Ages 3–5 | Child Health + Development | Special Needs | Ages + Stages | Ages 6–10

The Silent Treatment: Helping Kids Overcome Selective Mutism

selective mutism and how to help your child blond boy elementary ageColleen Haggerty remembers when her chatty 3-year-old, Tessa, stopped talking: It was during the Thanksgiving holiday weekend.

At first, Haggerty chalked it up to shyness. But when Tessa received a Christmas gift from family friends and didn’t thank them, Haggerty took her aside to cajole her, even offering her $10 to say the words. Tessa burst into tears and said, “I can’t.”

Eleven years later, Haggerty cringes about offering that reward, knowing that her Bellingham eighth-grader has selective mutism.

What is selective mutism?

Many people haven’t heard of selective mutism, but mental health professionals and scientists have been describing children with symptoms of the condition for more than a century.

Thought to affect up to 2 percent of early elementary school–age children, selective mutism is an anxiety-based mental health condition that causes kids to fear speaking in some situations but not others. Typically comfortable at home with immediate family, these kids experience anxiety either in specific settings or with specific people, and they become verbally paralyzed. Young kids might also avoid eye contact and gestures such as nodding. Tessa, who still can’t speak to her extended family but does fine in the classroom, describes the feeling as a zipper on her mouth and a wall in her throat.

Some experts see this condition as an extreme form of social anxiety (the fear of interacting with people and being judged negatively), but Angela McHolm, Ph.D., an Ontario-based clinical psychologist and co-author of Helping Your Child with Selective Mutism, views selective mutism and social anxiety as two separate mental health conditions, although they often overlap.

“One of the differences is that selective mutism tends to develop in the very early years — it typically shows up in preschool — while social anxiety tends to emerge later developmentally,” McHolm says. She has also seen kids who aren’t socially anxious but just can’t speak sometimes; they might be the first to raise their hands with an answer, then freeze up. The variations and degrees of selective mutism are as wide-ranging as the kids themselves.

Selectively mute kids are also assumed to be shy, and some are. But the problem with this assumption, McHolm says, is that people then expect they will speak if given enough time to get used to a situation. Shyness is not a mental health condition but a temperament trait characterized by a slowness to warm to others. However, selectively mute kids can’t start speaking of their own free will, nor can you coax them into a conversation. McHolm likens the anxiety to a phobia, such as fear of flying.

Another Bellingham parent, Sarah Daley*, attributed her daughter’s silence to introversion. But when Ellie* started kindergarten, her inability to talk to the teacher felt like a bigger issue than temperament. A former teacher herself, Daley didn’t want to raise a fuss and simply supported her daughter through the school year. But when she asked Ellie’s first-grade teacher if Ellie had been talking in class and the answer was no, she became an advocate for her daughter — and now encourages all parents to take action.

Help from the professionals

As soon as selective mutism is diagnosed (the earlier, the better), start treating it. It’s also essential to get kids talking to make sure that silence doesn’t become part of their self-identity, says Neil Kirkpatrick, Ph.D., a Seattle-area clinical psychologist who specializes in childhood anxiety disorders. Over time, not speaking can turn easily into a pattern of avoiding any situation where speaking might be expected. Social anxiety may develop as a result.

Start by going to a professional, such as a clinical psychologist with experience in treating childhood anxiety, to ensure an accurate diagnosis and to rule out other possibilities. Keep in mind that trauma rarely causes selective mutism, but the underlying anxiety likely needs to be addressed, Kirkpatrick says.

Anxiety disorders require a behavioral approach called “exposure training,” McHolm says. For speaking, this means using “conversational ladders,” a step-by-step exposure hierarchy from least anxiety-provoking to most; this helps get kids talking in the situations that normally freeze them up. If a child can’t talk to her teacher, for example, the conversational ladders must take place at school. No amount of talk therapy in a psychologist’s office will help break her silence in that setting.

When treating school-specific selective mutism, both McHolm and Kirkpatrick put together school “management teams” for kids. Getting the family and teacher on board is crucial, but equally important are the principal, a speech pathologist and the school counselor, all of whom provide continuity for the child.

Families usually need to prioritize speaking goals — and, as hard as this might be, put aside concerns about a child appearing rude or unmannered. Some families may want relatives to be part of the intervention, while others may just ask for understanding and support.

Daley’s priority for Ellie was speaking and reading aloud to her teacher. Daley began showing up at school to “help” with reading. Using the ladder approach, she and Ellie first sat at a table down the hall from the classroom to read. Over time, they moved closer to the classroom, and finally to a spot outside the door. Then they invited a classmate to read with them. Reading aloud gave Ellie a reason to use her voice without being the focus.

Next, the teacher walked past them as they read. Ellie clammed up at first, but eventually she was able to keep reading. Daley thought she would need to accompany Ellie into the classroom, but one day she got an email from Ellie’s teacher saying Ellie had just read to her.

Managing selective mutism

girl with hand over mouthWith lots of practice, a child’s speaking success eventually extends to new situations. But as tempting as it is to cheer when a child speaks, that’s the worst thing you can do. Keep it light, matter-of-fact and warm, McHolm says. “Don’t dwell on it, because these kids may feel even more pressure to perform again the next day.” Daley and Ellie’s teacher celebrate by emailing each other.

Tessa’s selective mutism has been trickier to address because the family members connected with her condition don’t live nearby. Over the years, Tessa has communicated using voice messaging, Skype, texting and notes, but she still hasn’t spoken face-to-face with her relatives, although she’s comfortable with them nonverbally and even jokes around.

Early on, Haggerty’s biggest challenge was helping other adults realize that Tessa’s silence wasn’t related to them as individuals. “People see it as a victory if Tessa talks to them — or, if she doesn’t, it’s something against them,” she says, “[but] it’s not personal.” Tessa, for her part, would like people to know that acting normal around her is what makes her most comfortable. She also emphasizes that bugging kids to talk doesn’t help.

Selective mutism is a complex disorder that’s poorly understood by educators, the general public and even professional clinicians. It can be a lonely place for families. But with the right help, kids can learn to manage their anxiety and overcome their silence.

* Names have been changed.

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