What is Selective Mutism? And Why is It So Unheard Of?

Chances are unless you know someone with selective mutism, you’ve probably never heard of it. Or if you have, you know little to nothing about it. So, what is selective mutism? And why is it so unheard of?

Selective mutism is largely unheard of, so why is that? What is the disorder and why is it so uncommon?

Growing up with selective mutism I always knew there was something different about me, but I didn’t understand what. The lack of knowledge and education around selective mutism made my life so much harder, so spreading awareness about SM is something that’s hugely important to me.

In this post, I will cover those questions as well as the signs and symptoms, types of treatment, causes, whether or not there’s a correlation with autism, and how to get a child with selective mutism to speak. So, if you haven’t heard of selective mutism this post will tell you exactly what you need to know!

This post is all about what is selective mutism!

 

What is Selective Mutism?

Selective mutism (SM)  is an anxiety disorder that causes someone to be unable to speak in certain situations, such as in school or even around extended family while being able to speak perfectly fine in other situations such as at home or around close friends. While SM is considered a childhood disorder, it can also carry on into adulthood if left untreated.

SM is considered by some to be an extreme fear or phobia of speaking or of situations where one may be expected to speak.

It’s important to note that not speaking is never a choice for someone with selective mutism, it’s an entirely involuntary response their brain produces to stress.

 

Related Post: How to Help a Child With Selective Mutism

 

What are the Signs?

Selective mutism can start at any age but begins most often between the ages of two and four. It’s often first noticed when a child begins to interact more with people outside of their family, such as at the start of school. The child will exhibit an inability to speak with many of their peers and teachers.

 

Forms of Communication

Some children with SM will use non-verbal language, such as nodding, pointing, or facial expressions to communicate. People with SM can sometimes be thought of as “professional mimes”, using whatever means they can to get their point across nonverbally. While others can’t use any form of communication while in their frozen state, including writing. Some children with SM may be able to respond verbally in a few words or a whisper but are still limited in their communication.

 

Body Language

Someone with SM may display frozen or paralyzed body language when met with interaction with someone outside their comfort zone. They may appear stiff and uncomfortable, avoid eye contact, or display anxious behaviours such as playing with their hair or tugging at sleeves.

It’s common for it to seem that a child with SM doesn’t smile, they often carry a very blank expression. The freeze state of SM often brings with it somewhat of a flat affect making it seem as if the child is unhappy or disinterested. This doesn’t necessarily actually reflect the child’s state of mind at that moment. The same child may be completely smiley and carefree while at home.

 

Sensory Issues

Some children with SM also have sensory processing disorder (DSI). Meaning they are oversensitive to stimuli such as light, sound, touch, taste, and smell. They may get overstimulated by bright lights, loud noises, or busy stressful environments, which can lead to frustration and anxiety. They may shut down or withdraw from situations that trigger their DSI, or it may lead to them acting out and displaying negative behaviours.

 

Fear of Making Mistakes

Many people with SM are afraid to do anything that may draw attention to themselves. They can be afraid to do anything outside their normal routine in case it provokes questions or comments. Children may refrain from even asking to use the washroom in class which could lead to accidents. They may also struggle in class because they’re unable to raise their hand or ask questions.

People with SM often have a fear of making mistakes, they’re afraid of doing or saying the wrong thing and being judged for it. Ironically, we likely end up more judged for not speaking than we would for anything else we could do or say, but our anxiety doesn’t let us think that way.

 

What Causes SM?

The exact cause of selective mutism is unknown, but it’s attributed to a predisposition for anxiety and genetic factors. People with SM can display a tendency to withdraw from new or unfamiliar situations and often have at least one other anxiety disorder such as social anxiety.

 

Related Post: What Causes Selective Mutism? Misconceptions & More!

 

Why is it So Uncommon?

SM is extremely rare, less than 1% of the population has the disorder. Therefore, it’s widely unknown by the general public and studies on the disorder are scarce. Textbook definitions are also limited and can even be misleading. There was a portion about SM in my Psych 101 textbook that incorrectly described the disorder as a developmental delay (*eye roll*). While developmental delays can be comorbid with SM, SM is not itself a developmental delay.

