Selective Mutism In Children: 'The Words Are Stuck In My Throat'

Michael, my nephew, has always been a shy kid around strangers. The youngest of six, his mother had a tubal ligation the day after he was born. His parents and siblings treated him as the baby of the family — literally calling him "baby" until he was at least three years old, carrying him about, and striving to meet his every wish. He was the last, after all, and they were going to savor every moment of his babyhood. Within the family, he was a chatterbox, but he'd hide behind his mother when in the company of people he didn't know well, and said nothing at all. This, too, was attributed to him being the baby of the family.

"Olivia, I'm scared of those people," he told me when I found him rocking back and forth in my bedroom on the day I invited some friends who had a boy his age over in the hope he could have a friend outside of the family. When he started daycare, Michael's carer was concerned. Not only didn't he speak at all, to anyone, on the first day, he didn't speak the day after either. Or the day after that. Then, he stopped speaking to me, and to his grandparents, and even to his parents and siblings, for longer and longer stretches of time. A little philosopher, he'd give insightful comments when he did speak: "Mommy, the words are stuck in my throat."

What Is Selective Mutism?

Selective mutism is a complex childhood communication disorder, linked to anxiety in children. While it usually occurs during childhood, it can indeed affect some adults as well. People with selective mutism find themselves unable to speak in particular social situations — commonly at school or daycare — while usually being fully able to effectively communicate in settings with which they are comfortable, like at home within their own family.

• An inability to speak in particular social situations.
• The inability to speak in those settings lasts for longer than one month — it isn't simply due to being scared of a new setting.
• The inability to speak isn't due to speaking a second language, a communication disorder like stuttering, or something that occurs within the context of another diagnosed disorder that can interfere with speech, such as autism.
• The inability to speak is detrimental to achievement or communication.

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Closely linked with social anxiety disorder, selective mutism will often coincide with anxiety, being painfully shy, and fearing social embarrassment or judgment. Selective mutism, like almost any other disorder, exists on a spectrum that ranges from mild to severe. Some children who are selectively mute are able to speak to those peers at school they are comfortable with, for instance, while others don't. At the severe end of the spectrum, as we saw with Michael, kids will stop talking to close relatives as well. 

Selective Mutism: Diagnosis And Treatment

How Is Selective Mutism Diagnosed?

Diagnosing selective mutism is a complex process in which many other problems have to be ruled out first. Most children who are diagnosed with selective mutism receive the diagnosis between the ages of three and eight, after already displaying symptoms of extreme shyness and being uncomfortable with people before. 

A combination of different professionals will be involved in the diagnostic process, and they will usually include a speech-language pathologist (SLP), the child's pediatrician, and a psychologist or psychiatrist, who can determine the safest SSRI antidepressants for anxiety in children, where necessary, and offer cognitive behavioral therapy. 

These professionals will look into many different aspects of the child's physical, emotional and social development, including:

• Observations offered by parents, teachers, and standardized testing in school.
• Hearing: hearing tests and ruling out ear infections are both part of the diagnostic process.
• Physical ability to speak, looking at the strength of facial muscles.
• The family's history of anxiety and other mental disorders.
• The child's history of social development and verbal expression.
• The child's ability to express themselves verbally within the family.

Treating Selective Mutism