What is Selective Mutism?
What is selective mutism? Selective mutism is an anxiety disorder that most commonly occurs in children but may also affect adults. This condition is characterized by an inability to speak in certain situations.
Those who have selective mutism are able to talk but find it incredibly difficult in some settings due to anxiety. It is most commonly diagnosed in children; however, it is still a rare condition. It is currently estimated that less than 1% of individuals have selective mutism.
How Anxiety Causes Selective Mutism
Selective mutism is believed to be an anxiety disorder, as the individual is not choosing to be silent, but rather they are too scared to speak.
Prior to 2013, when selective mutism was first classified as an anxiety disorder within the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), it was actually called “elective mutism."
Some actually refer to selective mutism as a phobia of talking; however, many people can be confident speaking in select situations, but then struggle in more unfamiliar settings.
Onset typically happens around 5 years of age, which may be due to the fact that children begin attending daycare or school at this age. For some, the issue may persist into their adult life.
Selective mutism often occurs alongside symptoms of social anxiety, including but not limited to:
- Avoiding conversation.
- Freezing when put on the spot.
- Extreme shyness.
- A lack of eye contact.
- Hiding or running away.
- Avoiding being in photos.
- Having anxiety over activities, like eating or using the restroom in public.
Many feel unable to speak due to intense anxiety or shyness, while others may fear that other people are judging, criticizing, or completely ignoring them.
Common Symptoms
There are symptoms of selective mutism that separate it from other anxiety disorders. If you or someone you know experience some or all of the following symptoms, it may be beneficial to speak with your doctor.
1. The Inability to Speak Even Though You Want To
Displaying a desire to speak, but holding back due to fear, anxiety or embarrassment can be an indication of selective mutism. This difficulty must be consistent and generally occurs in situations where communication is expected, like at school or work.
In order to be classified as selective mutism, symptoms must persist for at least one month and interfere with one’s ability to live their daily life.
2. Avoiding Eye Contact
Some may also try to avoid making eye contact with other people or fidget in particular situations. Completely lacking expression or lacking movement when in fearful settings is also common.
3. A Sense of Shyness
In young children, being very shy and reluctant to speak between the ages of 2 to 4 years of age is an early sign. Some toddlers might even fear interacting with other people entirely.
Many individuals will be able to speak easily in some cases, like at home or at a friend’s house. Once in an uncomfortable or anxiety-inducing scenario, this same person will be rendered unable to talk.
4. Use of Non-Verbal Gestures
The largest indicator of selective mutism is the inability to speak in certain situations or in specific places. Some may try to overcome this inability by expressing one’s needs using non-verbal communication instead of speaking.
Gestures such as pointing, nodding, or shaking one’s head are common, while others choose to whisper or write things down.
In all cases, this inability or difficulty to talk is not due to a lack of knowledge or intelligence, nor is it as a result of discomfort with the language that they are speaking. Selective mutism is not due to another condition, like a communication or learning disorder, but stems from anxiety.
How is Selective Mutism Treated?
If left untreated, selective mutism can lead to other problems including social anxiety, isolation, low self-esteem, or academic issues. If not caught early, there is a chance that a child will become comfortable with being silent and find it much more difficult to change their behavior.
The goals of treatment for selective mutism are centered around reducing anxiety in social situations, practicing speaking and reinforcing non-avoidant behavior. By making the person feel safe while gradually working on building their confidence, the anxiety surrounding communication will begin to decrease.
1. Psychotherapy
As with many anxiety disorders, psychotherapy will offer people the support they need to talk about their mental health and work through the fear that they have surrounding communication. Most programs involve a combination of desensitization and positive reinforcement.
2. Exposure-Based Therapy
Exposure-based therapy will gradually expose an individual to situations that make them uncomfortable, so they can practice speaking despite feeling anxious. This builds confidence over time and repetition.
3. Augmentative and Alternative Communication
Augmentative and alternative communication (AAL) is not a long-term solution but does give people an alternative way of communicating that may be less stressful. Using gestures, pointing, or writing words down offers short-term assistance in communicating without speech.
4. Visiting a Speech Language Pathologist
Speech language pathologists (CLPs) may also use ritual sound approach (RSA) in which they teach an individual to produce sounds from a mechanical standpoint. Therapy can begin with noises like coughing, working up to producing syllables and words.
5. Medication
Medication can also assist, especially in severe or chronic cases, or in cases where psychotherapy alone has not been effective.
Reach out to your doctor if you feel that you may struggle with selective mutism, as they will be able to work with you to determine your best course of action in receiving a diagnosis and what course of treatment will work best for you.