Selective mutism treatment

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This page was clinically reviewed by Dr Josephine Neale (MBBS,BSc, MRCPsych) in October 2021.

What is selective mutism?

Selective mutism is a severe anxiety disorder that causes a person to be unable to speak in certain social situations due to the intensity of panic and anxiety symptoms that this causes. This condition is similar to extreme examples of stage fright, where it feels like your body is ‘frozen’ in motion.

Selective mutism usually starts during childhood and affects around 1 in 140 young children. Factors that may influence the development of selective mutism include:

  • Being a child learning a second language, as confidence in their speech may be reduced
  • Presence of a speech and language impairment
  • Anxiety (either personally, or a family history of anxiety)
  • Family history of shyness or selective mutism
  • Reinforcement of mutism by increased attention and affection

Selective mutism can occur alongside autism, but there's no evidence to suggest that one causes the other.

Signs and symptoms of selective mutism such as being shy, withdrawn and poorly co-ordinated will be specific to certain situations and people. You may first spot the signs of selective mutism when your child begins nursery or secondary school, as they move out of their comfort zone and into an unfamiliar world of social engagement. Being able to speak freely among close family and friends, yet freezing up when among lesser known peers or relatives, marks the difference between excessive childhood shyness and an anxiety disorder such as selective mutism.

Diagnosing and getting help for selective mutism as early as possible can help to reduce the impact of this disorder on your child’s education and development. The effects of this condition on their everyday life can cause them to miss out on opportunities to develop their speech and stunt progress in their learning, due to not wishing to ask further questions or seek feedback on their work for fear of being pressured into a conversation or being centre of attention.

Signs and symptoms of selective mutism

As a parent, it can be difficult to determine the difference between excessive shyness, which is common in young children, and an anxiety disorder such as selective mutism. While your child may speak freely and openly in a comfortable setting with immediate family, signs and symptoms of the disorder become apparent when they're meeting new people or seeing people they don’t know well.

Children with selective mutism don’t pick and choose who they speak to; they become physically unable to speak as a result of intense anxiety and panic, which overwhelms them in certain situations. This might causes your child to feel frustrated and embarrassed, as they may want to communicate their thoughts verbally, but their mind and body isn’t allowing them to do so.

Selective mutism must be diagnosed by a qualified child health professional such as those found at Priory. The specific signs and symptoms we'll look out for include:

  • Your child struggles to speak in specific social settings
  • Your child can speak freely in more comfortable social settings
  • Their problems communicating in school environments are affecting their development and mental health
  • Your child has experienced symptoms for at least 6 months
  • Your child doesn’t have another behavioural or communication disorder which may be contributing to their inability to speak or function in certain social settings
  • Shyness and appearing withdrawn
  • Acting stubbornly or in an aggressive way when they get home from school
  • Having a low mood or appearing to be disinterested in daily life
  • Often seeking social reassurance from those close to them
  • Muscle tension and poor co-ordination
  • Appearing nervous and socially awkward in certain situations

Less severe forms of selective mutism may mean your child becomes confident enough to communicate through gestures such as shaking or nodding their head to agree or disagree with what's being said, even if the situation is making them feel socially uncomfortable. If your child is diagnosed with more severe selective mutism, they may shy away from using alternative forms of communication, for fear of being pressured into talking through this behaviour.

Therapeutic treatment programmes look to reduce the debilitating symptoms of selective mutism, helping your child to feel comfortable showing off their personality in a variety of social settings.

What causes selective mutism?

While there's no specific cause or reason why your child may develop selective mutism, its link with anxiety disorders, such as social anxiety disorder, suggests that children who are predisposed to developing symptoms of anxiety are most likely to develop the condition.

The fear of talking to certain people may stem from an inherited trait to feel worried or anxious, struggling with what others without anxiety conditions would perceive as everyday situations. If your child has a pre-existing speech or language problem or has difficulty hearing, this can contribute to their lack of self-esteem during social situations with people they don’t know well, and can also lead to the likelihood of developing selective mutism.

Here at Priory, we understand that selective mutism can severely disrupt your child's development and quality of life. Early diagnosis and treatment can help them overcome these symptoms, allowing them to grow into adolescence and adulthood with increased self-confidence and happiness.

