorders: Overview • Fears and Phobias • Psychopharmacology • School Avoidance


Books and Articles

Bernstein, Bettina E. “Pediatric Social Phobia and Selective Mutism.” Medscape, May 15, 2014. (accessed July 6, 2016).

Petersen, Andrea. “When a Child Doesn't Speak: Treating Selective Mutism.” Wall Street Journal, August 17, 2015. Available at: (accessed July 6, 2016).

Sluckin, Alice. Tackling Selective Mutism: A Guide for Professionals and Parents. London: Jessica Kingsley, 2014.


Child Mind Institute. “Selective Mutism.” (accessed July 6, 2016).

MedlinePlus. “Selective Mutism.” U.S. National Library of Medicine. (accessed July 6, 2016).

Selective Mutism Anxiety and Treatment Center. “What Is Selective Mutism?” (accessed July 6, 2016).


Anxiety and Depression Association of America. 8701 Georgia Ave., Suite 412, Silver Springs, MD 20910. Telephone: 240-485-1001. Website: (accessed July 6, 2016).

Selective Mutism Foundation. PO Box 13133, Sissonville, WV 253600133. Website: (accessed July 6, 2016).

* anxiety disorders (ang-ZY-e-tee) are a group of conditions that cause people to feel extreme fear or worry, sometimes accompanied by symptoms such as dizziness, chest pain, or difficulty sleeping or concentrating.

* communication disorders affect a person's ability to use or understand speech and language.

  This information is not a tool for self-diagnosis or a substitute for professional care.