Silent Cry for Help!
What is Selective Mutism?
Selective Mutism is a
disorder most commonly found in children, characterized by a persistent
to speak in select settings, which continues for more than 1 month.
children understand spoken language and have the ability to speak
typical cases, they speak to their parents and a few selected others.
Sometimes, they do not speak to certain individuals in the home. Most
are unable to speak in school, and in other major
social situations. Generally, most function normally in other ways,
some may have additional disabilities. Most learn age-appropriate
academics. Currently, Selective Mutism, through published studies,
be related to severe anxiety, shyness and social anxiety. Selective
be associated to a variety of things, but the exact cause is yet
These children may
respond, or make
their needs known, by nodding their heads, pointing, or by remaining
expressionless or motionless until someone correctly guesses what they
The majority of these children express a great desire to speak in all
but are unable to due to anxiety, fear, shyness and embarrassment. Many
participate in activities non-verbally. The withdrawn behavior is not
usually obvious until the child begins school.
Sometimes, even then, the child is viewed as shy and it is assumed that
shyness is temporary and will be outgrown. By the time Selective Mutism
recognized, if it is recognized, the child has usually experienced at
years in which no verbalization has become a way of life. The behavior
becomes increasingly difficult to change because of the lapse of time
How Did Selective Mutism Get its Name?
Mutism was first reported by a German physician, Kussmaul, in 1877. He
described physically normal children who developed mutism in certain
situations. He called the condition “Asphasia Voluntaria”,
meaning voluntary mutism. Later, an English physician, Tramer (1934)
several similar cases and coined the term “Elective
Mutism”. He suggested that
this term be used to classify children who spoke only to certain
people, (e.g. family
members or close friends), but not to others. It is our opinion that
“elective” is suggestive of a preference; therefore the
term implies a
deliberate decision not to speak. As previously noted, through our
term was changed to Selective Mutism in the DSM IV (1994) to imply a
oppositional or willful component. Accordingly the Foundation name has
changed to “Selective Mutism Foundation, Inc.” (1993).
What are the First Symptoms of
The first symptoms of
Selective Mutism are usually noticeable between the ages of 1 to 3
symptoms may include shyness, a reluctance to speak in some settings,
fear of people. Although there may be a predisposition to Selective
Mutism at birth,
the symptoms become obvious when the child is requested to respond
and/or interact in social situations, including preschool, elementary
and community environments.
Is Selective Mutism Caused by Abuse?
research has discarded this theory. However, due to the
misdiagnosis of the symptoms some parents have been suspected or
child abuse. Sexual abuse has been suspected as well. The Selective
Inc. wishes to emphasize the vital need to clarify these unjust
The suspicion or accusation of parental child abuse is devastating and
caused tremendous grief and deterred many families from seeking help
children. There is always a possibility that some children who have
do not speak. However, the abuse may not be specific to immediate
members, but could occur from any adult; or even other children. We
contacting the appropriate agencies only if there is a definite
What Causes Selective Mutism?
The cause has
established. Recent systematic research studies suggest the possibility
genetic influence or vulnerability for Selective Mutism. The majority
families who have contacted the Foundation have described either
themselves or other
family members as previously or currently experiencing Selective
extreme shyness, social anxiety, or other anxiety disorders.
How is Selective Mutism Diagnosed?
The crucial diagnostic
element is that the child has the ability to comprehend spoken language
speak normally, but usually fails to do so in select settings. These
will display reasonably appropriate verbal and interactive skills at
the presence of a few individuals with whom they feel at ease. The term
Selective Mutism should distinguish individuals who demonstrate
selectivity with whom they speak and are comfortable with, from
individuals who speak to no one. Populations, which should be excluded,
immigrants who speak another language, have no history of the disorder,
experience Selective Mutism for a short period of time, and those who
and temporarily stop speaking due to a traumatic event. In these cases
is usually transient.
Do Individuals Experiencing Selective
Mutism Have Associated Behaviors?
Yes. Associated behaviors
include no eye contact, no facial expression, immobility, or nervous
when confronted with general expectations in social situations. These
do not indicate willfulness, but rather an attempt to control rising
Some may withdraw by
when approached or touched and exhibit different forms of body
many cases the body language has been misinterpreted as abuse, however,
found that these behaviors stem from anxiety. Based on responses to the
Foundation, we suspect that some may have Obsessive-Compulsive Disorder
or Tourette Syndrome type symptoms, and a variety of phobias as well.
Is There a Relationship Between Selective
Mutism and Autism?
No. Selective Mutism is
sometimes erroneously mistaken for Autism. The striking difference
two is that Autistic individuals have limited language ability, while
individuals experiencing Selective Mutism are capable of speaking and
do so in comfortable situations.
