Psychologists and psychiatrists at Shier Private Practice, in Scottsdale, AZ specialize in the treatment of selective mutism. Our private outpatient clinic offers a comprehensive psychiatric/medical assessment and treatment plan. Treatment may include medications, behavioral therapies or a combination of treatments.

Children struggling with selective mutism have difficulty speaking in public where other people outside of their family can hear them. They will either not speak at all outside of the house or will speak in a barely audible whisper and they do not initiate conversation nor respond when spoken to. Children with selective mutism will usually talk at home and with immediate family members, but will often not speak, even around close friends or second degree relatives. Social anxiety tends to be a co-occurring issue which leads children with selective mutism to typically have an additional diagnosis such as social anxiety disorder otherwise known as social phobia.

The DSM-5 diagnostic criteria for selective mutism are:

1. 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.
2. The disturbance interferes with educational or occupational achievement or with social communication.
3. The duration of the disturbance is at least 1 month (not limited to the first month of school).
4. The failure to speak is not attributable to a lack of knowledge of, or comfort with, the spoken language required in the social situation.
5. The disturbance os mpt better explained by a communication disorder (e.g., childhood-onset fluency disorder) and does not occur exclusively during the course of autism spectrum disorder, schizophrenia, or another psychotic disorder.

Selective mutism is a relatively rare disorder with point prevalence ranging between 0.03% and 1% of school aged children. Typically its onset is prior to the age of 5 years but may not be recognized until entry into school where more social demands are placed on your child. Often teachers will approach parents to let them know about the communication struggles their child is facing at school and often it comes as a surprise to parents. Since these kids usually speak at home and around siblings it can sometimes come as very scary and unexpected news. It is important to rule out other causes of speech issues such as stuttering, speech sound disorder, autism spectrum disorder, schizophrenia or severe intellectual disability. Typically these conditions show the same level of speech impairment across various social settings versus children with selective mutism speak well at home but not in specific social situations.

Common consequences of selective mutism are academic and educational impairment as it is difficult for teachers to assess skills such as reading. Selective mutism also interferes with social communication which can compound your child’s existing fear of school and new places. It can lead to an increasing sense of social isolation and can result in getting teased and picked on by classmates.

Selective mutism is best treated as early as possible so if your child has not spoken by their mid-year of kindergarten seek an evaluation by a mental health professional. The diagnosis of selective mutism requires a thorough biopsychosocial psychiatric or psychological and medical assessment to confirm the diagnosis and rule out other psychological or medical conditions.

The treatment of selective mutism varies from individual to individual but may consist of medication to treat underlying anxiety in conjunction with therapy. Typically therapy targets anxiety by teaching various relaxation techniques which can be employed in conjunction with behavioral therapy. Behavioral therapy work is done both with the child as well as the family to create a hierarchy of speech goals that the child is supported to conquer. It may start with speaking around someone who they are very comfortable with and then slowly introducing another individual in the room or may start with easier goals such as saying a short sentence to grandma with harder future goals of making a request in class. Often it is necessary to work with the family in order to help family and friends recognize when they are inadvertently supporting the mutism by stepping in to make requests for their child or sibling, curtailing opportunities for the child to speak for themselves. In some cases selective mutism may disappear over time on its own but as it fades in its place remains the social anxiety which drove it into existence in the first place. For this reason, even if speech seems to be improving on its own, therapy is vital in order to address the social anxiety that fueled the selective mutism into being and which could lead to new anxiety-based struggles such as general anxiety, separation anxiety or phobias.

Last update: February 25, 2019

The content on this website is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.