What Is Selective Mutism?

Selective mutism affects children.

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Selective Mutism

Selective mutism is an anxiety disorder characterized by an inability to speak or communicate in certain social settings, such as at school, work, or in the community. The condition is usually first diagnosed in childhood.

It is estimated that less than 1% of children have selective mutism. The first described cases date back to 1877 when German physician Adolph Kussmaul labeled children who did not speak as having "aphasia voluntaria."

Selective mutism can have a number of consequences, particularly if it goes untreated. It may lead to academic problems, low self-esteem, social isolation, and social anxiety.

Selective Mutism Symptoms

If you believe that your child may be struggling with selective mutism, look for the following symptoms:

  • Expression of a desire to speak that is held back by anxiousness, fear, or embarrassment
  • Fidgeting, eye contact avoidance, lack of movement or lack of expression when in feared situations
  • Inability to speak in school and other specific social situations
  • Use of nonverbal communication to express needs (e.g., nodding head, pointing)
  • Shyness, fear of people, and reluctance to speak between 2 and 4 years of age
  • Speaking easily in certain situations (e.g., at home or with familiar people), but not others (e.g., at school or with unfamiliar people)

While these behaviors are self-protective, other children and adults may often perceive them as deliberate and defiant.

Diagnosis of Selective Mutism 

Although selective mutism is believed to have its roots in anxiety, it was not classified as an anxiety disorder until the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) published in 2013.

The use of the term "selective" was adopted in 1994, prior to which the disorder was known as "elective mutism." The change was made to emphasize that children with selective mutism are not choosing to be silent, but rather are too afraid to speak.

Selective Mutism in Children

The primary criterion for a diagnosis of selective mutism is a consistent failure to speak in specific social situations in which there is an expectation of speaking (e.g., school), despite speaking in other situations.

In addition to this primary symptom, children must also display the following:

  • Symptoms of selective mutism must have been present for at least one month, and not simply the first month of school.
  • Your child must understand spoken language and have the ability to speak normally in some situations (usually at home with familiar people).
  • Finally, a lack of speech must interfere with your child's educational or social functioning.

Children who stop talking temporarily after immigrating to a foreign country or experiencing a traumatic event would not be diagnosed with selective mutism.

Selective Mutism in Adults

In some cases, selective mutism persists from childhood to adolescence, and even into adulthood.

In order to be diagnosed with selective mutism as an adult, the following criteria are usually present:

  • Symptoms of selective mutism must have been present for at least one month.
  • Symptoms must interfere with functioning at work or in social settings.

Adults with selective mutism often display behaviors similar to those related to social anxiety disorder, such as fearing public spaces (i.e., restaurants) and/or speaking to unfamiliar people. Selective mutism (and social anxiety) may cause an individual to avoiding social situations or withdraw completely, leading to social isolation.

A health professional will likely ask questions related to these or other behaviors when considering selective mutism as a diagnosis.

Causes of Selective Mutism

Because the condition tends to be quite rare, risk factors for the condition are not fully understood. It was once believed that selective mutism was the result of childhood abuse, trauma, or upheaval.

Research now suggests that the disorder is related to extreme social anxiety and that genetic predisposition is likely. Like all mental disorders, it is unlikely that there is one single cause.

Kids who develop the condition:

  • Tend to be very shy
  • May have an anxiety disorder
  • Fear embarrassing themselves in front of others
  • Problems with self-regulation

Other potential causes include temperament and the environment. Children who are behaviorally inhibited or who have language difficulties may be more prone to developing the condition. Parents who have social anxiety and model inhibited behaviors may also play a role.

Selective mutism also often co-occurs with other disorders including:

  • Anxiety
  • Autism spectrum disorder (ASD)
  • Depression
  • Developmental delays
  • Language problems
  • Obsessive-compulsive disorder (OCD)
  • Panic disorder

Complications of Selective Mutism

Unfortunately, selective mutism may worsen anxiety. For instance, a child with selective mutism may dread going to school, where their condition makes it hard for them to be accepted among their peers.

Selective mutism can lead to communication problems. An adult who has selective mutism may be perceived as judgmental or passive aggressive if people around them don't understand their condition—an added layer that can make coping with the condition even more challenging.

Someone with selective mutism may withdraw from school, work, or everyday activities and socially isolate themselves. This may lead to low self-esteem and even depression.

If you or someone you know is experiencing the symptoms of depression, it's important to seek help. It may be beneficial to confide in trusted loved ones about your challenges; in addition, a mental health professional can help you navigate the frustrations you're experiencing.

Selective Mutism Treatment

Selective mutism is most receptive to treatment when it is caught early. If your child has been silent at school for two months or longer, it is important that treatment begin promptly.

When selective mutism is not caught early, there is a risk that your child will become used to not speaking, and as a result, being silent will become a way of life and more difficult to change.

Treatment for selective mutism may include therapy, medication, or a combination of the two.


A common treatment for selective mutism is the use of behavior management programs. Such programs often base the treatment around cognitive behavioral therapy (CBT).

In a study examining children with selective mutism who received CBT for five years, researchers found that the majority were able to speak outside of the home and symptoms lessened of comorbid anxiety disorders.

