Selective mutism
Selective mutism is an anxiety disorder where a person is unable to speak in certain social situations, such as with classmates at school or to relatives they do not see very often.
It usually starts during childhood and, if left untreated, can persist into adulthood.
A child or adult with selective mutism does not refuse or choose not to speak at certain times, they're literally unable to speak.
The expectation to talk to certain people triggers a freeze response with feelings of anxiety and panic, and talking is impossible.
In time, the person may learn to anticipate the situations that provoke this distressing reaction and do all they can to avoid them.
However, people with selective mutism are able to speak freely to certain people, such as close family and friends, when nobody else is around to trigger the freeze response.
Selective mutism affects about 1 in 140 young children. It's more common in girls and children who have recently migrated from their country of birth.
Signs of selective mutism
Selective mutism can start at any age, but most often starts in early childhood, between age 2 and 4. It's often first noticed when the child starts to interact with people outside their family, such as when they begin nursery or school.
The main warning sign is the marked contrast in the child's ability to engage with different people, characterised by a sudden stillness and frozen facial expression when they're expected to talk to someone who's outside their comfort zone.
They may avoid eye contact and appear:
- nervous, uneasy or socially awkward
- rude, disinterested or sulky
- clingy
- shy and withdrawn
- stiff, tense or poorly co-ordinated
- stubborn or aggressive, having temper tantrums when they get home from school, or getting angry when questioned by parents
More confident children with selective mutism can use gestures to communicate – for example, they may nod for "yes" or shake their head for "no".
But more severely affected children tend to avoid any form of communication – spoken, written or gestured.
Some children may manage to respond with a few words, or they may speak in an altered voice, such as a whisper.