Some folks are naturally shy, especially around people they don’t know. But if you shut down completely and find it impossible to talk in certain situations, you may have selective mutism.

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Selective mutism is an anxiety disorder that most often affects children. In fact, about 1% of children seen in behavioral settings in the United States have this condition.

Typically, selective mutism appears between ages 3 and 6 — right around when children enter school and begin to interact with more strangers for the first time.

While the word “selective” may seem to suggest that people with this condition choose not to talk, this isn’t the case. In the phrase “selective mutism,” the word “selective” means you can speak in some situations, like around people you know and trust, but not in others.

Symptoms of selective mutism often last for a few months to a few years, and the condition may improve on its own.

That said, this condition can sometimes last into adulthood — particularly if it goes untreated in childhood. It may also improve in childhood but reappear later in life, especially during difficult transitions involving new and unfamiliar people.

Read on to learn more about the signs and causes of selective mutism and get details on options for treatment.

Selective mutism doesn’t involve a total inability to speak — rather, it describes an inability to speak in specific social situations.

“Selective mutism can show up in any situation where there is a demand for performance and social pressures,” says Mona Potter, MD, a board certified child and adolescent psychiatrist and chief medical officer and co-founder of InStride Health.

If your child has this condition, they may talk freely at home around family members but become silent in the classroom at school. Or they may not speak in the presence of strangers, even at home or if they’re around parents and other familiar people.

As an adult, you may find it easy to talk around friends you’ve known for a long time but have a hard time saying a word in groups of co-workers you aren’t familiar with.

The main symptoms of selective mutism include:

  • experiencing general unease, nervousness, and shyness around unfamiliar people
  • having a tendency to avoid social situations that may require speaking to others
  • feeling “frozen” or feeling completely unable to speak during interactions with unfamiliar people
  • using nonverbal communication like nodding, pointing, and writing when unable to speak
  • needing to communicate through a trusted individual when dealing with strangers — for example, when asking for directions or paying for something
  • experiencing negative or unwanted effects on your school or work performance, social life, and relationships

FYI: Diagnostic criteria

In order to meet the criteria for a diagnosis, the above symptoms must last for at least 1 month. For children, the first month of school does not count, since it often takes time to become comfortable with new people before talking.

People who do not yet feel comfortable speaking the language required in a particular situation typically will not receive a diagnosis of selective mutism. For instance, a teen who doesn’t speak in class wouldn’t meet the diagnostic criteria if they recently moved to the United States and still feel hesitant about speaking English with their peers.

Before diagnosing this condition, mental health professionals will also rule out other mental health conditions that may involve difficulties with communication, including autism spectrum disorder and schizophrenia.

A speech-language pathologist (SLP) can help rule out any underlying communication disorders and diagnose selective mutism, says Holly Schiff, PsyD, a licensed clinical psychologist at Jewish Family Services of Greenwich.

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Experts still do not know exactly what causes selective mutism. According to a research review from 2010, some of the main theories include:

Behavioral theory

Selective mutism may happen as a learned but unconscious defense mechanism for coping with anxiety.

In a nutshell, your freeze response leaves you unable to speak when you find yourself in unfamiliar or uncomfortable social situations.

Social anxiety theory

According to the 2010 research review, some psychologists believe selective mutism happens as an extreme form of social anxiety since adults with social anxiety often avoid public speaking or talking with people they don’t know.

Other research from 2008, which looked at both children with selective mutism and those with social anxiety, challenges this idea. Children with selective mutism who participated in the study scored lower on the Social Phobia and Anxiety Inventory than children with social anxiety, instead of falling within the same range or scoring higher.

It’s also worth noting that social anxiety typically appears in the early to mid-teens, while selective mutism usually shows up during early childhood. Finally, selective mutism often goes away as a child gets older — but this does not happen with social anxiety.

Family systems theory

This theory links selective mutism with an enmeshed family relationship.

In enmeshed families, children may become overly dependent on their parents, as well as fearful and distrusting of the outside world.

Because the children believe they need their parent to survive, being without them in environments outside the home can trigger an intense fear that leads them to withdraw and shut down.

Post-traumatic stress theory

Another possibility is that selective mutism may happen as a response to abuse and other traumatic experiences. When you face a trigger that reminds you of your trauma, you may temporarily and involuntarily dissociate — in other words, become emotionally disconnected. This can make speech feel impossible.

Developmental psychopathology theory

According to this newer theory, children with early speech or language difficulties may face bullying or teasing from their peers when they enter school. These experiences may cause embarrassment, so they may avoid speaking in settings that don’t feel safe.

Psychodynamic theory

This earlier theory suggests that kids refuse to speak on purpose — for example, as a way of punishing parents out of anger or to maintain a family secret. This theory has been losing popularity as new research emerges, though.

Other research on selective mutism includes:

  • a small study from 2018, which suggests selective mutism more commonly affects girls
  • a small 5-year study from 2018, which suggests selective mutism may run in families and often co-occurs with other anxiety conditions

Selective mutism can affect a child’s ability to form and maintain friendships in school and make it harder for teachers to assess certain skills, says Lindsay Scharfstein, PhD, a licensed psychologist and founder of the private practice, Rockville Therapy Center.

The symptoms of selective mutism can also have a far-reaching impact.

“It can lead to social isolation and slower development of social skills, academic challenges and delays, and poor self-esteem as the child develops an internal sense that they cannot handle things,” Potter says.

As an adult, you may notice that your symptoms affect your ability to interact with people like supervisors, co-workers, or customers, which can then take a toll on your job performance, Scharfstein says.

