Beyond Mute: Other Characteristics of Selective Mutism

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

Inhibited/Timid
Perfectionist
Hypersensitive
Aggressive
Avoidant/Withdrawn
Controlling/Inflexible
Oppositional
Anxious
Fearful of new places, people, and things
Creative
Empathic
Discerning/Perceptive

Behaviors Related to Selective Mutism

Physical

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

Communication

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

Sensory

unable to tolerate certain textures, sounds, touch
picky eater
has difficulty with transitions and resists change
unable to follow directions

Avoidance

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

Somatic symptoms

stomach aches
headaches
pain
fatigue

Comorbid Conditions

Speech and language delays
Bilingual
Sensory processing disorder
Separation anxiety
Panic disorder
Generalized anxiety disorder
Specific phobias
Obsessive-compulsive disorder
Attention deficit hyperactivity disorder
Hoarding
Depression
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.