Selective mutism: children and teenagers

What is selective mutism?

Children with selective mutism can’t speak in certain places, with certain people or during certain social activities.

Most commonly, children don’t speak at preschool or school. But at home, they can comfortably speak with you and others in your immediate family.

Selective mutism is an anxiety disorder. Children with selective mutism don’t choose to be silent. They want to speak and try to speak, but their anxiety stops them.

Selective mutism is also sometimes called ‘situational mutism’.

All children feel anxious sometimes. But children with selective mutism have anxiety that is longer lasting and gets in the way of learning, friendships and other important aspects of daily life and development.

Signs and symptoms of selective mutism

You might first notice signs of selective mutism when children start going to preschool or school, at 3-6 years of age. You might notice behaviour or physical signs, or your child might tell you about these signs.

Behaviour signs
If your child has selective mutism, you might notice that they:

can’t speak to people outside your immediate family, including grandparents, carers, teachers and classmates
can’t speak to you in places where others might see or hear them speaking
look away when others are looking at them or speaking to them, lower their voice or whisper, use fewer words, or look at you when they speak to other people
find it hard to join in play or activities with other children and make friends
avoid doing things where they’re the focus of attention – for example, having their photo taken, giving something to a teacher or playing sport in front of people
find it hard to ask for help with things – for example, telling someone they’re hurt or asking to go to the toilet
seem distracted or seem to have trouble thinking clearly, paying attention or concentrating.

Physical signs
If your child has selective mutism, you might notice some physical signs when other people expect them to speak. For example, your child might:

‘freeze’
seem restless
look tense
tremble and blush
say they have a racing heart, clammy hands or a sore stomach.

If your child is old enough, they might tell you when or why they feel anxious. For example, your child might feel anxious when they don’t know what to say or are worried about making a mistake. They might think their voice sounds funny or not like people looking at them. But often children don’t know why they don’t speak.

It’s common for children with selective mutism to have another anxiety disorder like social anxiety, separation anxiety or generalised anxiety. Some children with selective mutism might also have language delay, communication disorders or autism.

Professional help: when to get it for children with selective mutism

If your child doesn’t speak outside your home for more than 3 months, they need professional help. It’s also important to get help if your child’s selective mutism is affecting their learning at school and their ability to socialise and make friends.

These professionals can help you:

Your child’s GP or paediatrician – these professionals can refer you to a psychologist or psychiatrist.
A psychologist who works with children with anxiety disorders – you can find one through the Australian Clinical Psychology Association or Australian Psychological Society.
A specialist anxiety clinic or selective mutism clinic – these are available in most states.
Your local child and adolescent mental health service – search online for these services.

Children who get professional help in their preschool and early school years often recover from selective mutism more quickly than those who don’t. Without professional help, there’s a chance that speaking difficulties might not completely go away or might persist into adulthood.

Diagnosing selective mutism

To diagnose selective mutism, your mental health professional will look at the way your child behaves and communicates in different situations, as well as their anxiety symptoms.

Your child might need a hearing or speech assessment to check whether they also have language delay.

Therapies for selective mutism

The stepladder approach and other graded exposure therapies are an essential part of treatment for selective mutism. The stepladder approach involves your child starting with ways of communicating that are easier for them, like nodding their head or pointing. Then your child gradually builds up to activities that require speech.

The stepladder approach requires regular practice sessions at your child’s preschool or school. This means you’ll need to share your child’s treatment plan with your child’s teacher and work with them to implement the approach.

If your child is older, your child’s mental health professional is also likely to use cognitive behaviour therapy (CBT). CBT can help your child identify any worries and build more confident and positive self-talk and social skills.

If your child has language delay, they’ll get speech therapy to build their language skills. This might not happen until later when your child is more comfortable using their voice.

Medicine is sometimes prescribed for children who take a while to improve with CBT.

How to help children with selective mutism: tips

If your child has selective mutism, they need your support to build speaking skills and confidence. There are many things you can do:

at home with your child
during everyday conversations
when working with people in your child’s support network.

At home

Acknowledge your child’s anxiety about speaking. Let your child know that they won’t get in trouble if they don’t speak when they’re away from home or you.
When you’re alone with your child, praise their speaking efforts and achievements, especially as they reach milestones.
Model positive and confident behaviour in social situations. For example, smile at people, say hello and ask how people are when you meet them.
Talk to your child about times when you feel anxious and how you manage this with calm breathing, helpful self-talk and wiliness to give things a go. This will help your child understand that it’s OK to talk about anxious feelings.
Read books with your child that are about nervous, scared or shy feelings or that have characters who overcome speaking difficulties. These can help your child understand their own challenges and give them ideas about how to overcome them.
Be patient with your child’s progress, and try to keep frustration to yourself. This will help your child build the confidence they need to speak.

Everyday conversations

Give your child time to respond to questions. If they do respond, continue with the conversation.
Try asking or rephrasing questions so your child can answer with a single word like ‘yes’, ‘no’ or ‘OK’. One-word answers can build up to a few words over time.
Encourage your child to use non-verbal communication, like gesturing or pointing, to be part of conversations. For example, if someone asks your child how old they are, you could say, ‘Sarah, you’re 5 years old’, and hold up your hand with 5 fingers. Your child can respond with a nod.
Help your child practise communicating in places outside your home, but make sure your expectations match what your child is capable of. For example, if your child is still building up to using words outside your home, they might be able to point to an item on a menu.
Give your child time to warm up their voice and join activities gradually. For example, chat to your child on the side while you watch other children play. Gradually move closer to the children so your child can join them.
If someone asks you why your child doesn’t speak, let the person know it’s something your child is working on. For example, ‘Jin talks at home. He’s learning to feel comfortable speaking in other places’.

Your child’s support network

Tell teachers, relatives, family friends and other carers that your child has selective mutism. Let them know the best ways to interact with your child. This might include some of the conversation tips above.
Work with your child’s teachers to plan your child’s preschool or school transitions. For example, at the start of a new school year, ask for your child to be put in a class with familiar children. Or take your child on a tour of a new classroom and ask to meet their new teacher and spend time playing a nonverbal game.
Organise playdates at home with 1-2 of your child’s friends. Set up activities that help your child relax, like bubbles, ball games or trampolining. The longer the playdate, the more likely your child is to start communicating.

With regular practice at home, at school and in the community, children with selective mutism can overcome speaking difficulties. But it can take time – up to several years. Even when your child does start to speak, they’ll need support to build speaking confidence in all situations. It’s important to monitor how much your child speaks and talk with your child’s health professional if you have any concerns.

Financial support for children with selective mutism

Your child might be able to get Medicare rebates for up to 10 sessions with a mental health professional each calendar year.

To get these rebates, your child will need a mental health treatment plan from a GP (this covers the services your child needs and the goals of the treatment) or a referral from a psychiatrist or paediatrician.

If your child is showing delays in their social skills and learning, they might be eligible for support from the NDIS.

Causes of selective mutism

We’re still learning about what causes selective mutism but, like other anxiety disorders, it’s common for it to run in families. This suggests that there’s a genetic link.