How to parent a child with selective mutism

Parenting is full of supposed certainties. How a child should behave. How parents should react to their behavior. It can be hard to remember that our children are all unique individuals and that there really isn’t a blueprint for perfect parenting.

One generally accepted truth, however, is that children are noisy. So if your child chooses to retreat into a world of silence, it can be alarming.

What Is Selective Mutism?

Selective Mutism (SM) affects between 0.47 percent to 0.76 percent of children, and occurs when a child who is physically able to speak begins to withhold speech in certain situations or around certain people.

“The degree of mutism can vary,” says Ashley Smith, Ph.D., a licensed psychologist who specializes in the treatment of anxiety disorders, “ranging from complete silence and no nonverbal communication with anyone when outside of the home to milder variations like not speaking to teachers but talking with peers, not speaking verbally but communicating with others through non-verbals, or whispering to parents to relay communication when outside of the home.”

“Even if children want to talk to more people, they feel like they can’t or something is stopping them,” adds Heidi McBain, MA, LMFT, LPC, RPT, a licensed marriage and family therapist who describes SM as an involuntary reaction to anxiety or stress.

McBain’s own daughter exhibited signs of SM, which ended up causing problems at her school. “We had to get the director involved because the teacher was taking it so personally that our child was not talking to her or the other children in her class,” she says. “Also, extended family would come to visit and feel the same way.”

Managing other adults’ feelings is often one of the hardest parts of parenting a child with SM. McBain’s advice to parents of sometimes silent children is to be patient. “Don’t try to force them to talk, period. Empathize with how they are feeling and how difficult it can be to talk to people outside of their immediate family,” she says.


Signs And Symptoms Of Selective Mutism

The American Speech-Language-Hearing Association describes the symptoms of SM to be a “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.” They also suggest parents make a note of any of these other signs:

  • a lack of eye contact
  • hiding or freezing
  • general anxiety
  • tantrums if asked to speak

And though it sounds similar, SM is more than normal childhood shyness. Ofra Obejas, LCSW, a child and family therapist, cautions parents against using the word “shy” to describe children dealing with SM, as it minimizes the child’s experience and ascribes a personality type rather than a diagnosis.

“Even the most socially awkward or ‘shy’ child might say a word here and there, even if only a one-word answer,” says Obejas. “SM is when there is no talking whatsoever in some situations (when there is demonstrated ability to talk in other settings), or speaking in a barely audible voice as if the child is afraid to be heard.”

That word — “afraid” — is key, and the connection between SM and anxiety is important. The Selective Mutism, Anxiety and Related Disorders Treatment Center (SMART) claims that 90 percent of children diagnosed with SM also exhibit social phobias or social anxiety.

Obejas reminds us that despite its name, SM is not a conscious decision not to communicate. “The term selective implies a choice, suggesting that a child is able but refuses to speak,” she says, “when in fact it is not a rational choice but a behavior that  stems from emotional overwhelm, due to anxiety or feelings of helplessness.”


Treatment Plans

McBain and Obejas, both registered play therapists, believe that play offers a safe place for children to explore their feelings and anxieties. Other treatment plans include helping children to manage their anxiety and develop a sense of agency over their own lives, which helps to build confidence and resilience.

Smith, who conducts educational workshops for school districts on the subject of SM, recommends cognitive behavioral therapy, including graduated exposure (in which the child takes small steps to conquer their fears).

For example, she suggests “maybe whispering to parents in the hallway of the school, whispering to parents in the classroom when no one is there, talking with a full voice to parents at school when no one is there, whispering to a teacher, increasing volume with that teacher, or playing a recording of the child talking in front of the class. When reinforced with rewards and support,” she says, “this can be quite effective.”


What Not To Do

It can be frustrating for parents to deal with other people’s reactions to their child’s SM, and they may even begin to regard it incorrectly as a behavior issue. “When the behavior is perceived as willful,” says Obejas, “there might be anger towards the child, and threats of punishment, which will only increase distress and exacerbate the condition.”

Ruth Carter, a professional speaker who, interestingly enough, has struggled with SM since the 4th grade, advises parents of children with SM to remember that their child is not trying to hurt them. That it’s not personal at all. “Respect that the child is doing the best they can,” they say. “Just because they don’t talk, it doesn’t mean they’re not communicating. Give them a way to communicate in a way that makes them feel comfortable and in control — like a little notebook they can carry and write in if they want.”

Because a refusal to speak in some settings can be viewed as defiance or as a rejection of groups of people, SM can cause friendship problems and lead to bigger school issues. On this, Smith has the following advice:

“Threatening a child (talk or else!) or putting them on the spot to speak will likely make anxiety worse,” she says, “so it is important to help children feel comfortable and to be patient with the process.”

In the end, parents have to trust that their child’s confidence will grow over time. In the meantime, respect and understanding can be the best medicine.

Have you grappled with SM as a parent?