Selective mutism is a long-lasting and severely limiting mental illness in which a child is unable to speak when they should. Selective mutism is classified as an anxiety condition, but because it is so different and complex, it may be thought of as a neurodevelopmental disease. Children with selective mutism are very rare and have a lot of different symptoms. They usually show up when they are starting school.

According to the empirical evidence, researchers and therapists in both psychology and psychiatry have been puzzled by selective mutism’s dramatic symptoms for almost 150 years. Selective mutism was first thought of as a rebellious behavior disorder, as shown by the names that were used for these kids: “voluntary aphasia” and “elective mutism” which suggested that they choose to be quiet in certain settings or around certain people. The current point of view is less judgmental about children’s reasons. The word “selective” refers to the fact that children only don’t speak in certain situations. Also, most people think that the normal non-speaking behavior of kids with this disorder is caused by fear and nervousness which mostly happens in certain social situations. This is why selective mutism is now seen as an anxiety disorder.

Prevalence of Selective Mutism

Reports say that between 0.7% and 2% of people have selective mutism. The wide range of prevalence could be because of different sampling methods, like using clinical or community samples, sample traits, like age range or immigrant status, or the ways that the prevalence was measured. Selective mutism usually starts between the ages of 2 and 4, but parents often don’t notice until the child starts school. Selective mutism can become chronic if it is not addressed. It can affect a person’s ability to communicate, their mental health, and their quality of life as an adolescent and an adult.

Enuresis, encopresis, obsessive-compulsive disorder, depression, premorbid speech and language problems, developmental delay, and Asperger’s disorders are a few of the comorbidities that can accompany selective mutism. The exact symptoms and level of intensity of these comorbidities change from person to person.

Evidence suggests that a lot of the time, kids who have selective mutism also have social anxiety disorder. Due to this, these kids might need help making friends. Children who have selective mutism often have trouble making friends and are unable to behave normally. Children who have behavioral inhibition may be quiet and hide when they are in a setting that makes them feel anxious. Mutism may be a form of withdrawal that lets the child avoid talking to other people. A child with selective mutism might rather be alone because talking to other kids might make them feel too anxious. Peers may also not talk to a child who selectively mutates because they may not seem interested in playing. Also, kids with selective mutism are less socially adept than kids who are growing normally. Mutism often makes it hard to interact with other kids, and kids may tease those who are mute. On the Child Behavior Checklist, social problems measure, kids with selective mutism have been found to score much higher than the average child. There is a chance that long-term problems will arise with getting along with others and making friends. There are also rebellious and defiant traits that go along with selective mutism. People have said that children with selective mutism are rude, angry, disobedient, sulky, stubborn, negative, manipulating, suspicious, controlling, demanding, and hostile. Children who have selective mutism act defiant and hostile at school and home. Hence, most people think of selective mutism as a long-term problem with a bad result.

Since selective mutism can get in the way of social relationships, academic growth, and well-being, identifying it and getting the required treatment as soon as possible is important. According to the DSM 5 TR, the following criteria and features can help diagnose individuals with selective mutism:

Diagnostic Criteria

A. The person consistently fails to speak up in social settings where they are expected to (for example, at school), even though they do so in other situations.

B. The problem gets in the way of doing well at school, work, or social interactions.

C. The problem has been going on for at least one month, and not just the first month of school.

D. The person does not speak because they don’t know or feel comfortable with the spoken language that was expected in the social setting.

E. The problem is not better explained by a speech disorder (like childhood-onset fluency disorder) and does not only happen in people with autism spectrum disorder, schizophrenia, or another mental disorder.

Diagnostic Features

• Children with selective mutism don’t talk to others or reply when others talk to them when they are in social activities with other people.
• People don’t talk when they are with other people, like kids or adults.
• If a child has selective mutism, they will only talk to close family members at home.
• They will not talk to close friends or second-degree relatives like grandparents or uncles.
• Most of the time, the problem is marked by a lot of social nervousness.
• Selective mutism makes kids often refuse to speak at school, which hurts their grades because teachers have a hard time checking academic skills like reading.
• People may find it hard to talk to others because they cannot speak.
• However, kids with this disorder can sometimes communicate without words (for example, by grunting, pointing, or writing), and they may be happy to talk to others when they don’t have to (for example, by playing nonverbal roles in school plays).

Treatment of Selective Mutism

As selective mutism can show up in many different ways, there are also many different ways to treat it. Some of these are behavioral therapy, systemic desensitization, cognitive behavioral therapy, family therapy, and psychotherapy with drugs and anxiety medicines.

According to the sources, behavioral methods are an important part of helping people with selective mutism. Behavioral techniques try to get people to talk more, feel less anxious, and stop acting out or trying to get attention in unsuitable ways. Behavioral methods use positive feedback, stimulus fading, shaping, self-modeling, response start, vocal praise, video feed-forward, systematic desensitization, and revealing a desired prize. The goal of behavioral treatments is to stop rewarding quiet behavior and start rewarding talking behavior.

Systemic desensitization is another way to treat it. Systemic desensitization means learning how to handle and get through situations that make you feel more anxious over time. Peer relationships may be a big part of this type of therapy, which may work especially well for kids who are selectively mute. As a first step in systematic desensitization, a child with selective mutism may be given a job that is meant to make them feel little worry. If the kid is feeling nervous or overwhelmed, comfortable friends may be able to help and support them. One of the long-term goals of care for a child with selective mutism could be to help the child talk to their teacher and classmates without any problems. The discovery of good relationships between peers has implications for how well treatment works. In particular, talking to friends with whom the child is comfortable could help them use their speech with other people and in different places.