Selective mutism (SM) is so much more than not speaking. People with selective mutism feel a great deal of anxiety that affects their ability to express themselves in many ways, not just verbally. Over 90% of people with selective mutsim also have social anxiety, which is defined as an intense fear of being judged, negatively evaluated, or rejected in social or performance situations. Many of the behaviors commonly seen in children with SM are directly related to this type of anxiety.
The following example illustrates how muteness is only one piece of the puzzle.
Petunia’s preschool teacher was concerned. She was obviously a shy little girl. Petunia would sit quietly with the group during circle time, but would not sing along with the other kids. At recess when peers approached to ask if she wanted to play, she would run off to another part of the playground. When the teacher asked Petunia a question she would freeze and remain silent. Over time, Petunia began to refuse to engage in the daily rotating activities and would not open her lunch box or eat anything at snack time. She chose to sit on the floor instead, sometimes watching others and sometimes just staring at the floor. The teacher’s gentle encouragement just seemed to make Petunia withdraw more. When Petunia was picked up from school each day, she would immediately run to the use the restroom, since she refused to go during class time. Despite these behaviors at school, Petunia was energetic, talkative, funny, and quite independent at home.
The criteria for the diagnosis of selective mutism, according to the DSM-5, includes the following:
- The child shows 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 1 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., child-onset fluency disorder) and does not occur exclusively during the course of autism spectrum disorder, schizophrenia, or another psychotic disorder.
This diagnostic criteria focuses solely on a child’s inability to speak, but the silence is just the tip of the iceberg. There is so much more going on underneath the surface. The underlying anxiety that drives SM and makes communication difficult can manifest in various ways. Listed below are some things you might observe in a child (or adult) who has selective mutsim. Please note that some of these characteristics may be symptoms of anxiety which are only present in certain situations. Most children with SM display a marked difference in behavior at home versus behavior in social activities including school.
Temperament and Personality Characteristics
- Fearful of new places, people, and things
Behaviors Related to Selective Mutism
- frozen expression with lack of eye contact
- tense and stiff body movements
- fidgets, bites nails, twirls hair, picks skin, chews on things
- does not raise hand or point
- unable to hand over or take an object from another person
- shuts down when new people approach
- unable to eat in front of others
- can’t use public restrooms or ask to use the toilet
- unable to perform in front of others
- acts extremely silly or wound up in front of new people or in new places
- has frequent and intense tantrums
- uses gestures in place of speech
- can’t initiate play or ask an adult for help
- unable to express and display emotions such as happy, sad, angry, scared, confused
- unable to demonstrate knowledge on tests (both written and oral)
- has difficulty expressing self through music, art, writing
- lacks social skills
- unable to tolerate certain textures, sounds, touch
- picky eater
- has difficulty with transitions and resists change
- unable to follow directions
- unable to join in group activities
- hides behind parent
- turns head or body away from others
- ignores requests
- refuses to go to school or participate in social activities
- ignores family and friends in certain situations
- refuses to have photos taken
- stomach aches
- Speech and language delays
- Sensory processing disorder
- Separation anxiety
- Panic disorder
- Generalized anxiety disorder
- Specific phobias
- Obsessive-compulsive disorder
- Attention deficit hyperactivity disorder
- Autism spectrum disorder (although this is impossible according to the DSM-5 criteria, there are some children with ASD that also have symptoms of SM)
Looking beyond the lack of speech is essential in helping the child with selective mutism. Many people think that children with SM can communicate in other, non-verbal ways, such as sign language, writing, gestures, or communication cards. However, this does not work for all kids. Some children with SM need accommodations for difficulties in toileting, eating, or sensory issues. Most children will need help to learn and practice appropriate social skills.
Selective mutism needs to be understood as an anxiety and communication disorder that encompasses much more than failure to speak. Treatment and accommodations should focus on the whole child and address all difficulties, not just speech.
Click for PDF to print or share: Common Characteristics of Children With Selective Mutism