Selective mutism is a severe form of social anxiety. It results in an individual being unable to speak in certain social situations. However, this person may be able to talk with a few people that they are comfortable with, in a safe environment. It’s important to note they are not choosing silence, they may wish to talk, but they are paralyzed by their fear. This results in silence in situations where there may be consequences such as being shamed or punished. This disorder often occurs in children, but some teenagers and adults also have it. It affects around 0.8% of people at some point in life.
- Consistent failure to speak in specific social situations (in which there is an expectation for speaking, e.g., at school) despite speaking in other conditions.
- The disturbance interferes with educational or occupational achievement or with social communication.
- The duration of the disturbance is at least 1 month (not limited to the first month of school).
- The failure to speak is not due to a lack of knowledge of, or comfort with, the spoken language required in the social situation.
- The disturbance is not better accounted for by a communication disorder (e.g., childhood-onset fluency disorder) and does not occur exclusively during autism spectrum disorder, or psychotic disorders such as schizophrenia.
- Shyness, social anxiety, fear of social embarrassment, and/or social isolation and withdrawal
- Difficulty maintaining eye contact
- Blank expression and reluctance to smile
- Difficulty expressing feelings, even to family members
- The tendency to worry more than most people of the same age
- Sensitivity to noise and crowds
The cause of selective mutism still remains largely unknown. Previous theories suggested that selective mutism was caused by childhood trauma but we now know this not to be true as trauma victims are often withdrawn in all social situations. There are also many children with selective mutism that have not experienced any trauma.
One of the suggested theories is that selective mutism is caused by an inhibited temperament. Children with selective mutism often experience high levels of anxiety and display inhibited behaviour as a way to cope.
Another theory is that those with selective mutism have auditory processing difficulties similar to people with autism. The excess stimulation causes them to mentally shut down and therefore not speak.
Another common reason for selective mutism is speech or language disorders. People with speech and language disorders may feel ashamed and experience negative reactions to their disorders causing them to fear speech.
Treatment for selective mutism can be difficult as it often takes a long time. One thing that is important is to receive treatment at an early age to prevent any long lasting issues. The earlier the fear is conquered the greater chance of the child living a “normal” life.
Forming an exact treatment depends on the person’s age, any comorbid mental illnesses, and a number of other factors.
Some of the proposed treatments are stimulus fading, systematic desensitisation and anti-anxiety medication.