Understanding Selective Mutism in Teens


Selective mutism is a challenging anxiety disorder affecting children and adults. The condition typically presents as an inability to speak in certain social situations, often in the presence of unfamiliar people or new settings. The condition causes significant distress and feelings of panic, making it incredibly difficult for affected children to communicate.

Although it can be a persistent disorder if left untreated, there is hope for teenagers with selective mutism. By working with a qualified mental health professional, young people with selective mutism can learn coping strategies and techniques to overcome their apprehension and begin to communicate more freely.

Selective mutism is not a choice, and teenagers with the disorder do not intentionally refuse to speak. With appropriate support and treatment, adolescents with selective mutism can find ways to express themselves and engage with the world around them.

Signs and Symptoms of Selective Mutism

Parents and caregivers may first notice signs of selective mutism when their child begins interacting with people outside their immediate family, perhaps when starting kindergarten or preschool. The condition often begins in early childhood, before age four, but can manifest anytime. A child may have difficulty maintaining eye contact during early school years. As people expect a child to speak by age two, older children experience low self-esteem that can persist into adulthood.

Some common behavioural signs of selective mutism in children include:

  • Becoming distraught and unable to speak when separated from their parents
  • Difficulty speaking or responding to others outside of immediate family
  • Looking away or lowering their voice when others try to engage them
  • Avoiding activities where they are the centre of attention

Physical signs can include freezing, trembling, looking tense, blushing, or complaining of symptoms like a racing heart or stomach ache when a child speaks or is outside their comfort zone.

Children with selective mutism may struggle to make friends, socialise, answer questions, and ask for help.

Selective mutism is not a sign of disobedience. If your child has selective mutism symptoms, seeking professional help is essential.

What Causes Selective Mutism?

Experts in adolescent psychiatry have noted several factors that influence the development of selective mutism, including:

  • Genetic predisposition
  • A family history of anxiety
  • A pre-existing tendency towards unease in new situations

While there is no single cause for selective mutism, specialists consider it an anxiety-linked fear or phobia of talking in unfamiliar circumstances.

Many children with the condition already tend to be nervous and struggle to cope with everyday events. Speaking becomes even more challenging if they have speech or language difficulties or a hearing problem.

Some children with selective mutism have difficulty processing sensory information. Loud noises or crowds can cause them to shut down and be unable to speak. This behaviour is neither controlling nor manipulative and does not necessarily signify autism. Although a child could have both selective mutism and autism, the conditions are not related.

teenager mental illness

Is Selective Mutism a Social Anxiety Disorder?

Selective mutism is considered a type of social anxiety because children with the condition experience extreme unease and apprehension in certain social and classroom situations, leading to a consistent inability to speak. So, selective mutism is a form of social anxiety that occurs under specific conditions.

Teens with social anxiety, or social phobia, experience intense and persistent fear of things like:

  • Social situations
  • Meeting new people
  • Speaking in public
  • Being observed or judged by others
  • Eating or drinking in public
  • Participating in group activities

The dread of being judged or scrutinised by others can be so overwhelming that it interferes with daily activities, relationships, and school performance. Young people with this disorder often experience non-verbal symptoms. Other manifestations include sweating, trembling, blushing, nausea, and emotional distress.

Because interacting with other students at school and making friends is difficult, a child with selective mutism is at risk of social isolation.

What Are Anxiety Disorders?

Anxiety disorders are recognised mental health conditions distinguished by excessive and persistent feelings of dread, worry, and unease. Several anxiety illnesses exist, including generalised anxiety disorder (GAD), panic disorder, agoraphobia, specific phobias, and separation anxiety disorder. Each type of disorder has unique features. However, all share the common aspects of persistent and excessive nervousness and worry.

Young people with anxiety conditions experience symptoms like restlessness, irritability, fatigue, muscle tension, and disrupted sleep. These symptoms interfere with daily activities, social interactions, and relationships.

Anxiety is common and affects people of all ages. The good news is that anxiety disorders, including selective mutism, are treatable with therapy, medication, or the two combined. With appropriate treatment, teens with anxiety disorders can achieve relief from symptoms and improve their quality of life.