What is the Diagnostic and Statistical
Mental Disorders (DSM IV)?
the classification of Selective Mutism in the DSM IV affected diagnosis
The DSM IV is the most widely used diagnostic
book utilized by mental health professionals in the United States
. The DSM is usually revised at 10 or more year intervals. Due to the
research on Selective Mutism, the diagnostic criteria had to be
examining existing publications. The previous available publications
various theories, many of which described children experiencing
Mutism as refusing to speak, and displaying controlling, manipulative,
oppositional, and angry behaviors. Due to this, as we perceive,
mischaracterization of Selective Mutism children, Selective
with anxiety had been neglected, and parents had been frequently blamed
causing Selective Mutism.
The efforts of this
including providing research participants for published, legitimate
studies was instrumental in influencing important changes, including
diagnostic guidelines and renaming the disorder from Elective Mutism (DSM III
Selective Mutism 313.23 in the
DSM IV (1994). Another important change brought about by our efforts
in replacing the term “refusal to speak” with
“failure to speak”; thereby
eliminating the notion that non-verbalization is intentional.
How is Selective Mutism Treated?
on the treatment of phobias have proven to be somewhat successful.
should be consistent, and should include desensitizing the child by
short-term goals, positive reinforcement, and rewards to motivate the
speak. Pressure, including punishment, bribery, or consequences are
One-word responses should be elicited at first, with gradual requests
After extensive treatment, some have been able to speak spontaneously
if not all social situations.
known to be
effective in treating adults with anxiety and/or social anxiety have
effective for many children, usually in conjunction with behavioral
Several articles, which provide behavioral strategies, can be found in
libraries and journals that publish studies.
Is Selective Mutism Limited to
No. Some children do
experience Selective Mutism for short periods of time while others
this problem for many years. Based upon
some literature and individual responses to the Foundation, Selective
can be a persistent disorder, which can become intractable over time.
adults report they are still struggling with symptoms of Selective
while others have overcome it. Many adults, who now able to speak
report having one or a combination of anxiety, depression and panic
When Should Selective Mutism be
There are 2 chief factors
determining when treatment is necessary, age and severity. If the
persists for more that 2 months, or another dominant language is not
interfering, and if there are no verbal responses at all, treatment
begin immediately. For the child who exhibits mild symptoms, such as
in a soft voice, and interacts with others, treatment may not be
necessary unless the symptoms continue for many months. It is
sometimes difficult to know if or when to intervene, as there are
degrees of the disorder. Many children improve over time without
while with others, the disorder becomes intractable.
forms of Selective Mutism, immediate intervention is advisable because
symptoms can increase. Generally speaking, a younger child has a good
recovering, if treated, because of the shorter interval of time where
verbalization has occurred in school or in other major settings.
How Can Parents Help Their Child Who
is Experiencing Selective Mutism?
Parents can help their
child by providing every opportunity for socialization and speaking.
techniques should be implemented in all social environments where
is difficult. Parents should consider contacting their teachers,
psychologist, school counselor, or social worker. These individuals can
very important role in assisting families and implementing a consistent
treatment plan in school.
Do Children Experiencing Selective
Mutism Have Special Education Needs?
Selective Mutism is not
associated with learning or other impairments, therefore, special
programs should be cautiously considered. There are no special
programs in public schools available for these children. Individual
would need to be designed. Most programs can be implemented within the
education environments. Others may require coordination between regular
special education, a 504-accommodation plan, or school staff, depending
skill level and resources available within the school district.
How Can Educational Evaluators Assess
the Skills of a Child Experiencing Selective Mutism?
Professionals will need
modify their typical assessment strategies when working with these
these children may fail to verbalize, evaluation scores do not reflect
true academic levels, IQ’s, or potential. In order to avoid
children into inappropriate educational settings, evaluators need to be
particularly cautious. An effort should be made to evaluate the child
with the parent present. The child can be asked to read into a tape
home. Some skills and speech and language samples may be obtained and
over the telephone, as many children experiencing Selective Mutism will
verbally respond. Testing material that is used for the hearing
be utilized as well. One of our goals is to promote the
development of appropriate testing material for those
children who may have additional
How Can Teachers Assist a Student Who
is Experiencing Selective Mutism?
Teachers play an integral
part in helping students who are experiencing Selective Mutism. By
understanding that the symptoms are not intentional will reduce the
and anger which teachers often disclose. Consistent behavioral
should and can be easily implemented in the classroom. Strategies
on encouraging, not forcing the child to speak. Praise and rewards for
speaking, and participation in classroom tasks (e.g. monitor), will all
contribute to lowering the anxiety, while helping the child to feel
positive, and independent.
How Many People Have Selective Mutism?
Some published literature
suggests that Selective Mutism is rare, and found in less than 1
child guidance, clinical, and school social casework referrals.
on the overwhelming responses to the Foundation, we suspect that it is
prevalent than originally assumed. Some publications suggest a slightly
percentage of females experiencing Selective Mutism than males.
However, due to
unreported, undiagnosed and misdiagnosed cases, the ratio is unknown.