What are the signs and symptoms of SM? Hint: It’s not just shyness. Selective mutism is an anxiety disorder, usually diagnosed in childhood, in which an individual is nonverbal in certain settings and situations, despite being able to communicate when comfortable or at home. If you know a child who displays the following behaviors, you may know a child with SM:

• Speaks freely at home and with family but is nonverbal due to anxiety in public settings or around strangers
• Is paralyzed with fear or shuts down completely when unable to communicate

Additionally, those with SM may also: 

• Struggle to make eye contact when uncomfortable
• Present as behaviorally inhibited 
• Rely on pointing, nodding, writing, and other forms of nonverbal communication to answer questions 
• Speak through a trusted individual—e.g., whispering an answer to a question to a parent or friend at school 

Selective mutism often co-occurs with other forms of anxiety, particularly social anxiety. A child is diagnosed with SM when the pattern of being unable to speak is persistent over time and causes significant impairment in daily functioning. An SM diagnosis is likely if it is difficult for a child to effectively participate in school or form friendships with other students their age due to an inability to speak in public.

An SM diagnosis can only be made by an experienced professional. There is no single cause of selective mutism, but it is generally understood to be an anxiety disorder related to shyness, social anxiety, and inhibited temperament in which speaking situations are avoided and this avoidant behavior gets reinforced over time. Disorders such as expressive/receptive language and communication disorders may increase a person’s risk for developing SM. Some research also suggests that being bilingual may increase a person’s risk for developing SM as compared to monolingual speakers. Although extremely rare, traumatic or stressful events may be related to the onset of SM. The majority of people with SM do not report a history of traumatic events.

According to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, in order to be diagnosed with selective mutism, an individual must meet the following criteria:

• Consistent failure to speak in specific social situations in which there is an expectation for speaking (e.g., at school) despite speaking in other situations. 
• The disturbance interferes with educational or occupational achievement or with social communication.
• The duration of the disturbance is at least one month (not limited to the first month of school).
• The failure to speak is not attributable to a lack of knowledge of, or comfort with, the spoken language required in the social situation. 
• The disturbance is not better explained by a communication disorder (e.g., stuttering) and does not occur exclusively during the course of autism spectrum disorder disorder, schizophrenia, or another psychotic disorder.

There are many research-based treatment options for selective mutism. However, there is no one-size-fits-all approach. Treatments for SM may include behavioral and cognitive-behavioral (CBT) strategies, medication, and speech-language therapy. All treatments should be pursued under the care of an experienced professional.

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