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Selective Mutism

​Selective Mutism is a little known anxiety disorder, which according to global statistics affects approximately 1 in every 143 people. Although, due to limited research on prevalence, it is suspected this number is a lot higher. Many people suffering from selective mutism can go undiagnosed because they are often mislabelled as defiant, socially awkward and/or shy. Sadly, it is not unusual for selective mutism to continue into adolescence and adulthood.  ​Selective Mutism prevents a person from communicating in certain social situations, and is often first detected by a concerned caregiver or a teacher at kindy or school. The parents are often the last to realise, because those with selective mutism chat happily in environments where they feel comfortable and safe such as home.   ​If someone you know and love does not get the right support there can be devastating consequences. Untreated Selective Mutism is likely to become more entrenched and complex making it harder to treat.  Those who are unsupported with selective mutism can develop other issues later on.  These include but are not limited to obsessive compulsive disorder (OCD), generalised anxiety disorder, social anxiety disorder, depression, substance abuse and even progressive mutism.   Progressive Mutism is a condition which causes the person suffering from selective mutism to shut down completely in all social settings, even with family.   It is important to understand that selective mutism is NOT a choice. This condition is as physiological as it is psychological.  The stress response 'Freeze' plays a major role in the physiological aspect of selective mutism.   When the freeze response is triggered the muscles in the face and throat stop working making it impossible for someone to speak and make facial expressions.   Even non verbal communication becomes difficult if not impossible, such as waving, smiling, nodding, writing and moving comfortably.  Anxiety and the stress response can create an intertwining loop which can be challenging to break. However, with patience and a kind supportive approach using cues of safety, and gradual exposure this loop can be rewired. Selective Mutism needs a whole collaborative approach working on the inside out. Children with selective mutism require a team of parents, families, friends and teachers working together to help create a safe supportive space for them to grow.  Teens and adults also require the people in their social circles to work together in an understanding and supportive way. To help someone with selective mutism we must work on the environment by removing pressure and expectation for immediate speech. It is paramount to understand that selective mutism is a journey, there is no quick fix, it takes time and support. Caregivers, family members, co workers must become aware of their tone of voice and body language, and must be willing to create spaces which feel safe and relaxed.   When a person who is suffering from selective mutism feels safe and comfortable the nervous system can disengage from the 'freeze' response allowing them to socially engage.  This is why it is important to work on reducing the anxiety without emphasis on the selective mutism.  ​ The word 'selective' in selective mutism does not mean the child is selecting when to talk, but it is indicative to the freeze response being triggered in a variety of situations which shut the person down.  For example, a child may talk and play freely with peers on the school playground, but within a classroom setting the same child may struggle to speak and socially engage.  ​ No two people or children with selective mutism present the same. There is a spectrum for selective mutism, ranging from low profile to high profile.  Each strategy to help support a person with selective mutism must be individually tailored to meet that person's unique needs.

References 

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders; DSM-5-TR (Arlington, American Psychiatric Publishing, 2013). 

National Health Board (NHS), "Selective Mutism" last modified August  27, 2019. https://www.nhs.uk/mental-health/conditions/selective-mutism/ 

White, Joe; Caroline, Bond, Claire, Carroll, "An exploration of how selective mutism training informs teachers’ understanding and practice," Support for Learning, 37, no.1 (2022): 1-18. DOI: 10.1111/1467-9604.12392

Johnson, Maggie; Wintgens, Alison, The Selective Mutism Resource Manual (Bournemouth, Routledge, 2016).

Schwenck, Christina; Vogel, Felix. "Psychophysiological mechanisms underlying the failure to speak: a comparison between children with selective mutism and social anxiety disorder on autonomic arousal" Child and Adolescent Psychiatry and Mental Health 15, no.81 (2021) 1-17, https://doi.org/10.1186/s13034-021-00430-1. 

Porges, Stephen. The Polyvagal Theory: Neurophysiological Foundations of Emotions Attachment Communication Self-Regulation. New York: W.W. Norton & Company, 2011
Felix Vogel,  Angelika Gensthaler,  Christina Schwenck, “Frozen with Fear? Attentional Mechanisms in Children with Selective Mutism,” Cognitive Therapy and Research, no. 46 (2022) 629-645. https://doi.org/10.1007/s10608-021-10289-3

If you or someone you know is struggling with Selective Mutism you can join a support room online by clicking on this link  https://www.facebook.com/groups/7745344102195931/

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