Having selective mutism means some social situations cause so much fear or anxiety that you find speaking difficult or impossible. This anxiety disorder usually starts in childhood, but the effects can be lifelong. Identifying and treating this condition quickly improves its overall outlook, especially during early childhood.
Selective mutism (SM) is a mental health condition where you can’t talk in certain situations because of fear or anxiety. It usually affects young children, but it can also affect adolescents and adults.
This condition is more than being shy, bashful or timid. SM is an anxiety disorder. It can overlap with other anxiety-related conditions and have lingering effects later in life.
SM is fairly rare. It affects less than 1% of people (across all age groups). It almost always begins in childhood around age 5, often coming to attention soon after a child starts preschool, kindergarten or grade school. It’s less common — but still possible — in teenagers and adults.
SM seems to affect women and people assigned female at birth (AFAB) about twice as often as men and people assigned male at birth (AMAB). However, that number may be skewed because of bias or stereotypes about how talkative people should be based on their sex assigned at birth. More research is necessary to determine if the disparity between sexes assigned at birth is accurate.
SM is rare overall, but it’s especially rare in adults. You might recognize the symptoms of it in yourself, or you might recognize them in your child (or a child you care for). Everyone with a diagnosis can benefit from treatment, regardless of age.
The “selective” in this condition’s name means it only happens in certain situations (remember that it’s not a willful or deliberate choice not to talk). If you have SM, you have no trouble talking in comfortable situations. However, you consistently find talking difficult or impossible in uncomfortable situations.
The symptoms can take different forms. Some people are completely unable to talk (or nearly so). Others may communicate less or in limited ways.
This is going to great lengths to avoid communicating or avoiding it entirely. It can look like:
Experts can’t fully explain why SM happens. However, they suspect several possible factors may cause or contribute to it. These include:
Other mental health conditions
SM has strong connections to other mental health conditions. These aren’t necessarily causes. They’re simply more likely to happen in people with SM. These conditions include:
Family history or genetics
Anxiety disorders can run in families. People with SM are much more likely to have a first-degree relative (a parent, sibling or child) with SM or another anxiety disorder.
Other communication disorders
Some children develop SM because of anxiety related to how they talk or how well they understand others (like from auditory processing disorders or learning delays).
Children can also develop SM because of speech disorders (like stuttering or other forms of fluency disorder). Some children develop SM because they don’t like their voice or feel anxious about how they sound.
Children with certain social factors or circumstances are more likely to develop SM. These include:
SM can negatively affect your life in many ways. These can include:
A mental health provider, like a psychiatrist or psychologist, will usually diagnose SM. Other providers, especially speech-language pathologists or speech therapists, may rule out other conditions to help with the diagnosis.
A provider makes this diagnosis based on symptoms and behaviors. They’ll ask questions about your (or your child’s) experiences and other factors that could contribute to this condition.
Your provider will typically use screening questionnaires, checklists or other tools to help determine if you meet the criteria. The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, fifth edition text revision™(often referred to as “the DSM-5®”) has five criteria that you must meet to receive a diagnosis of SM:
With treatment, it’s possible to reduce the severity and frequency of symptoms. With early diagnosis and treatment, some people may see the symptoms vanish entirely.
The most common treatment approaches are:
Mental health therapy
Mental health therapy (especially cognitive behavioral therapy, or CBT) is generally the first option. It’s also the most likely to help. Behavioral therapy helps you understand and cope with anxiety and other distressing feelings that cause SM symptoms. It can also help with modifying tantrums or other disruptive behaviors that can happen with SM.
For children, these forms of therapy should involve the people raising them, too. Parental figures (including legal guardians or other loved ones) can contribute to the success of mental health therapy.
Speech therapy involves working with a speech therapist or another specialized healthcare professional. It can be particularly helpful when SM happens with speech disorders.
Medications can be part of treatment for SM, especially if mental health or speech therapy aren’t effective on their own.
The most common medications for treating SM are selective-serotonin reuptake inhibitors (SSRIs). These mainly treat depression but can also treat anxiety-related disorders, including SM. Other medications may also help. Your healthcare provider (or your child’s provider) can tell you more about these and help you choose.
Your healthcare provider is the best person to tell you about the possible side effects and complications of the specific medication(s) you’re taking, and what you can do to limit or avoid those effects.
SM isn't preventable. Experts don’t fully understand what factors can contribute to or cause it, so there’s no way to reduce the odds of it happening.
In children, SM can affect how they do in school, socialize and make friends. It can also cause children to avoid talking even when it’s important.
If you have SM as an adult, it can continue to have negative effects. SM can keep you from making friends or developing relationships (social, work, romantic, etc.). It can also affect how you do at school or at work.
For many people, the symptoms seem to disappear by adulthood. The symptoms can still be there, but shift and look more like another anxiety disorder (especially social anxiety disorder).
The outlook for SM is good overall, especially with early diagnosis and treatment. When diagnosed and treated in early childhood, most people with SM can overcome or learn to cope with it, so it doesn’t affect their lives as much (or at all).
When SM goes undetected or untreated, the outlook is less positive. It isn’t dangerous, but the negative effects can be significant. People with SM often experience anxiety and depression. Some struggle with social situations and feel lonely or isolated. It can also affect their education, career and other important parts of their lives.
You may feel frustrated if your child won’t speak in certain situations, even if you tell them to. That frustration can be intense if your child avoids talking by using tantrums or other forms of acting out behavior.
It’s important to remember that SM is a mental health condition. It’s not something your child has control over. But you can control how you react to your child’s condition and its symptoms.
Some of the most important things you can keep in mind include:
SM “triggers” are situations or circumstances that make it likely that someone with SM won’t talk. Some common examples include:
The above list is just some of the more common triggers. Some people may have specific triggers that aren’t like those listed above. Triggers can also shift and change over time.
No, SM and autism spectrum disorder are separate conditions, and experts group them into separate categories. However, autistic people are more likely to have SM.
A note from Cleveland Clinic
Selective mutism is a condition that makes you unable to talk in certain situations because of fear or anxiety. It’s likely to start in childhood around school age but can also affect teens and adults. It’s important to remember that children who have it aren’t being disobedient or stubborn, and SM isn’t something they can control by themselves.
If you suspect your child has SM, talk to their pediatrician or another healthcare provider. Treatments are available, and the outlook is generally positive (especially when treatment begins early). With encouragement and support, your child can learn to speak for themselves without letting fear or anxiety deprive them of their voice.
Last reviewed by a Cleveland Clinic medical professional on 10/02/2023.
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