Managing selective mutism: tips for parents

If you think that your child may be showing signs of selective mutism, and if you're waiting to receive professional support, the following tips may help you to manage this condition:

  • Reassure your child that they can speak normally, and will eventually be able to do so in situations they find difficult, when they feel more comfortable
  • Avoid placing pressure on them to talk; this will only serve to raise anxiety
  • Give your child praise if they communicate in any way, in the situation that they find difficult, for example, non-verbally by shaking their head or waving. Praise them away from the situation so they don't feel embarrassed during it
  • Don't avoid social situations but try to make them as comfortable and enjoyable as possible for the young person, so their fear of the situation begins to gradually reduce
  • Ask others who'll be coming into contact with your child not to draw attention to them not speaking

Treatment for selective mutism

If you believe that your child may have selective mutism, it's important that you get help and support from mental health professionals as soon as possible. Early diagnosis and mental health treatment for the disorder can increase the chances of your child overcoming or vastly improving related symptoms.

If you're an adult with selective mutism, treatment can still be effective, although the process may take longer due to the fact that your behaviours may have become deep-seated over time.

If your child has a co-existing mental health condition alongside selective mutism, such as depression or an anxiety disorder, or a learning disability that affects their ability to communicate, then this may affect how long or complex the treatment programme will be.

Treatment options at Priory focus on reducing associated anxiety symptoms surrounding speaking in certain situations, as opposed to simply focusing on the speech itself. Whether triggering scenarios are found during nursery, school, work or social settings, the aim of talking and behavioural therapies will be a progressive, step-by-step process to gradually reduce the pressure to speak, which is at the core of symptoms of selective mutism.

Ensuring that your child’s self-confidence is built up over time and teaching them coping mechanisms and techniques can ultimately lead to successful conversations in group situations and the ability to speak freely to all manner of people within a variety of settings.

In order to reach this stage, therapies used to treat selective mutism in both children and adults include:

Cognitive behavioural therapy (CBT)

Among the most effective methods of treating selective mutism is CBT.

This action-based and problem-solving talking therapy is carried out by highly trained therapists, where you or your older child can benefit from further understanding of the disorder and anxiety in general. The therapist will provide a range of techniques for managing anxiety during triggering situations, focusing on how negative thoughts and feelings may be contributing to anxiety symptoms.

Younger children can still benefit from CBT, although the focus will be less on detailed understanding of anxiety, and more about assessing their general wellbeing.

Stimulus fading

The child may talk at ease with someone, such as a parent. In stimulus fading, another person is introduced to the situation. Then, as they become included in talking, the parent withdraws and talking continues.


This method attempts to reduce the fear of certain people hearing the sound of you or your child’s voice.

Many people with social anxiety and selective mutism will feel more comfortable through non-vocal means of communication, such as instant messaging or emailing, which can be used before increased exposure. Exchange of voice recordings and voicemail messages builds to more direct forms of communication such as telephone or video conversations.


With two-way communication among people other than close friends and family being the desired goal, shaping uses techniques which steadily move towards this through activities such as reading aloud or taking part in interactive reading games. This is before graduating to face-to-face conversations when ready, and is particularly useful for treating young children with the condition as an entertaining form of engagement.

Graded exposure

This involves gradual exposure to scenarios which cause increasing levels of anxiety. Increasing a child's exposure to these scenarios can create positive reinforcement from positive experiences.

Positive reinforcement

Selective mutism usually stems from your child associating talking with a negative experience. In order to reinforce that all forms of communication can be acceptable, responding positively to any type of communication can help your child learn to feel less pressure to speak and not have to feel relief every time such a moment passes.

Medication for selective mutism

There is no specific medication to treat selective mutism. However, medication may be appropriate for the treatment of other disorders associated with selective mutism, including anxiety or depression. This is usually only suitable for older children, adolescents and adults. Antidepressants can help to relieve anxiety and depression symptoms enough for therapy to be effective, especially if you or your child haven't initially responded well to therapeutic techniques.

If mental health symptoms are particularly extreme, then these may need to be treated first, which may also have a positive impact on the symptoms of selective mutism.

Private medical insurance

We are a registered and approved provider for all of the UK's leading private medical insurers. All of the services we offer at Priory can be funded through private medical insurance. This includes:

  • Mental health treatment
  • Addiction treatment
  • Eating disorder treatment

All clients will have access to our highly skilled and accredited clinicians, many of whom are published experts in their fields of treatment. Whatever your requirements, we're committed to working with you to get your life back on track.

Registered and approved provider

We are a registered and approved provider for all of the UK's leading private medical insurers.

Selective mutism treatment near me

We have selective mutism treatment centres located throughout the country, meaning you can access the support you need in a location that’s convenient for you. To find your nearest selective mutism treatment centre, please use the search form below.

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