By Claire Mitchelmore, Provisional Psychologist
(AI-assisted)

What is selective mutism

Selective Mutism is an anxiety disorder in which your child may find themselves unable to speak in one or more social situations (e.g. at school, in public places, with friends or extended family members) despite the ability to speak comfortably in other settings (e.g. at home with immediate family). They may have difficulty speaking with certain people, in particular places or during specific activities. It is most common for children to not speak at preschool or school.

It should be noted that your child is not choosing to be silent in these situations. Rather, overwhelming anxious thoughts and feelings are preventing them from doing so. As your child struggles to communicate, you may notice them having difficulties in learning, social interactions, and overall development.

All children feel anxious at some point and may be quiet is some situations. The duration of the difficulties (more than one month) and a significant impact on your child’s daily functioning are required for your child to be diagnosed with Selective Mutism.

Your child’s inability to speak also cannot be the result of a lack of knowledge about the language being spoken or another communication disorder like stuttering. In this regard, your child may be referred for a hearing or speech assessment to rule out whether they have a language delay.

Signs and symptoms of selective mutism

Your child may be old enough to tell you when they feel anxious. They might share that they feel worried about how they might sound to others or do not know what to say or do in certain social situations. However, your child may not know why they feel this way.

Instead, you may need to look for anxious and avoidant behaviours related to selective mutism. For instance, you may notice that your child:

• has difficulty speaking to anyone outside your immediate family, especially in public or social settings,
• may avoid eye contact, speak quietly or use fewer words, or rely on a familiar person to communicate with others,
• struggles to join group activities, make friends, or be the centre of attention, or
• may find it hard to ask for help and can appear distracted or have trouble focusing and concentrating.

Your child may also display some physical signs when expected to speak, for example your child might:

• ‘freeze,’ or run and hide away,
• become restless,
• appear tense,
• start to tremble and blush, or
• complain that their heart is racing, or that they have clammy hands or a sore stomach.

How does it affect children?

The anxiety associated with speaking in certain settings can result in a range of developmental and social challenges for your child.

Firstly, selective mutism can hinder your child’s the development of broader communication skills. This can include challenges with speech clarity and intelligibility due to limited opportunities to practice speaking. Non-verbal skills can be similarly affected, such as engaging in appropriate eye contact, maintaining a comfortable conversational distance, and turn-taking in conversations.

Struggles with communication may extend into the classroom and you may start to notice a decline in your child’s academic performance. In this instance, your child may struggle with verbal assessments, participate less in class discussions, and experience difficulties in developing literacy skills like reading and writing. They may also struggle to ask for help or express their needs, leading to missed opportunities for support.

Finally, selective mutism can have a detrimental effect on your child’s social and emotional development. Their experience of significant social anxiety and fear of judgment in social situations can lead to social withdrawal and avoidance of social interactions, resulting in further social isolation. In some instances, your child may even become the target of bullying. These difficulties in forming and maintaining relationships can, in turn, adversely impact your child’s self-esteem and overall emotional wellbeing.

How can I support my child’s ability to communicate?

Overcoming selective mutism takes regular practice. There are several things you can do at home, at school and within your social network to support your child.

At home, you can support your child by:

• reassuring them they won’t be punished for staying silent outside the home, and praise their speaking efforts privately to build confidence;
• modelling positive social behaviour by interacting warmly with others, and sharing your own experiences of managing anxiety to normalise and guide emotional coping;
• reading books about shyness or characters overcoming speech challenges to help your child relate and find strategies, and
• above all, being patient and avoid showing frustration, as this fosters a safe and encouraging environment for your child’s progress.

You can work with your child’s school to put a plan in place to support your child. This may include:

• formulating a plan to help ease transitions with new teachers and other students, e.g., arranging a tour of the school, meeting a new teacher and playing a silent game with them, or arranging for some familiar students to be in the same class as your child the following year; or
• alternative means of communication such as the use of cards, hand signs, or other non-verbal tools of communication.

Let those within your social network, such as friends and extended family members, know that your child has selective mutism. Explain the best ways they can interact with your child. This may include things like:

• giving your child time to warm up and respond to others,
• using non-verbal communication, or
• rewording questions so that your child has the option to give a one-word answer such as ‘yes’ or ‘no’.

These skills take time to develop and may be linked to other anxiety disorders and/or neurodevelopmental challenges. You may therefore consider receiving targeted therapy and support from a mental health practitioner.

How can therapy help my child build confidence in speaking?

Therapeutic approaches such as Cognitive-Based Therapy (CBT) can significantly support your child with selective mutism by:

• Addressing anxiety

A therapist can help your child develop a range of coping strategies for anxiety, providing them with the skills to remain calm when anxious thoughts and feelings arise. They can also help your child identify and challenge negative thought patterns related to speaking, which can help reduce feelings of anxiety in social situations.

• Building communication skills

In addition, your therapist can help your child develop their communication skills by developing and practicing communication scripts and role-playing social interactions.

• Gradually increasing their comfort in speaking situations. 

Your child’s confidence in speaking to others may be further enhanced using gradual exposure to speaking situations, starting with less anxiety-provoking situations and working up to more challenging situations.

Whilst therapy can directly target your child’s development, your therapist can also collaborate with you, your family and other relevant professionals to develop environmental strategies that best support your child.

In this regard, parent and caregiver sessions may be provided to help you and your family to better understand and support your child. Your therapist may also collaborate with your child’s speech therapist, occupational therapist, paediatrician, or other allied support to identify education, strategies, and other supports that can be used at home, school, or in social settings. Furthermore, the therapist may use assessment information to advocate for your child’s functional needs in educational and social settings, and motivate to apply for or adjust disability funding (if required).

Ready to Take the Next Step?

At Spencer Health, we assess and work with children, adults, parents and families with a variety of presentations. We offer a range of services including assessment, therapy and coaching with many services being delivered via telehealth. If you are ready to book in an initial evaluation of your child, or are maybe interested in just having an initial conversation with one of our trained psychologists to decide if it is worth pursuing treatment, please get in touch. Spencer Health is a neuroaffirming organisation and we are lucky to count many neurodivergent psychologists as colleagues.

If you would like to meet more of our team, or learn more about our services you can do so here https://spencerhealth.com.au/spencer-health-team/ or if you are ready to book in, you can do so here https://spencerhealth.com.au/contact/