Understanding Selective Mutism

Words First Speech and Language Therapist, Erantia Coertze, Explains This Often Misunderstood Condition

Selective mutism (SM) is a condition where an individual is unable to speak in certain social situations. The key term here is “unable.” This goes beyond mere reluctance or shyness; SM is classified as an anxiety disorder, similar to a phobia.

SM affects approximately 1 in 140 children, being more common in girls and among children who have migrated to a different country. Children with SM may be described as sensitive and cautious, often striving to get things right, and they can find uncertainty particularly challenging.

The term “selective” can be misleading, as the child or young person (CYP) isn’t choosing when to speak; they genuinely cannot speak due to the panic and anxiety they experience in that moment. For this reason, some experts prefer the term “situational mutism.”

What Happens During Selective Mutism?

The CYP may want to communicate, but when they find themselves outside their comfort zone, the expectation to speak triggers a panic response, causing them to freeze. As a result, they may become increasingly wary of situations where speaking is anticipated, leading them to avoid speaking altogether and withdrawing from activities that might draw attention to themselves.

They may not exhibit visible signs of fear, displaying a blank facial expression while experiencing an internal whirlwind of panic. This response is often characterised as a “freeze” reaction.

How is Selective Mutism Diagnosed?

Identifying the signs of SM early is crucial to helping the child feel less anxious about speaking and preventing an escalation of problematic situations. A Special Educational Needs Coordinator (SENCO) can refer the child to an appropriate professional, such as a Speech and Language Therapist (SaLT), an Educational Psychologist, or a Child and Adolescent Mental Health Services (CAMHS) provider.

If you already have a partnership with Words First, please inform your therapist about your concerns. Our interdisciplinary team, consisting of SaLTs, Psychologists, and Counsellors, provides a comprehensive approach to addressing SM.

Once referred, the professional will likely gather information from parents and school staff to better understand the child’s overall development and learning. They will assess the factors that contribute to the mutism, including the speaking expectations placed on the child, situations that increase their discomfort, and how others react to their speaking or silence.

If others respond in ways that heighten the child’s anxiety, this may reinforce the mutism.

A diagnosis of SM is typically confirmed if the following criteria are met:

• The CYP does not speak in specific situations but can communicate normally when relaxed.
• The mutism has persisted for at least one month (or two months if the child is in a new environment) and is not due to unfamiliarity with the spoken language.
• The mutism interferes with their ability to engage, interact, play, and learn.
• The condition is not better explained by another communication or behavioral disorder.

How Words First Helps Children and Young People with Selective Mutism

We understand that SM can significantly improve when appropriate support is implemented and key individuals around the child are aware of what alleviates their anxiety versus what exacerbates it.

Unfortunately, many common strategies used by adults to help children with SM can inadvertently reinforce the issue. These include speaking for them, pressuring them to talk before they are ready, permitting them to avoid social situations, and inadvertently rewarding avoidance behavior.

Our approach to supporting a CYP with selective mutism is grounded in the work of renowned SaLT, Maggie Johnson, a leading expert in SM.

Our strategies include:

• Providing education and advice to parents and school staff, while agreeing on modifications to address maintaining factors.
• Identifying at least one trusted adult at school to build rapport and trust with the CYP, and utilizing friends and family members as communication ‘bridges’ in specific situations.
• Discussing SM with the CYP to enhance their confidence and independence both at home and in school.
• Implementing a ‘small steps’ program to encourage speaking with one trusted adult in school, gradually expanding the range of people and/or situations in a phased manner.
• Offering ongoing support for confidence building, social skills development, and assertiveness training for the CYP.

How Can You Help a Child or Young Person with Selective Mutism?

If you know someone with SM and are looking for ways to enhance your interactions with them, here are some helpful tips for parents and staff:

What Not to Do:

• Don’t take it personally! Remember, they’re not choosing to be silent.
• Avoid asking direct questions, as this can put them on the spot.
• Don’t overreact when they do speak; while it’s tempting to show excitement, excessive praise may increase their self-consciousness.
• Don’t treat them too delicately; they can enjoy playful interactions, but it’s best to address any necessary corrections in private.
• Avoid surprising them; providing advanced warning can help reduce anxiety, especially in new situations.

Positive Strategies:

• Be patient and allow them to speak when they feel ready.
• Use a calm voice and relaxed body language, and speak at a slower rate if you’re naturally fast-paced.
• Allow the CYP to sit at the back or side of the classroom for a less intimidating vantage point.
• Engage them in conversation without expectations, simply commenting on their work (e.g., “I really like how you’ve…”).
• Create opportunities for communication without direct questions (e.g., “I love this colour; I wonder how you mixed it?” instead of “How did you make this colour?”).
• Respond warmly to any form of communication, including gestures or whispers.
• Foster an environment where all forms of contribution are valued, emphasizing that active listening and note-taking are also important.
• Encourage classmates to support the CYP by not pressuring them to speak or overreacting if they do.

For further information and support, consider visiting the Selective Mutism Information and Research Association.