You might also find some everyday situations challenging, such as:

  • making an appointment with a doctor, dentist, or veterinarian
  • scheduling services, like work on your car or a repair in your apartment
  • placing an order at a restaurant or grocery store
  • doing group activities, like school projects or hobbies and sports
  • asking a neighbor to grab your mail when you’re away

Getting support for selective mutism can make a big difference, no matter your age.

While selective mutism may improve on its own, experts still recommend seeking treatment after getting a diagnosis.

According to Schiff, the condition becomes increasingly difficult to treat as a child gets older, so the sooner it’s addressed, the better.

“Treatment focuses on reducing anxiety, teaching coping skills, and desensitizing through gradual exposure to speaking in new settings and with new people,” Schiff says.

A number of different approaches can help treat selective mutism. According to Schiff, the most common treatments include:

Speech-language therapy

Many children with selective mutism have underlying speech or language impairments. SLPs can assess a child’s skills in a variety of settings and with a range of people to rule out any possible speech and language disorders.

The SLP can then coach them through exercises to gradually increase their confidence when speaking. They may focus on working with the child in situations where the child tends to remain silent — for example, helping improve communication with teachers and classmates.

Cognitive behavioral therapy (CBT)

CBT focuses on unpacking and changing thought patterns about yourself, other people, and the outside world that may contribute to anxiety in certain situations.

In the small 5-year study from 2018, children between ages 3 and 9 participated in 6 months of school-based CBT. At the 5-year follow-up, 17% reported improved symptoms and 70% no longer met the diagnostic criteria for selective mutism.

Behavioral therapy

This technique gradually exposes you to increasingly challenging situations so you can become more comfortable speaking in new situations over time.

For example, your child with selective mutism may start a conversation with you, and then a third, unfamiliar person joins in. Once your child becomes comfortable talking in front of both of you, you leave the conversation.

Or you might record videos of your child talking in a comfortable situation, then watch the videos together. When your child sees proof of their conversational abilities, they may feel more confident in less familiar situations.

Family therapy

When family dynamics seem to play a role in selective mutism, it can help if parents and siblings participate in therapy. A family therapist can pinpoint the root causes of selective mutism and suggest ways family members can support the child in overcoming it.

If you are not sure about the right approach for you or your child, you can seek guidance from a speech-language pathologist, child psychologist, or other mental health professional. Your child’s doctor can also offer a referral to a therapist.

You can use the American Speech-Language-Hearing Association’s searchable database to find an SLP in your city and state. Your child’s school can also help with a referral to a specialist.

Can medication help?

Certain healthcare professionals, such as a primary care doctor, your child’s pediatrician, or a psychiatrist, may prescribe antidepressants or anti-anxiety medications.

Typically, they’ll recommend medication when severe depression or anxiety contributes to symptoms of selective mutism or makes them worse.

That said, no medication can treat selective mutism specifically.

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Most children overcome selective mutism in time, and the condition only rarely persists into adulthood, says Nina Vasan, MD, MBA, a board certified psychiatrist and chief medical officer at Real.

According to Vasan, your child’s improvement generally depends on a few key factors, including:

  • the level of support from loved ones
  • how long they’ve had the condition
  • the cause and severity of selective mutism
  • whether they have any additional anxiety conditions

However, Scharfstein says most people notice improvement within just a couple of months of treatment.

If you have any concerns about your child’s speech or their reluctance to speak in certain situations, a good first step involves connecting with your pediatrician or family doctor.

You can also support your child with these tips:

  • Share information with their doctors, teachers, coaches, family members, and other relevant people: The more adults have information about selective mutism and understand your child’s condition, the more likely they are to offer the right accommodations and support.
  • Offer consistent praise or a reward when your child speaks in a challenging situation: Scharfstein says specific verbal praise is always best — for example, “I like how you asked Cindy to borrow a crayon” or “I’m proud of you for asking where the bathroom is all by yourself.”
  • Give them time to respond: When your child pauses in an uncomfortable situation, Scharfstein advises giving them at least 10 seconds to speak rather than jumping in to speak for them. Parents can accidentally reinforce selective mutism by speaking for their kids, since that sends the message, “This is too scary for you and you need my help,” Scharfstein adds.
  • Use forced-choice questions: When you ask yes-or-no questions like, “Is this red?” your child doesn’t have to speak — they can nod or shake their head. That’s why Scharfstein recommends using questions that encourage a response, like “Is this red, blue, or a different color?”
  • Do not punish a child for not speaking: Remember, your child isn’t purposely choosing not to speak, and punishing them may only contribute to their anxiety. Instead, remain encouraging and focus on rewarding them whenever they do speak up.
  • Ease them into social situations: When arranging play dates or other plans around people your child doesn’t know well, Vasan suggests choosing activities that don’t require your child to talk, like painting or watching a movie. That way, they can become more comfortable with someone before speaking.

If you try these strategies for a few months but your child’s selective mutism doesn’t improve or seems to get worse, you may want to reach out for support. According to Potter, it’s also important to seek help if your child’s lack of speech begins to interfere with their social life or performance in school.

Selective mutism is an anxiety disorder marked by an inability to speak in specific situations — usually around unfamiliar people. It typically affects young children, but it can also last into adulthood or reappear after improving.

The most helpful treatment approach often depends on the cause.

For example, if anxious thoughts play a major role in selective mutism, CBT may have benefits. On the other hand, when enmeshed family dynamics factor in, it may be worth trying family therapy.

Working with a speech-language pathologist can also help your child gradually feel more confident speaking in new situations and with unfamiliar people. You can support your child at home by offering patience, encouragement, and praise while slowly exposing them to new social situations.

Rebecca Strong is a Boston-based freelance writer covering health and wellness, fitness, food, lifestyle, and beauty. Her work has also appeared in Insider, Bustle, StyleCaster, Eat This Not That, AskMen, and Elite Daily.