Techniques used in cognitive behavioral therapy for individuals with selective mutism may include:

  • Desensitization: This is the process by which, over time, a person can overcome sensitivity to anxiety triggers by experiencing them directly. It's a slow and gradual process.
  • Exposure therapy: During exposure therapy, a psychologist creates a safe space wherein an individual is exposed to the object of their fear (with selective mutism, this may be speaking in front of or directly to a stranger).
  • Reinforcement: A therapist may teach someone with selective mutism how to use positive reinforcement to alleviate anxiety. For instance, together, you may come up with positive coping statements to use instead of negative self-talk when in situations that trigger selective mutism.
  • Shaping: Shaping is a process by which desired behavior is rewarded with positive reinforcement (however, undesired behavior is not negatively reinforced). For instance, when a child with selective mutism makes any attempt to speak to a teacher or another child, a caregiver may reward them with extra television time or a later bedtime.


Medication may also be appropriate, particularly in severe or chronic cases, or when other methods have not resulted in improvement. The choice of whether to use medication should be made in consultation with a doctor who has experience prescribing anxiety medication for children.

Coping With Selective Mutism

In addition to seeking appropriate professional treatment, there are things that you can do to help your child manage their condition.

  • Inform teachers and others who work with your child. Teachers can sometimes become frustrated or angry with children who don't speak. You can help by making sure that your child's teacher knows that the behavior is not intentional. Together you need to encourage your child and offer praise and rewards for positive behaviors. 
  • Choose activities suited to their current skills. Don't force your child to engage in social situations or activities that demand spoken communication. Instead, choose activities that don't involve speech such as reading, art, or doing puzzles.
  • Reward progress but avoid punishment. Where rewarding positive steps toward speaking is a good thing, punishing silence is not. If your child is afraid to speak, they will not overcome this fear through pressure or punishment.
  • Don't pressure your child. Parental acceptance and family involvement are important in treatment, but you should avoid trying to force your child to speak. Putting pressure on your child will only increase their anxiety levels and make speaking all that more difficult. Focus on showing your child support and acceptance.

In general, there is a good prognosis for selective mutism. Unless there is another problem contributing to the condition, children generally function well in other areas and do not need to be placed in special education classes.

Although it is possible for this disorder to continue through to adulthood, it is rare and more likely that social anxiety disorder would develop.

Frequently Asked Questions

  • What triggers selective mutism?

    Being in public spaces or around less familiar people (such as classmates or co-workers) usually triggers selective mutism.

  • Is selective mutism a form of autism?

    No. However, selective mutism and autism may co-occur in some individuals.

  • What are the symptoms of selective mutism?

    Symptoms include a desire to speak that is held back by anxiety or fear, fidgeting, lack of eye contact, lack of movement or lack of expression when in social situations, and the inability to speak in certain social situations.

  • Does selective mutism go away?

    Selective mutism may not go away on its own; but, it can be overcome—it's best to seek treatment to address any underlying anxiety.

10 Sources
Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Kotrba A. Selective Mutism: A Guide for Therapists, Educators, and Parents. Eau Claire, WI: PESI Publishing and Media; 2015.

  2. Muris P, Ollendick TH. Selective mutism and its relations to social anxiety disorder and autism spectrum disorderClin Child Fam Psychol Rev. 2021;24(2):294-325. doi:10.1007/s10567-020-00342-0

  3. Hua A, Major N. Selective mutismCurr Opin Pediatr. 2016;28(1):114‐120. doi:10.1097/MOP.0000000000000300

  4. American Speech-Language-Hearing Association (ASHA). Selective mutism.

  5. Wong P. Selective mutism: A review of etiology, comorbidities, and treatmentPsychiatry (Edgmont). 2010;7(3):23‐31.

  6. Steffenburg H, Steffenburg S, Gillberg C, Billstedt E. Children with autism spectrum disorders and selective mutism. Neuropsychiatr Dis Treat. 2018;14:1163-1169. doi:10.2147/NDT.S154966

  7. Oerbeck B, Overgaard KR, Stein MB, Pripp AH, Kristensen H. Treatment of selective mutism: a 5-year follow-up studyEur Child Adolesc Psychiatry. 2018;27(8):997-1009. doi:10.1007/s00787-018-1110-7

  8. Bunnell BE, Mesa F, Beidel DC. A two-session hierarchy for shaping successive approximations of speech in selective mutism: Pilot study of mobile apps and mechanisms of behavior changeBehav Ther. 2018;49(6):966-980. doi:10.1016/j.beth.2018.02.003

  9. Muris P, Monait N, Weijsters L, Ollendick TH. Symptoms of selective mutism in non-clinical 3- to 6-year-old children: Relations with social anxiety, autistic features, and behavioral inhibition. Front Psychol. 2021;12. doi:10.3389/fpsyg.2021.669907

  10. Cleveland Clinic. Is your child just shy—or is it selective mutism?

Additional Reading
  • American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Washington, DC: Author.

  • Freeman JB, Garcia AM, Miller LM, Dow SP, Leonard HL. Selective Mutism. In: Morris TL, March JS, eds. Anxiety Disorders in Children and Adolescents. New York: Guilford; 2004.
  • Selective Mutism Foundation. Understanding Selective Mutism

By Arlin Cuncic
Arlin Cuncic, MA, is the author of "Therapy in Focus: What to Expect from CBT for Social Anxiety Disorder" and "7 Weeks to Reduce Anxiety."