Selective Mutism

Selective mutism is a fascinating disorder of children who are able to speak, but refuse to do so in public situations. Child and adolescent psychiatrists are often consulted when the disorder has become more chronic and is interfering with educational and social adjustment. It is typically first diagnosed in preschool or kindergarten, when the child is first expected to interact in a broader social environment. There may be a link between selective mutism in children and social phobia in adults.

Clinical Description

A child with selective mutism consistently does not speak in specific social situations in which there is an expectation for speaking, such as school. The child is able to speak in other situations. The symptoms must persist for at least 1 month and be severe enough to negatively impact educational and interpersonal functioning.

Epidemiology

Selective mutism has a prevalence of less than 1% of school-age children in mental health settings (about 0.7% prevalence overall). Girls are thought to be affected twice as often as boys.

Tip

Children with selective mutism are typically extremely aware of the frustration they are causing to the adults and peers in the environment. They are also usually hypervigilant about covert attempts to “get them to talk.” A referral to “get the child to talk” in school needs to be quickly reframed, as this type of control struggle rarely is effective and frequently exacerbates the disorder. Helping the child to feel comfortable, to participate, to make friends, and to be academically successful are more appropriate goals. The other children in the class need to be educated to minimize their concern about the selectively mute child speaking and not to overly react if the child does speak. I have seen children who are beginning to speak shut down again if their peers or teachers are too joyful about the utterances.

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