Selective mutism

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Is your child chatty when at home with the family but appears unable to speak when out and about or in school or nursery? Will they speak to some people and not others? If you’ve noticed a pattern of talking and not talking, then your child might have selective mutism.

Who is affected?

• Selective mutism affects one in 150 children.
• It's more common in girls and children who are self-conscious about making mistakes (when learning a new language for example).
• Selective mutism usually occurs in early childhood and is first noticed when the child begins to interact outside the family circle – for example, when the child starts nursery or school.
• Any sensitive child can develop selective mutism – it is not a sign of bad parenting.

As a parent, you know it’s not that your child is being wilful, naughty or rude. They simply have a strong fear of having their voice heard. They become increasingly wary of any form of communication which could lead to an expectation of them to speak. In time they learn to avoid distress by avoiding communication.

How to recognise selective mutism

The main signs that a child has selective mutism are:

• they may speak freely to their peers out in the playground but stop talking when approached by an adult
• you notice they speak freely at home to some people but not others
• they may physically freeze and look very anxious when approached to speak, this will appear very different to a child who is simply shy
• when away from home or their ‘safe space’, they may not ask for what they want or need, even important needs such as going to the toilet and getting a drink during the day
• they may attempt to whisper to you or to a peer to ask for what they want.

What you can do to help your child

As with any phobia, when helping a child with selective mutism we are aiming to:

• understand the fear
• help the child to face the fear
• take the pressure to speak from the child
• …. one tiny step at a time.

What we can do to help you

When supporting children, it is vital that parents and nursery or school staff work together. Our team of speech and language therapists will guide you through a structured approach to support your child. Our role is to give you all the information you need and show you how to carry out treatment in your setting. We will support you along the way.

If you would like to speak to a therapist informally to see if a referral to our service is needed, please call our Therapy One Point helpline.

There is more information in the ‘Further resources’ section.

Please also see Films and training tab.

How to recognise selective mutism

The main signs that a child has selective mutism are:

• they may speak freely to their peers out in the playground but stop talking when approached by an adult
• parents tell you they speak freely at home to some people
• they may physically freeze and look very anxious when approached to speak, this will appear very different to a child who is simply shy
• they may not ask for what they want or need, even important needs such as going to the toilet and getting a drink during the day
• they may attempt to whisper to you or to a peer to ask for what they want.

Further information on signs, causes and support can he found here:

• In-depth information on signs, causes and how Selective Mutism is diagnosed (from NHS.uk)
• The Royal College of Speech and Language Therapists also have helpful information on signs, support and further reading (from RCSLT.org).

As with any phobia when helping a younger child with selective mutism in an Early Years setting, we are aiming to:

• understand the fear
• help the child to face the fear
• take the pressure to speak from the child
• … one tiny step at a time.

How to recognise selective mutism in secondary age children

• they may speak freely to their close friends in the class or corridor but stop talking when approached by an adult or another student or adult
• parents tell you they speak freely at home to some people
• they may physically freeze and look very anxious when approached to speak, this will appear very different to a child who is simply shy
• they may not ask a question or seek advice, even for important needs.

Helping young people in secondary education

Children and young people in secondary education need a team around them to guide them through their speaking difficulties. It is vital that parents, educators and the speech and language therapy team work together to plan and deliver a coordinated set of steps.

Here is what really counts:

• all teaching staff have the same briefing so there is consistency in approach and attitude. This is especially important when there are supply teachers
• the young person is involved in their therapy and their environment. For example, which room do they feel comfortable in? Is there a specific teacher they feel more comfortable with? Where does the young person prefer to sit in class?
• the young person is reassured that there is no expectation on them to speak if they cannot
• they are reassured in private that staff will not single them out unless they ask for this to be done
• there is a focus on building confidence and independence
• there are agreed ways to communicate non-verbally such as registration using thumbs up
• everyone knows their own role and the role of others in the team supporting the child, both in school and in the community
• When things go wrong, the team thinks carefully about how this is fed back to the young person
• Issues such as oral exams are considered well in advance and a plan agreed.

Read about the onset, diagnosis and key strategies to reduce anxiety.

