What it is
Selective Mutism (SM) is an anxiety disorder where a child can speak comfortably in some settings (usually at home) but consistently doesn’t speak in others (school, public) despite the ability to do so. It typically starts before age 5 and is often related to social anxiety. It’s highly treatable with behaviorally focused therapy.
SM is not willful defiance or a language disorder, though speech/language differences can co-occur.
Common signs and symptoms
- Consistent failure to speak in specific social situations where speaking is expected
- Speaks freely at home but communicates nonverbally (nodding, pointing) at school or with less-familiar people
- Freezing, blank facial expression, or whispering in feared settings
- Interference with learning, socializing, and daily functioning
Why it happens
- High social-evaluative anxiety; “freeze” response becomes conditioned in certain settings
- Behavioral inhibition temperament; family history of anxiety
- Avoidance and others speaking for the child maintain the pattern
What helps
- Behavioral therapy with exposure and “brave talking”
- Stimulus fading: start with easy settings/people and gradually add new ones
- Shaping: reward small steps (sounds → words → sentences) using positive reinforcement
- Self-modeling: videos of the child speaking in comfortable settings to build confidence
- Consistent, low-pressure opportunities to speak; avoid pressuring or answering for the child
- School collaboration
- Individual plan with teacher, counselor, SLP; accommodations (nonverbal responses first, then gradual speech goals)
- Seating with supportive peers; predictable routines; avoid calling on the child unexpectedly early on
- Speech-Language Pathology (SLP)
- Rule out or address articulation/language issues that can increase anxiety
- Medications
- For severe or persistent cases: SSRIs may be considered with therapy
Parents, teachers, and clinicians working together is crucial; small, celebrated steps matter.
When to seek help now
- SM persisting beyond a few months of school or causing significant academic/social impairment
- Co-occurring anxiety, tantrums before school, or somatic complaints
- Signs of depression or self-harm in older children/teens (urgent help)
How to talk to a clinician/school
- “My child speaks at home but not at school. We’d like behavioral therapy focused on gradual speaking exposures and a school plan with accommodations.”
Outlook
Most children improve substantially with early, structured intervention. Progress often begins within weeks; full comfort across settings may take months.
Resources for readers in the USA
- Immediate help: 988 Suicide & Crisis Lifeline; Crisis Text Line text HOME to 741741
- Find care: Psychology Today (filter for child anxiety/selective mutism); FindTreatment.gov; NAMI HelpLine
- SM-specific: Selective Mutism Association (selectivemutism.org)
- School supports: 504/IEP accommodations; school counselor and SLP collaboration
- Low-cost/community: Community Health Centers (findahealthcenter.hrsa.gov); 211
- Insurance tips: Verify in-network child CBT, SLP services, telehealth; copay/coinsurance, deductible, out-of-pocket max
- Urgent options besides ER: Mobile Crisis for youth via 988 (where available), crisis stabilization units
Disclaimer: Educational information, not a diagnosis. If in crisis, use the resources above.