Imagine you’re six years old and doing well at primary school. You’ve got good grades and are an attentive student. There is just one problem – you can’t speak, whether that be to your teacher or your peers. Selective mutism is not a choice not to talk but a crippling anxiety disorder where children (and more rarely teenagers) feel unable to express themselves verbally. 

An inability to speak in highly anxious situations is accompanied by other symptoms – from freezing completely to avoiding eye contact and becoming agitated. There are as many manifestations of selective mutism as there are people suffering from it.

It generally appears at around the age of four to six years old, especially as the child starts school. Often a child can be a real chatterbox in “safe” situations but freezes when an outsider is introduced to the “threatening” circumstances.

Early intervention is key – a technique called sliding in. The child, supported by their speech and language therapist or CAMHS worker as well as their families are involved. Like with all CBT interventions, this includes creating a hierarchy of situations, from the easiest (like whispering to his/her parent at school) to the ultimate (and hard-fought-for) achievement of being able to speak to staff and peers. 

It is vital to avoid putting the child or teenager under pressure, for example pushing them to talk in a highly feared situation. Imagine you have a paralysing fear of snakes and someone suddenly told you that you had to have a cuddle with a cobra – that’s what it’s like when you ask someone suffering from selective mutism to talk in front of the whole school. The key is slow steps. 

Selective mutism doesn’t just affect children. A small proportion goes on to have a chronic condition. As if secondary school wasn’t hard enough already, imagine being unable to communicate with teachers and most importantly other students. Teenagers can become lonely and feel frustrated and it’s therefore vital to increase self-esteem and self-confidence. The efficacy of sliding in in teenagers is mitigated. CBT is the therapy of choice but the teenager has to be the one who initiates and controls the therapy. 

To conclude, selective mutism is an often-overlooked severe anxiety disorder. Early intervention is the goal and can avoid unnecessary suffering and isolation.

Cuddle the cobra and move forwards. 

Two personal stories of selective mutism:

“My family consists of myself, my partner and my 17-year-old twin daughters. I have been with my partner for 5 years and he has heard approximately only 20 words from the twins in that time. Both my children were diagnosed with selective mutism within 3 months of starting school. They went to a nursery that fed directly into a primary school. We were advised on their very first school parents evening that no one had ever heard their voices. This came as a total surprise as they were always very loud outside of school in all scenarios and with all people. Speech and language therapists were called in and the diagnosis was made relatively easily and quickly. the girls were appointed a teaching assistant and flashcards to display ensuring their needs were met. We tried various techniques.

The anxiety and fear they experience;

• People looking at them.
• People paying them attention.
• Being forced to talk.
• People laughing at them.
• People talking about them.
• Not knowing what is coming next.
• Being different or standing out.

Two examples of challenging times;

• One of my daughters had a panic attack in the classroom at school, this was the result of being asked a question, she internalised her panic attack so no one could see but we ended up in A&E for 8 hours immediately after the class. She had locked herself in the toilets at school and called me hyper hyperventilating.
• My other daughter was ill at school snd was so afraid to talk, she ended up being sick and keeping it in her mouth with her hand.

We have had endless speech therapists, Special Educational Needs workers, and support from CAMHS, sadly nothing has worked. They operate on a one size fits all solution (which of course, doesn’t work for all). Very few actually fully understand and discharge or dismiss anyone that doesn’t respond to their way. I am not a fan. They leave children with zero support. It has massively impacted my children. They live a shadow of the life they should be living due to the limits of selective mutism, judgement and lack of understanding from others. They have always struggled to make friends, complete work experience, or be independent. I have had to quit my job on 3 occasions to provide support in school as schools were unable to do so. I frequently have to leave work when a situation arises that they cannot seek help in. We now research and plan our own treatments and therapies”.

“I have two daughters and my youngest daughter has Selective Mutism. She was diagnosed in 3rd grade at 9 years old but I knew something was different when she was about 2 or 3. I thought some of it was her personality and was hoping she would grow out of it. When she was 3 I learned she never spoke at daycare. She had been already attending for two years and she never said a word up until she started kindergarten. Without a diagnosis, it was very difficult to get help and an understanding from the schools. Comments received were; she is defiant, refuses to speak, just stares at the teacher blankly, sometimes responds nonverbally, she isn’t comprehending (even though she was above average on nonverbal assessments). Once I saw a psychologist she was quickly diagnosed and then I requested a referral. My daughter is afraid to stand out in any way and will try to blend in or be invisible. She is afraid people will ask her questions. She is afraid people won’t or don’t like her because she “will not “ talk to them. She also has sensory processing so anxiety from noise, light, clothing and smells. She has a hard time travelling on the school bus, witnessing fire drills, anything out of routine in fact. I am in the process of trying to qualify for speech therapy through the school and will request a referral evaluation next week. Selective Mutism has affected her social life and ability to make friendships (she has had just one friend since kindergarten and is now entering the 6th grade this year) school has been very difficult. So has understanding from family members, vacations, transportation to and from school due to parent work schedules and self-confidence”.

More Reading: Recovery from Selective Mutism is possible. Read Catherine’s story.

How can No Panic help? No Panic’s Youth One-to-One Mentoring Recovery Programme is a 6 week, one hour per week telephone course with a No Panic Mentor. We use cognitive behavioural therapy to develop an understanding of the relationship between thoughts, feelings, actions and physiology. Find out more……