5 Symptoms Of Selective Mutism In Children & Its Consequences

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Selective mutism in children is an inability to interact with people or talk comfortably in a social setting. It is an anxiety disorder of childhood where children may talk freely at home or with people they are close to but are extremely reserved in a group of people. Often they may find it difficult to open up and communicate in public places.

Read on to know about the causes, symptoms, consequences, and treatments for selective mutism in children.

Symptoms Of Selective Mutism In Children

Selective mutism in children usually begins around two to four years and becomes evident when children start attending school. You may notice the following symptoms during the early childhood years (1) (2).

1. Inability to speak in public

The child has trouble communicating in public or social settings, such as school, playgrounds, and parties. They may also get intimidated by others easily and go mute when someone tries to talk to them.

2. Difficulty in making friends

They may face trouble forming good relationships with peers. Since the child has difficulty in making conversation, their communication with their peers is limited, making it difficult for them to bond and make friends.

3. Hesitation to use a language other than the mother tongue

Some children may feel uncomfortable when they have to communicate in a second language.

4. Speech problems

This could either be a lack of clarity of speech or the child feeling paralyzed in social situations. The child may fear to open up in front of people, thus shutting down completely.

5. Using non-verbal communication

The child might use hand gestures, nod the head to convey a no or yes, or use facial expressions and body language to avoid communicating verbally.

Sometimes, children with selective mutism may also face difficulty talking to familiar adults in front of other people. These adults could be as close as the parents of the child.

Causes Of Selective Mutism In Children

The exact cause of selective mutism in children is not known. However, studies suggest that it could be due to a combination of several factors (3) (4).

  1. Genetic factors: If selective mutism runs in the family, a child is at a higher risk of developing it.
  2. Neurodevelopmental factors: Children with neurodevelopmental conditions such as speech problems or autism spectrum disorder tend to develop selective mutism.
  3. Temperament: Behavioral inhibition trait, in which the child goes through avoidance or fearfulness around unfamiliar people, is also associated with selective mutism.
  4. Environmental factors: A major change in life, such as starting school, can also trigger symptoms of selective mutism. Unlike shy children who begin to open up with time, children with selective mutism may find comfort in staying mute.

Besides these, the following factors could also contribute to selective mutism in children.

  • Pre-existing anxiety disorder
  • Shy personality and fear of embarrassment
  • Fear of interaction or making friends
  • Nervousness in general
  • Family problems
  • Previously untreated mental disorders
  • A traumatic experience
  • Speech problems

Consequences Of Selective Mutism In Children

Selective mutism may lead to the following consequences in the child (3).

  1. Isolation: The child may begin to find comfort in solitude. They may feel better when alone as they do not have to face the anxiety of communicating with people, which can lead them to feel isolated.
  2. Anxiety disorder: Children with selective mutism may develop anxiety issues. When the child gets nervous in social situations, it could lead to immense stress and anxiety.
  3. Depression: Selective mutism in children may lead to depression as they prefer being alone at all times. This could lead to feelings of loneliness and persistent sadness.
  4. Communication disorder: It can also lead to communication disorder, wherein the child may face difficulty in comprehending and responding during conversations.

Diagnosing Selective Mutism In Children

The child’s psychiatrist would follow these steps to diagnose selective mutism and rule out other mental health issues (3).

  • The professional enquires about the child’s medical history, speech development, language development, and academic performance.
  • They get an insight into the child’s behavior in school or other social setups and at home too.
  • They may also examine the child’s ears, lips, tongue, and jaws, conduct a neurological exam, and do some tests to rule out other medical problems, such as schizophrenia.

A few other professionals, such as trained speech and language pathologists, may be involved to test and assess the child to understand any underlying emotional problems that could have led to the onset of the disorder.

Treatment For Selective Mutism In Children

There are multiple ways of treating selective mutism in children. The following options may be used depending on the child’s symptoms (2) (3).

1. Speech therapy

Speech therapy is used to help the child overcome speech and comprehension issues.

2. Stimulus fading

In this technique, the child is encouraged to talk to a person they are usually comfortable talking to in a relaxing environment, and then a new person is introduced to them.

3. Shaping

The shaping technique is an approach that involves making gestures, whispering, or using facial expressions until the child becomes comfortable communicating. It is good for the parents and immediate family members to learn to acknowledge these gestures and communicate similarly with the child. This allows the child to feel safe and comfortable.

4. Self-modeling

Self-modeling involves allowing the child to watch videos of themselves communicating comfortably at home. This helps boost the child’s confidence.

Some other methods to treat selective mutism in children include behavioral therapy and family therapy, which help resolve emotional issues. In some cases, medications prescribed by a professional may be used to reduce the child’s anxiety.

Dealing With Selective Mutism In Children

Here are some tips that can help you and the child deal with selective mutism (5).

  • Let the child warm up and feel comfortable before they have to begin speaking.
  • Observe the child’s body language when they are speaking.
  • Let the child feel free to hesitate, and give them the space they need if they find it challenging to overcome the hesitation of conversing.
  • Repeat what you say if the child is unable to comprehend without mocking or intimidating the child.
  • Accept the child’s level of communication.

Frequently Asked Questions

1. Is selective mutism a special educational need?

Yes. Children with selective mutism might require special attention to their educational needs and the way of teaching (6).

2. What happens if selective mutism is left untreated?

If left untreated, selective mutism might give rise to the following conditions in children:

  • Isolation
  • Anxiety disorders
  • Low self-esteem

Selective mutism in children may manifest as an inability to speak in public, a reluctance to make friends and speak in other languages, and a preference for nonverbal communication over verbal language. Interaction with them regularly could assist them in overcoming the disorder. However, it is critical to diagnose and manage the condition early to avoid depression, isolation, communication difficulty, and other complications. The children can gradually gain confidence and talk to people in any environment with the support and encouragement of parents, caretakers, teachers, and specialists.

Key Pointers

  • Selective mutism is when children talk freely at home but do not interact in a social setting.
  • Some symptoms are difficulty making friends, speech problems, and hesitation in using languages other than the mother tongue.
  • Anxiety disorder, shy personality, and traumatic experiences are some causes for selective mutism.
  • Making children feel comfortable, accepting their level of communication, and giving them space are some ways to deal with selective mutism in children.


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Manjari Srivastava

Manjari Srivastava is a graduate of psychology. She also holds certificates in Basics In Clinical Psychology and Identifying Early Signs Of Psychosis In Adolescents And Young Adults.  Previously, she volunteered with an NGO specializing in positive psychology, where she took up individual counseling sessions for students. She also taught English to underprivileged children and helped them with their studies. At MomJunction,... more

Dr. Arva M Bhavnagarwala

Dr. Arva Bhavnagarwala has completed her post-graduation from Masina Hospital in Mumbai. She has worked at Jaslok Hospital and Research Center as a Clinical Associate. Currently, she practices Pediatrics at her private clinic in South Mumbai and is attached to Masina Hospital as a consultant pediatrician. Dr. Bhavnagarwala is a National Advisory Board Member of Indian Pediatrics, the official publication... more