This lack of knowledge can be incredibly frustrating for someone with SM, as they often feel misunderstood by those around them. People often mis-assume the disorder for something else, such as autism, shyness, or even just general defiance. There’s not a lot of public knowledge of the disorder and it’s not something you hear about or see represented very often.

The only public representation of the disorder I know of is Raj from The Big Bang Theory and even then most people probably aren’t aware of it. The disorder is only mentioned by name once in the episode “The Cornhusker Vortex”. It’s unfortunate to have what could be widely known representation be somewhat swept under the rug in the show.

 

Selective Mutism and Autism. What is the Correlation? Is there One? 

The short answer is, no there isn’t. The two disorders are entirely separate. While the disorders may share some overlapping symptoms, those symptoms are generally only present in someone with SM while in their freeze state, whereas someone with autism would display those symptoms all the time. Though, the two disorders are comorbid, meaning it’s not uncommon for them to occur together.

Some other comorbid disorders include separation anxiety, generalized anxiety disorder, OCD, depression, premorbid speech and language abnormalities, developmental delay, and Asperger’s disorders.

 

Related Post: Selective Mutism and Autism: Is There a Link?

 

How Do You Get a Child with SM to Speak?

You don’t pressure them. This is so important, I cannot stress this enough. Do not force a child with selective mutism to speak, this only reinforces their anxiety around speaking and makes it harder for them to do so in the future. For a child with SM to speak they need to feel comfortable enough to do so. This means you need to feel like a safe person. A safe person does not pressure or make them feel obligated to speak. Demanding speech is a surefire way to ensure someone with SM never speaks to you.

If someone with SM doesn’t feel comfortable talking to you, spend time with them doing an activity that doesn’t require speech or talk to them without expectation of a response. This will let someone with SM know that they can feel safe with you, then they may begin to talk, little by little, and eventually, they may feel fully comfortable being themselves around you. You may hardly even recognize the quiet person they were before

 

How Do You Treat SM?

Treatment for SM is not just about getting the child to speak, it’s about reducing the anxiety around speaking. This begins in the home and at school. It’s important to remove all pressure on the child to speak so that they feel safe in their environment. Then they may begin to feel comfortable saying one or two words or maybe speaking to one person. The goal is to eventually get them comfortable enough to speak to all people in all environments. The need for further treatment can be prevented by early intervention and by creating these safe spaces for your child. This means informing your child’s teachers about the disorder and getting them to follow suit in the classroom.

It’s important to note you shouldn’t get too excited when the child does speak, respond in a warm kind manner as you would with any child, but don’t make a big deal out of it!

 

Further methods of treatment include:

• Cognitive Behavioral Therapy (CBT)
• Behavioral Therapy
• Graded Exposure
• Stimulus Fading
• Shaping
• Positive and Negative Reinforcement
• Desensitization
• Medication

The most common method of treatment is Behavioral Therapy. This involves gradual exposure to increasingly difficult tasks. Over time the child learns the anxiety they feel about speaking has decreased. They can then accomplish these tasks without avoidance.

Medication is generally only used in older kids and teenagers whose anxiety is especially debilitating or has led to depression. It is best used alongside other forms of treatment.

 

As you can see selective mutism is so much more than just not speaking. Hopefully, now you have a much better understanding of the disorder and why knowledge of it is so scarce.

 

Post by Morgan Peters

 

Other Posts You May Like:

How to Help a Child With Selective Mutism

What Causes Selective Mutism? Misconceptions & More!

Selective Mutism and Autism: Is There a Link?

 

Sources:

“Selective Mutism.” NHS Choices, NHS, 17 Feb. 2023, https://www.nhs.uk/mental-health/conditions/selective-mutism/#:~:text=Selective%20mutism%20is%20an%20anxiety,untreated%2C%20can%20persist%20into%20adulthood.