Understanding Selective Mutism: More Than Just “Being Shy”

What Is Selective Mutism?

Selective Mutism (SM) is a childhood-onset anxiety disorder where children are unable to speak in specific social settings—even though they can speak comfortably in other settings. For example, a child might be a chatterbox at home but freeze up completely in school.

This isn’t about being stubborn or antisocial. In fact, children with SM often want to speak—they just can’t. The anxiety is too overwhelming.

“Selective mutism is a childhood onset anxiety disorder, and the main symptom is not speaking in certain social situations.”— Koskela, 2023

While it affects less than 1% of the population, its impact on social development and learning can be profound.

Signs of Selective Mutism

Some common signs include:

• Talking freely at home but not at school

• Becoming silent around unfamiliar people—even family

• Relying on gestures or facial expressions to respond instead of speech

• Seeming “shut down” in certain social situations

“Children with SM are extremely anxious and can’t talk, even when they want to.”— Child Mind Institute, 2025

Why Evaluation Is So Important

Diagnosis is not always straightforward. Children with SM might not have any speech or language disorder—and yet, they don’t speak. Sometimes, language delays, developmental disorders, or hearing loss may be contributing factors.

Since most children with SM won’t speak to clinicians, parent interviews are essential to gather history and context.

Speech-language pathologists (SLPs) observe behavior in familiar environments and work to build connection over time. Establishing a secure and engaging environment is essential for encouraging a child to communicate.

Treatment Options

There is no “one size fits all” approach to treatment. But research has shown that Cognitive Behavioral Therapy (CBT) and behavior-based interventions are particularly effective.

• School-Based CBT

Gradual exposure, rewards, and play-based sessions help children speak up at school.

• Modular CBT

Targets the root causes of anxiety with techniques like muscle relaxation, parental training, and behavior modeling.

• Web-Based CBT

14-week programs with online therapist support and tasks like voice recording help children desensitize to speaking.

• Integrated Interventions

Focus on behavior through exposure and speech exercises—though they may not address the anxiety itself.

• Brave Buddies® Program

An immersive, group-based treatment offered by the Child Mind Institute that helps kids speak in classroom-like settings.

“Brave Buddies® is designed to help children ages 3–12 diagnosed with selective mutism overcome their anxiety and speak in any setting.”— Child Mind Institute, 2025a

Supporting Children with SM in Daily Life

The treatment process should be gentle, individualized, and include caregivers, teachers, and therapists. Children should never be pressured to speak. Instead, small successes should be celebrated.

Tips from the Child Mind Institute:

• Wait 5 seconds before repeating a question

• Use labeled praise to encourage progress

• Rephrase your questions to be more open-ended

• Echo their words so they feel heard

• Narrate their actions to model language and engagement

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What About Medication?

Medication is not typically the first line of treatment, but it can help in some cases—particularly when anxiety is severe. SSRIs like fluoxetine have been used with mixed results.

Conclusion

Selective Mutism may be rare, but with early diagnosis and the right support, children are likely to recover. A compassionate, gradual approach—grounded in evidence-based strategies—can help children with SM find their voice and thrive in all areas of life.

If you think your child may be struggling with Selective Mutism, it is important to seek out help from a speech-language pathologist.

References

• American Speech-Language-Hearing Association. (n.d.). Selective mutism. https://www.asha.org/practice-portal/clinical-topics/selective-mutism

• Brave Buddies® Program. Child Mind Institute. (2025a, February 21). https://childmind.org/care/areas-of-expertise/anxiety-disorders-center/brave-buddies-program/

• Chatzinikolaou, M.-D., & Iliopoulou, T. (2021). Selective Mutism in Children: A Literature Review of Cognitive Behavioural and Integrative Psychotherapeutic Schemes. https://www.researchgate.net/publication/351128311

• Complete Guide to Selective Mutism. Child Mind Institute. (2025, February 2). https://childmind.org/guide/parents-guide-how-to-help-a-child-with-selective-mutism/

• Dow, S. P., Sonies, B. C., Sheib, D., Moss, S. E., & Leonard, H. L. (1995). Practical Guidelines for the Assessment and Treatment of Selective Mutism. http://resources.childhealthcare.org/resources/guidelines_for_selective_mutism.pdf

• Koskela, M., Ståhlberg, T., Yunus, W. M. A. W. M., & Sourander, A. (2023). Long-term outcomes of selective mutism: A systematic literature review. BMC Psychiatry. https://link.springer.com/content/pdf/10.1186/s12888-023-05279-6.pdf

• Sharp, W. G., Sherman, C., & Gross, A. M. (2007). Selective mutism and anxiety: A review of the current conceptualization of the disorder. Journal of Anxiety Disorders, 21(4), 568–579. https://www.sciencedirect.com/science/article/abs/pii/S0887618506001162

• Wong, P. (2010, March). Selective mutism: A review of etiology, comorbidities, and treatment. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2861522/