The Diagnosis and Treatment of Selective Mutism

Talk to your family doctor or paediatrician if your child has symptoms of selective mutism. They can help rule out developmental issues like hearing or speech delays. The next step is to ask for a referral to a child psychologist or adolescent psychiatrist who can diagnose and treat selective mutism. Your child’s verbal and non-verbal behaviour will be evaluated in different situations. An assessment will reveal any co-occurring mental health disorders.

It is encouraging that most children can overcome selective mutism with appropriate treatment. Psychotherapy for the condition involves gradually exposing your child to increasingly challenging speaking tasks in a supportive relationship. Your child will practise more manageable steps first and then progress to more demanding tasks. Success is rewarded with praise and small prizes. Children gradually recognise that their speaking-related fear is decreasing and that avoidance is unnecessary.

Selective mutism must be recognised early so families and schools can work together to reduce the child’s worry. Your child may need speech therapy or a referral to a school educational or clinical psychologist. Some problems are avoidable in a school setting if parents, teachers, and educators work together to reduce the child’s stress by creating a positive environment. This approach involves:

  • Not letting the child know you’re worried
  • Reassuring them that they’ll speak when they’re ready
  • Concentrating on having fun
  • Praising all the child’s efforts to interact with others

Several techniques based on cognitive behavioural treatment help selective mutism and encourage children to talk, like graded exposure, stimulus fading, shaping, and positive and negative reinforcement. Family members, teachers, and educators can use these under the supervision of a speech and language specialist or psychologist.

Cognitive Behavioral Therapy is a practical and goal-oriented approach based on the understanding that thoughts, feelings, and behaviours are interconnected. CBT aims to help teenagers identify negative thought patterns contributing to their worry and replace them with more positive and realistic ways of thinking.

The therapist works closely with a teenager during CBT to develop a robust treatment plan tailored to their unique needs and goals. Sessions involve helpful exercises and homework assignments to challenge negative thoughts and behaviours. With the help of their therapist, teenagers gradually build up their communication skills and become more comfortable speaking in social and classroom situations.

The therapist will help teenagers and younger children develop effective coping strategies to manage their nervousness, including relaxation techniques, mindfulness exercises, and positive self-talk. CBT is also an excellent way to help teens build confidence and self-esteem, which can lead to long-term social success. It is a safe and evidence-based approach that effectively treats selective mutism. It is a positive and empowering therapy that helps teenagers take control of their anxiety and work towards a happier and more fulfilling life. With CBT, an anxious child can overcome their fears and speak comfortably and authentically.

Medicine might be appropriate for older children with selective mutism and teens whose anxiety has led to depression and other problems. It should not be prescribed as an alternative to environmental changes and behavioural approaches. However, antidepressants can be used alongside a robust treatment programme to decrease anxiety levels, especially if previous attempts to treat a child have made insufficient progress.

With the proper support and treatment, a child with selective mutism can overcome nervousness and improve their self-esteem and social interactions.

Overcome Selective Mutism at The Wave

Overcoming selective mutism isn’t easy, but our approach, centred around the unique needs of your anxious child, will help them achieve complete recovery and positive growth. We prioritise the restoration of self-esteem and confidence by providing tools and strategies to help navigate challenging social and classroom situations. Our renowned experts are dedicated to treating children with the utmost care and sensitivity. We provide a safe, supportive environment for your teenager to recover from selective mutism.

Created by specialists in adolescent psychiatry, The Wave Programmes are unlike any others. We offer a unique combination of top-tier treatment for mental health alongside educational opportunities and GAP-year experiences.

A degree of anxiety is normal when we meet new people or talk in public. However, we understand that for some young people, such situations feel impossible. As a concerned parent, seeing your child struggle with talking is difficult. Our compassionate treatment options will empower them to manage symptoms and triggers.

Your child can break free from selective mutism with an individualised, robust treatment plan targeted at healing and growth, combined with opportunities to learn through fun activities, educational programmes, and team-building exercises. Get in touch to discover more about your child’s opportunities at The Wave. We are here to help children thrive.

Fiona - The Wave Clinic

Fiona Yassin is the founder and clinical director at The Wave Clinic. She is a U.K. and International registered Psychotherapist and Accredited Clinical Supervisor (U.K. and UNCG).

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