Top tips for schools

Reduce the pressure to speak:

• avoid direct questions and instead use rhetorical questions for example rather than ‘tell me how you did that’ you could say 'I wonder how you did that?'
• increase the use of comments so there is always the opportunity for the pupil to speak
• acknowledge the difficulty and provide reassurance, for example, ‘I understand it is difficult to speak at the moment but it will get easier and you’ll be able to speak when you’re ready'
• rather than putting the pupil on the spot, discuss with them how they would like to participate in an activity before it begins by offering a choice such as when sharing weekend news, ask if the pupil would like to write their news down and give them a choice of a friend or adult to read it out.
• set up non-verbal communication methods (writing, photographs, etc.) so your pupil has a way to:

• ask for a drink or to go to the toilet
• ask for help
• make choices for activities and food
• tell someone about a problem such as illness or bullying.

Support friendships

• make sure the pupil is always included in activities, games and conversation
• make sure they have peers around them at break time and lunch time
• find out the interests of your pupil and discuss with their family the kinds of clubs and activities they might enjoy with their peers
• recognise their strengths and skills
• boost self-esteem and confidence.

Key considerations

• share these strategies with all staff members working with your pupil. Make sure supply teachers or new members of staff are made aware before the day begins so the pupil enters an environment where their difficulties are understood and strategies are consistently used by everyone
• identify a key adult that can build rapport, offer encouragement and support.
• seating arrangements (for example sitting at the very front of the class can reduce confidence)
• liaise with the pupil’s family so that success, concerns and strategies can be shared.

What we can do to support you to help them

It is vital that education staff, parents and our team work together. Our team of speech and language therapists will guide you through a structured approach to support a child or young person with selective mutism. Our role is to give you all the information you need and show you how to carry out treatment in your setting. We will support you along the way.

If you would like to speak to a therapist informally, to see if a referral to our service is needed, please phone our Therapy One Point helpline.

There is more information in the ‘Further resources’ section.

Are you able to speak freely at home and with some of your friends but get extremely anxious when expected to speak at school or to certain peers or adults? If your anxiety only occurs in specific situations then you may have a condition known as selective mutism. Selective mutism can occur alongside other diagnoses such as autism, anxiety or phobias.

If you feel your anxiety about talking in certain situations is holding you back from reaching your ambitions or developing your independence we are here to help you. We will work support those around you at home or in your education placement to support you overcome your anxiety about talking.

Information for you

Helpful advice on selective mutism for young people

We recommend the The Selective Mutism Resource Manual, Maggie Johnson & Alison Wintgens, 2016. Speechmark Publishing Ltd. This manual is considered to be the UK’s number one treatment manual for selective mutism. There is an appendix that focuses on young people in particular called: When the Words Won’t Come Out. There are questionnaires around interests, worrying thoughts and current communication profile.

There is more information in our ‘Further resources’ section.

SMIRA is a registered charity in the UK that provides information leaflets, useful resources and personal life experiences of people who have selective mutism.

NHS.uk describes selective mutism, the onset, diagnosis and key strategies to reduce the anxiety your child may be experiencing.  

Take a look at this YouTube clip, featuring young man who started speaking at secondary school after not speaking at primary school, and a large part of secondary ‘Overcoming selective mutism’ by Saki Galaxidis

Books

The Selective Mutism Resource Manual, Maggie Johnson & Alison Wintgens, 2016. Speechmark Publishing Ltd. This manual is considered to be the UK’s number one treatment manual for selective mutism.

Resources from The Selective Mutism Resource Manual: ‘When the Words Won’t Come Out’ booklet. Questionnaires around interests, worrying thoughts, current communication profile.

Can I tell You About Selective Mutism? By Maggie Johnson & Alison Wintgens, Jessica Kingsley. Publishers, June 2012 ISBN 9781849052894 www.jkp.cpm . This book can be used to teach staff members and peers about selective mutism and how they can best support someone who has selective mutism.

My Friend Daniel Doesn’t Talk by Sharon Longo, Speechmark Publications .

Why Doesn’t Alice Talk at School by Lucy Nathanson. Independent Publishing Network.

My Name is Eliza and I Don’t Talk at School by Lucy Nathanson. Independent Publishing Network.

These books are very useful particularly in the classroom to educate and support children’s understanding of selective mutism.

Can’t Talk? Want to Talk! By Jo Levett, Speechmark Publications. This book teaches children about selective mutism and supports teachers and parents to understand difficult speaking situations and strategies that can reduce anxiety.