All About Selective Mutism: Frozen In Silence

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Have you ever been in a scenario where you wanted to speak, but couldn’t?

For those with selective mutism, this is a reoccurring reality.

Selective mutism is a condition in which a person cannot speak in certain situation. Typically, selected mutism begins in childhood. For example, a child may go the entire day at school without speaking but then speak once at home.

Selected mutism should not be confused for shyness.  Selected mutism is considered a rare disorder. The prevalence runs between .03% to 1% but that could be an underestimation. Because of the rarity of the disease, many who have it do not come forward,  nor do they seek treatment.

The onset of the condition typically begins in children under five. Symptoms are often apparent when a child begins school. Mental illness history in the family increases the risk of developing a variety of mental health issues like selective mutism.

In 1877, German physician Adolph Kissmaul called it “aphasia voluntaria” then in 1934, child psychologist Moritz Tramer coined it “elective mutism.” Still, both terms implied that the behavior was oppositional or defiant. This could not be further from the truth. Therefore, in 1994, the DSM-IV adopted the term “selective mutism” which accurately reflected the reality of the disorder as an inability to speak.

Sadly, if left untreated, selective mutism can have a devastating impact on a person’s life. Anything from failed relationships to failed jobs, the negative effects of this condition are endless.

What treatments are available for individuals with selective mutism?

In the early stages, intervention can help treat selective mutism. Treatment involves a variety of strategies depending on the individual’s needs. The specialism may create a behavioral treatment program focused on specific speech and language problems, and/or work in the child’s classroom with teachers.

A behavioral treatment program for children may include the following:

• Stimulus fading: having the child talk freely in a relaxed situation and gradually introduce a new person into the room.
• Shaping: reinforcing all efforts by the child to communicate (e.g. gestures, whispering, mouthing) until audible speech is achieved.
• Self-modeling technique– have child watch videotapes of them communicating effectively in order to increate self-confidence to increase confidence in setting where mutism common occurs.
• Target problems that are making mute behaviors worse
• Role playing- initiate activities to help the child gain confidence when speaking in a variety of settings.

Selective Mutism as an Adult:

Selective mutism in older adult is not uncommon. The issue lies in its misdiagnosis. The condition in adults often is diagnosed as severe depression, locked-in syndrome and persistent Mutism is defined as the state of condition of being speechless. If speech occurs, it is very restricted. Mutism is not uncommon in the senior population because it is often caused by brain damage.

Psychologists have struggled to fully understand selected mutism. Some suggest it is manifestations of social anxiety while other point to autism. However, the one voice often unheard is the perspective of those who struggle with it. An article in Research Digest, interviews five people with the condition. Four of the participants were interviewed using instant messenger. The last participant was psychology student and study co-author Aaron Walker, a prize-winning psychology student who managed to largely overcome his selective mutism.

The Voices of Selected Mutism

Hannah, aged 26, was diagnosed with selective mutism at age 17. Since she has only been able to speak verbally with her parents. She described the sense of isolation.

“It isn’t me. I know who I am and I’m not shy or quiet, maybe that makes it harder. When I’m with my parents I can be myself but around everyone else it’s like it [selective mutism] takes over. I can get the words in my head but something won’t let me say them and the harder I try the more of a failure I feel like when I can’t.”

Lily, 23, was diagnosed at the age of 12. She feels regret sometimes for a wasted life:

“A lot of the time I worry about things I haven’t done, that I should have. [Interviewer: What kind of things?]. “All the things normal people do. I could have gone to university, I always did well at school. But it was different there, teachers knew about my problem. Maybe I’d have been able to get a job and be in a relationship. A lot of the time I imagine what my life would be like if I didn’t have selective mutism.”

Finally, the psychology student opened up about his condition. Through a variety of interventions and treatments, he was able to overcome the bulk of his selective mutism. Now he is able to live a life of normality.

Selective mutism is a condition rarely talked about but it can be debilitating for those who struggle with it. If left untreated, selected mutism can result in severe depression or even addiction in an attempt to overcome the pain. Do not wait to seek treatment. The earlier you reach out, the better. If you or anyone you know is struggling with substance use disorder or mental illness, please call toll-free 1-800-777-9588.