What is Selective Mutism?

As the mother of a child who is affected by Selective Mutism, I have tried to educate myself on the condition as far as possible.  Many people have never encountered a Selectively Mute child, and find their behaviour difficult to understand.

The Selective Mutism Information and Research Association (SMIRA) describes Selective Mutism as follows:

"Selective Mutism is an anxiety disorder in which affected people speak fluently in some situations but remain silent in others. It was once considered rare but is now known to affect more than 6 in 1000 children which is about the same number of children who are affected by classic autism.  Yet still very few professionals are trained in dealing with selective mutism or have very little knowledge of it." [1]

 Children with Selective Mutism are capable of talking normally in some circumstances - at home for example - but are unable to talk in other settings - such as school.  

It can often seem as though the child is willfully 'refusing' to speak, but this is not the case.  He or she is experiencing severe anxiety which is preventing them from being able to speak - they will often have physical symptoms such as a tightening feeling in the throat.




Image courtesy of Tina Phillips / FreeDigitalPhotos.net

Our story.

Our experience has been that schools are often ill-informed about this condition.  We were first approached by the school when our son was in the Reception class (aged 4-5).  The class teacher told us that he was 'obviously a very shy child' and that he was 'extremely quiet' in class.  This absolutely did not fit with our perception of a lively, very noisy four year old.  His speech had developed completely normally, he was confident and articulate - our third child, and by this time, we felt we had a pretty good idea of how things were supposed to be.

The concerns escalated as it became apparent that he could not talk at all in the school setting.  We had numerous discussions with the staff members involved, all of whom appeared to be under the impression that he could not talk at all.  The conversations would go round in circles - we would explain that he spoke normally at home, at the library, in the play park - he was able to talk normally in all situations other than school.

It was decided that he should be enrolled in a speech therapy group within the school, a small gathering of children designed to teach and encourage effective speaking and listening skills.  We were given a booklet that explained in excruciating, patronising detail how to talk to our children.  The leaflet suggested that we should read to our son, should try to engage him in conversation, and should focus on making eye contact.  I made no secret of the fact that I found the leaflet patronising to the point of insult.  My husband and I are both qualified teachers, we had two older children, both of whom were able to speak completely normally in all situations including school.  

Predictably, the speech therapy sessions achieved very little.  He already knew the social rules of conversation, he knew about turn-taking, about listening and responding appropriately.  There was nothing that they could teach to a child who had been holding his own in conversations since he was two.  Some of the other children involved in the group were there because they talked too much or too loudly.  Of course, the impression of a four year old was that these children were in the group because they were naughty, and clearly he was there because somebody thought that he was also naughty.

Despite this, he was happy at school.  He would go in happily in the morning, come out smiling in the afternoon, and was always willing to demonstrate what he had learned.  Academically he was above average, his reading was excellent, his writing and number work developed quickly as well.  At parental consultations we were shown a grid detailing his achievements and indicating an above-average ability across the board for anything that did not involve speaking out loud.

Patience and perseverance on the part of one of the Reception teachers led to the development of what became known as the 'school voice'.  This was a whisper, so quiet that you virtually had to be touching his mouth to feel the tiny movement of air that passed for a sound.  Not the usual four year old's dramatic stage whisper that can be heard on the other side of a room, but a strangulated, painful whisper that could barely be interpreted.  

The school voice has remained in place throughout the last two years, and shows no real signs of disappearing.  His whispers are now a little more audible, and he has developed the ability to project the whisper across the room to make himself heard, but he is unable to use his normal voice, the voice he refers to as his 'home voice'.

What does it feel like to suffer from Selective Mutism?

Obviously I can only testify to what my son has told me.  We started out in the early days, carefully ignoring the issue in the hopes that it would just go away of its own accord.  I was very wary of 'labelling' him, very reluctant to create a self-fulfilling prophecy by drawing attention to his difficulties.

After a while, it became clear that the speech issues were here to stay.  It was no longer possible, or desirable to ignore the problem.  At this point, I decided to address it head on: we bought books related to the topic, and openly discussed it with him.  I hoped that by naming the condition and demonstrating that there were other people like him, we might have a breakthrough.

One of the books 'Why Dylan Doesn't Talk' asked a question about how it felt to be unable to talk even when you really wanted to.  My son's response was interesting:

  • Well, you know, don't you - it's when the hand comes up.
  • The hand?
  • Yes, that hand in your body - the one that squeezes and stops your voice from coming out.

As far as he was concerned, everyone had a hand inside them which had the power to prevent speech.

Later, he would describe it as follows:

"My home voice is scared of teachers, so it puts a brick on my tongue to stop me from talking when a teacher is near, then it moves the brick when the teacher is gone."

It is common for children to experience physical symptoms in situations where they are expected to speak.  There is a huge anxiety element to Selective Mutism, and just as with any other anxiety disorder, there are likely to be physical symptoms accompanying it.

In addition to the 'squeezed' feeling in his throat, our son also experiences feelings of nausea  before school, headaches, stomach aches - all those symptoms that we all get from time to time when faced with something worrying, stressful or just plain difficult and unpleasant.  I hate the thought that he is unhappy in school, hate the idea of him living with this kind of background anxiety.

To read a personal description of the experience of Selective Mutism, you can read this article by an InfoBarrel writer who suffered from the condition as a child.

What can be done to help?

Everything that I have read on the subject of Selective Mutism suggests that early intervention is best.  It would appear that the 'success rate' of interventions is improved when treatment has started early.  

Unfortunately, most education preofessionals are not familiar enough with the condition to be able to identify it.  I imagine that situations like ours are not uncommon - faced with a child who isn't talking in class, teachers automatically assume that there is a speech problem, especially if there is no obvious sign of anxiety.  I have always maintained that it is not 'normal' for a child to be unable to speak in school, but my protestations have largely fallen on deaf ears, as teachers clamour to tell me how happy he is, how well behaved he is, how clever.  Sadly, I suspect it is often the case that a quiet child is significantly easier to deal with and more pleasant to have in class than one who displays stress and anxiety through loud or aggressive behaviour.  The mute child lacks the drama and urgency required to make them a priority for intervention.

That said, there are plenty of strategies that have been shown to help alleviate the anxiety associated with Selective Mutism.  The 'Sliding In' or 'stimulus fading' technique is one which is often recommended.  This requires the involvement of a trusted person as a communication partner - often a parent.  The partner talks and plays with the child in a room at the school with no-one else present.  Gradually, the class teacher or key worker is introduced to the situation, initially just standing by the open door, then gradually moving closer.  The hope is that eventually the child will become used to the presence of the teacher, and will be able to talk freely. [2]

It is important for any treatment or intervention to focus on reducing the anxiety associated with speaking, rather than on trying to pressure the child to talk.  It is often the case that the child is concerned about the sound of their voice - in such cases, a process of reducing sensitivity to the sound of their voice in the classroom setting can help.  This can be facilitated through the use of video recordings, or voice recordings amongst other things. [3]


My hope for the future.

I am convinced that my son's school experience would be very different now if we had been able to secure some appropriate help for him when it was first realised that there was a problem.  As parents we had no prior knowledge of the condition, and the school staff appeared to be equally unqualified to help.  My hope is that increased awareness of Selective Mutism, within the educational professions, and amongst the public generally, will allow children with the condition to be identified and helped at an early stage.