Imagine if every time you went to certain places or met new people, however kind they tried to be, you became so anxious that your fight or flight response kicked in, your vocal cords froze and you were unable to get a word out. Imagine the rising feeling of panic and embarrassment as those around you looked on, expecting or pressuring you to speak, yet the words still would not come.
Now, imagine that happening multiple times a day, preventing you from answering questions; asking for help; asking to use the bathroom; initiating conversations; talking to your peers, your teacher or some relatives; or even saying things like "hello", "goodbye", "please" or "thank you".
Eventually you become so afraid of the fear that you avoid situations where you expect to become anxious. What effect does this have on your self-esteem, your confidence, and your ability to make relationships, learn and function in the world?
What is selective mutism?
This, for many people with selective mutism (SM), is their normal existence. They want to speak, but cannot in many situations due to extreme anxiety – or they can only manage to say a very few words, at best, except in their comfort zone (usually home), where they speak normally.
Most schools will have some children with SM. The incidence is around one in 140 among primary-age children, increasing to one in 50 for those who are bilingual.
One of the biggest issues facing children and young people with SM is that this condition is often sadly misunderstood as a "choice", as being about control, or, in older youngsters, as an expression of sullen defiance.
The truth is that SM is a phobic/fear-based freeze response to the expectation to speak; choice does not come into it. The "selective" part of the name, which often causes confusion, does not mean the child "selects" whom to speak to. It's a medical term that means "not pervasive"; in other words, the child is not mute all the time, everywhere.
Selective mutism support
The good news is that SM can be overcome with help, particularly if it is recognised at a young age and appropriate interventions are introduced. Even for older young people and adults, there is still a lot that can be done, although the longer they have had SM, the more entrenched it is likely to be and the greater the likelihood that they will have developed other mental health problems, such as social anxiety.
We know that leaving a child to “grow out of it” rarely works and that putting interventions in place as soon as the condition is recognised, even before official diagnosis, gives the best outcomes. So, what in practical terms, can schools do?
1. Get informed
Firstly, get as informed as possible about SM so that you can put a plan of action into place. The Selective Mutism Information and Research Association (SMIRA) has an extensive library of information and advice on our website that is free to download and distribute. It is important that all members of staff (including support staff) are made aware of how to treat a child with SM, as just one adverse experience can put back a child’s progress greatly.
2. Communicate with parents
Ensure the parents or carers of the child are aware that their child is not speaking in school or college and that they have access to information on SM, though you may find they already know more than you! Include them (and the child either directly or via the parents/carers) in planning and delivering interventions as every child with SM has a different pattern of non-speaking and other needs.
3. Build a network
Consult with a speech and language specialist or educational psychologist who has knowledge of SM if your interventions don’t seem to be working or you suspect that there may be other issues alongside the SM such as speech, language and communication needs (SLCN) or autism. Check if your local authority has a care pathway for SM, and which agency takes responsibility, so you know who to contact, as regions within the UK vary as to their provision.
Join a SM social media group for support and advice. SMIRA has a Facebook group for professionals, a general group and a group for teens and adults, and other organisations also have groups.
4. Don’t make assumptions
Don’t assume that the child’s anxiety just extends to speaking; they may have difficulties with other forms of communication, too, such as written (computers may be helpful) and other anxiety-related difficulties, such as eating or changing for PE in front of others.
And do not assume that abuse is the cause of the mutism, although children with SM may be vulnerable to bullying because they cannot speak up to report it.
There is increasing evidence that anxiety disorders have a biological basis arising from genetic, neurodevelopmental, temperamental and environmental factors.1 People with SM have a highly reactive limbic system which can cause a very rapid anxiety reaction to perceived threats which may appear out of proportion to the situation when viewed from the perspective of someone who doesn’t have the condition.2
Out-of-the-ordinary events, such as starting school or changing class, may be sufficiently traumatic to a child with a predisposition to SM for it to kick in or worsen. It is therefore particularly important to plan well for transition times and give children with SM plenty of advance warning of changes to the normal routine so accommodations can be made.
5. Don’t expect progress to be linear
Anxiety fluctuates from day to day or even within a day, so if a child speaks on one occasion, but fails to under similar circumstances on another, don’t get frustrated, take it personally or lose heart. Often it is two steps forward and one back with the treatment of SM and it may be necessary to take a step sideways and rethink the strategy.
6. Do not pressure the child
Above all, do not pressure the child to speak – that will just increase their anxiety and make it even more impossible and may ultimately result in school refusal. But do give opportunities to speak – you can find out how to do this without triggering the anxiety shutdown in SMIRA’s resources.
We are all anxious to a degree at the moment due to the Covid-19 pandemic. This is a particularly difficult time for those with SM – see the SMIRA website for further advice specific to this.
Shirley Landrock-White is a secondary teacher and SMIRA chair. Claire Carroll is senior practitioner educational psychologist at One Education, Manchester and a SMIRA trustee
- Muris, P, and Ollendick, TH (2015). "Children who are anxious in silence: a review on selective mutism, the new anxiety disorder in DSM-5", Clinical Child And Family Psychology Review, 18(2), 151-169. doi: 10.1007/s10567-015-0181-y
- Selective Mutism Resource Manual 2nd Ed. Johnson and Wintgens, Speechmark (2016)