Medicines for Selective mutism

What it is

Selective mutism is an anxiety condition in which a person — usually a child — is consistently unable to speak in certain situations or settings (such as at school, or with people they do not know well), despite being able to speak normally and comfortably in other situations (such as at home with close family). It is important to understand that selective mutism is not the child being deliberately silent, difficult, defiant, or choosing not to speak, and it is not shyness alone or a problem with the ability to speak — rather, it is an anxiety-based condition, where the anxiety in certain situations effectively prevents the child from being able to speak, even though they may very much want to. It usually starts in early childhood, often around the age of starting nursery or school (when the child is expected to speak in new social situations), and it is more common in certain children (for example those who are naturally more anxious or inhibited, and it can be associated with other anxiety). A child with selective mutism speaks freely in situations where they feel comfortable and secure (such as at home), but is unable to speak in situations that trigger their anxiety (such as school, or with unfamiliar people), and may appear frozen, expressionless, or withdrawn, and may communicate in other ways (such as nodding or pointing) in those situations. Selective mutism can significantly affect a child’s life — particularly their education and social interactions — and can be distressing for the child and family, and it is important to recognise and address it, ideally early. The encouraging point is that selective mutism can be helped, and children can improve and overcome it with understanding and appropriate support: the approach is based on reducing the anxiety and gradually building the child’s confidence to speak, with support from family, school, and, where needed, speech and language therapy and other professionals; a pressured or forceful approach (trying to make the child speak) is unhelpful and can make it worse. Understanding, patience, and the right support are key. The key messages are that selective mutism is an anxiety condition (usually in children) where a person is consistently unable to speak in certain situations despite speaking freely in others, that it is not deliberate or defiance, and that understanding and appropriate support help children overcome it.

How it is treated

Selective mutism is helped by understanding it as an anxiety condition, reducing the anxiety, and gradually building the child’s confidence to speak, with support from family, school, and professionals; a patient, non-pressuring approach is essential, and early support helps. A crucial foundation is understanding that selective mutism is anxiety-based and not deliberate, defiance, or simple shyness — this understanding shapes the whole approach, as pressuring or forcing a child to speak, or showing frustration, increases their anxiety and is counterproductive, whereas a patient, supportive, low-pressure approach helps. Recognising it (usually when a child consistently does not speak in certain settings such as school, despite speaking at home) and seeking support, ideally early, is important, as earlier intervention tends to help; a GP, health visitor, school, or educational and speech and language services can help, and assessment (for example by a speech and language therapist or relevant professionals) can confirm the situation and guide support. The approach to helping generally involves reducing the child’s anxiety and gradually building their confidence and ability to speak in the situations that are difficult, in a step-by-step, supportive way — this often involves techniques that gradually and gently help the child become comfortable communicating and then speaking in the anxiety-provoking settings, at their own pace, without pressure. Support from and coordination between family and school (and any professionals involved) is very important, so that the approach is consistent and supportive across the child’s life — for example, creating a relaxed, low-pressure environment, not drawing attention to the child’s not speaking, allowing other ways of communicating initially, and gradually and gently encouraging speaking as the child becomes more comfortable, following the guidance. Speech and language therapists, and sometimes other professionals (such as psychologists), often guide the support, and there are established approaches for helping children with selective mutism. Addressing any associated anxiety, and supporting the child’s overall wellbeing and confidence, are part of the approach. Support for the family, and understanding from those around the child, help. With understanding and appropriate, patient support, many children with selective mutism improve and are able to overcome it over time, though it can take time and patience. It is worth seeking help if selective mutism does not improve, is affecting the child, or there are concerns, so support can be arranged. The reassuring and encouraging messages are that selective mutism is an anxiety condition that is not the child’s fault or deliberate, that it can be helped through understanding, reducing anxiety, and gradually building confidence to speak with consistent support from family, school, and professionals, that a patient, non-pressuring approach is essential, and that many children overcome it with the right support; so understanding, a supportive low-pressure approach, and early, coordinated support are the keys to helping a child with selective mutism.