Selective mutism (SM) is a type of childhood anxiety. When a child suffers from SM, they are unable to speak in one or more social settings. Normally, these children are able and willing to speak in some settings, most often at home and have the ability to speak and use language.
Children with selective mutism may exhibit the following in uncomfortable or new social settings:
- Will be motionless or expressionless
- Will avoid eye contact or withdrawal from the situation
- May be anxious before the social situation
- May have physical signs of anxiety such as stomachache or headache
- May have insomnia
- May have additional forms of anxiety, such as separation anxiety
In order for a child to be diagnosed with SM, symptoms must be present and persist for at least one month and the behavior must impair the child in daily life. Generally the child may not participate with other children in the classroom or will refuse to participate in other school activities because of their fear of having to speak.
Children with SM normally show developmental appropriate growth in other areas and understand and can use age appropriate skills, except if it would require speaking in public.
Signs of SM may be apparent between the ages of one and three. At this age, it is often seen as shyness. Signs would include the reluctance to speak to people outside of the family and a general fear of people outside the family. Often, however, SM is not diagnosed until a child enters school and is required to speak in several settings.
If selective mutism continues for more than two months, or if all verbal response stops, a child should receive treatment. Some children will have a mild form of SM and do not require any treatment and will naturally become more comfortable speaking in public. For other children, treatment is essential so that symptoms do not continue indefinitely.
Treatment for SM usually includes behavioral management strategies and often includes desensitizing the child, setting goals, and positive reinforcement. Some anxiety medications have been found to be helpful when used in conjunction with behavioral strategies.