What is selective mutism?

crutchfieldsquareDear Dr. Crutchfield: My daughter is very shy, and sometimes at school her teacher tells me that she refuses to speak. What could be the problem?

Your daughter may have a condition called selective mutism. Selective mutism is an anxiety disorder seen in childhood. It manifests itself not only in a child’s unwillingness to speak, but also as the actual inability to speak in certain social settings, most commonly school.

The difference between general mutism and children with selective mutism is that children with selective mutism are able to speak and communicate quite well and freely in situations when they feel secure, comfortable and relaxed.

Selective mutism is also associated with social anxiety in the majority of cases. Social anxiety is a phobia or extreme fear of talking to or with others in social settings. The condition does not express itself the same in all children.

Some children show a complete shutdown of communication and a total inability to speak. In other children, their communication may turn into a whisper to people they feel extremely comfortable with, or, if possible, they may physically abandon the area and hide until they feel safe and more secure. Some parents describe their children as being extremely timid or shy, and some experts think that selective mutism is on the extreme end of the social shyness scale.

Most cases of selective mutism are diagnosed between ages three and eight. Some may also have problems with speech development and learning disabilities.

The key for the best treatment of selective mutism is early diagnosis. The earlier a child is treated, the better the prognosis. The longer a child has the condition, the more difficult it will be to correct.

Untreated long-term selective mutism can have profound effects on social skills, coping skills, academics, mental health, and long-term happiness and success as an adult.

If you suspect your child has selective mutism, talk to your pediatrician and arrange for an appropriate evaluation only with a psychiatrist or psychologist with extensive experience with children who have selective mutism.

The key is to diagnose children early so they can obtain the best and most proper treatment as soon as possible. Early diagnosis will enable them to develop proper social and coping skills, defeat their anxiety, and lead to a better chance of having a successful, happy life.

Charles E. Crutchfield III, MD is a board-certified dermatologist and Clinical Professor of Dermatology at the University of Minnesota Medical School. Dr. Crutchfield is a graduate of the Mayo Clinic School of Medicine. He has a private practice in Eagan, MN and has been selected as one of the top 10 dermatologists in the U.S. by Black Enterprise magazine and one of the top 21 African American physicians in the U.S. by the Atlanta Post. Dr. Crutchfield is an active member of the Minnesota Association of Black Physicians, MABP.org, and was selected as one of “The Top100 History Making African-Americans” by The Grio, an NBC affiliate.