What is Selective Mutism? - Causes, Symptoms & Treatment

Instructor: David White
Although it is a rare and largely under-analyzed condition, selective mutism can be a significant impairment for those who live with the disorder. Through this lesson, you will learn how to define selective mutism, explore some of the potential causes, and gain insight in the variety of treatments.

What is Selective Mutism?

Mental illnesses are often incredibly complex and treating them can take years of dedication to therapy and, in some cases, medication. Yet, talk therapies remain one of the most successful treatments because they allow a safe space for a person to verbally explore the causes of their impairment. But what if the individual becomes so anxious or uncomfortable in social settings that he can't talk?

This inability to speak that I am referring to is what is known as selective mutism, which is characterized by an inability to speak in certain social situations. Unlike traditional mutism, which is an affliction that causes an inability to speak at all, selective mutism happens to people who can speak and understand verbal communication. Selective mutism is a disorder that begins in childhood and, if left untreated, can continue to affect a person into adulthood.

Selective mutism is characterized by periods of involuntary loss of speech.

Generally speaking, selective mutism occurs when a child becomes so overwhelmed by anxiety or fear that they sort of freeze and become unable to communicate verbally. The disorder tends to be specific to certain situations, particularly where stress levels are high with the expectation to speak to others. Individuals experience it in different ways. For example, a child who feels anxious when placed into a social situation at school may find he is unable to speak in front of peers, but is able to speak to a teacher. Another child may have incredible difficulty speaking to others in a school environment at all. But at home, where there is a sense of comfort and safety, both of these children have no trouble speaking to and engaging with others.

Symptoms of Selective Mutism

The most obvious symptom is, of course, that the person cannot speak in certain situations. Selective mutism tends to be related to anxiety disorders. In many cases, the disorder manifests in children who have social anxiety, which is anxiety caused by being around or having to engage with people in social settings. Because of this, additional symptoms may include extreme shyness, awkward behavior in social situations, an inability to make eye contact, responding in socially inappropriate ways, fear of social embarrassment, and a commitment to routine.

It is important to note that this is not the same as being oppositional or refusing to speak. In cases of selective mutism, the person often would like to speak but finds that he is simply unable to do so, which means that it is involuntary. In order to arrive at a diagnosis of selective mutism, there generally needs to be multiple instances of mutism that occur for a period of more than one month.

What Causes Selective Mutism?

Because it is rather uncommon, the causes and treatment of selective mutism are only now being explored closely. Nevertheless, the predominant theory is that selective mutism is related to inherited predispositions to anxiety. If parents have a history of anxiety disorders, for example, the child may also develop symptoms of anxiety that can evolve into selective mutism.

Another theory suggests that it may be related to inhibited temperaments, which is an inability to adequately and comfortably articulate emotions. For example, if a child does not develop a strong ability to express his emotions (i.e. inhibited temperament), he may allow stress and anxiety to build up inside, resulting in a moment of significant overwhelm wherein he is incapable of speech.

Some researchers suggest that the issue has a neurological origin, wherein the brain's sensory processors become overwhelmed, shutting down a person's ability to speak. This, however, is also believed to be anxiety related, as it is caused by strong feelings of overwhelm.

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