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Selective mutism can be a challenging condition to deal with, especially if you struggle to speak in specific situations or with certain individuals. However, it's important to know that there is help available. If you suspect that you may be experiencing selective mutism, it's crucial to seek support. In this article, we'll explain what this condition is and provide guidance on how to get the assistance you need.

What is selective mutism?

Selective mutism is an anxiety disorder that primarily affects children. In this condition, individuals who are otherwise capable of speaking choose not to speak in specific social situations or with particular people. It’s important to understand that selective mutism is not a speech disorder but an anxiety disorder, that makes speaking difficult in certain contexts or with specific individuals.

What causes selective mutism?

Selective mutism is caused by several factors that are linked to genetic, biological and environmental factors. If you suffer from social anxiety, this can be an underlying factor.

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Selective mutism in children

Selective mutism is a rare condition affecting less than 1% of people (across all age groups), with most sufferers being under the age of 5 years old. It is a problem and cannot be controlled at will. A child may sometimes communicate by nodding, using gestures or writing notes. It can be triggered by stressful events such as a move or a change in pre-school and is more common in cases of autism, cognitive difficulties and if a child is multilingual.

As selective mutism is considered an anxiety disorder, it may seen in children with social anxiety, generalized anxiety disorder (GAD), separation anxiety, agoraphobia, panic disorder or other specific phobias.

Selective mutism and social anxiety

Selective mutism has much in common with a social phobia. What distinguishes them is that there are more physical symptoms with social phobia. Selective mutism also means that individuals are more likely to have language disorders. The situations that trigger anxiety also differ between the syndromes, with social phobia causing anxiety in more situations and the onset often occurring at a later age. However, there are similarities between the syndromes.

Autism and selective mutism

There are similarities between selective mutism and autism, but what distinguishes them is that individuals with autism have difficulties in all social situations. In contrast, someone who is selectively mute can function socially in some situations. In autism, an individual may have trouble understanding social situations, but not in selective mutism.

Selective mutism as a language disorder

Selective mutism can sometimes be interpreted as difficulties with speech, but it is not a language disorder. People with selective mutism can speak in some contexts while remain silent in others. School staff may need support from a speech therapist to deal with children who suffer from selective mutism.

Help with selective mutism.

Anxiety disorder in the form of selective mutism is a common and treatable problem. Seek help today to help reduce your symptoms.


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Symptoms of selective mutism

The diagnosis can develop early and is often noticed in preschool. Children with selective mutism may present as shy, but if it doesn’t improve within a month, it could be selective mutism. Some of the symptoms are:

  1. Silence in specific situations: Individuals with selective mutism are silent or communicate by nodding or using body language in certain social situations or with certain people.
  2. Often visible in childhood: Symptoms usually appear in childhood.
  3. Related to anxiety: Selective mutism is closely linked to anxiety.
  4. Speech in familiar or safe environments: At home or with close friends and family, people with selective mutism often do not have difficulty speaking.

Selective mutism treatment

The symptoms can sometimes disappear without treatment, but some may need support. Treatment may include Cognitive Behavioural Therapy (CBT), relaxation exercises and social skills training. There is little scientific evidence to suggest that medicine therapy helps with the treatment of selective mutism.

Speech therapy for selective mutism

If you are a parent, you can seek help from a speech therapist. During treatment, the child is gradually encouraged to speak by modifying the environment and taking the initiative to communicate with others.

How therapy can help with anxiety

Talking to a psychologist can give you the tools to understand and manage the symptoms. This can help you overcome the condition and improve your quality of life.

First steps to change

You can always book a 20—or 45-minute session with one of our therapists or psychologists. We are here to make the difficult easier.


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12 FAQs about Selective Mutism

What is selective mutism?

Selective mutism is an anxiety disorder usually affecting children, where individuals who otherwise can speak do not speak in certain social situations or with certain people.

What are the most common symptoms of selective mutism?

The symptoms often develop in childhood and are similar to anxiety disorders. People with selective mutism may be able to talk to people they feel more comfortable with but remain silent in other contexts.

How is selective mutism different from social phobia?

Social phobia has more physical symptoms, anxiety in more contexts and a later age of onset, while someone with selective more often has a language disorder.

Is selective mutism a language disorder?

Selective mutism can sometimes be interpreted as a difficulty with speech, but it is not a language disorder.

How common is selective mutism?

This diagnosis affects around 0.7-0.8% of all children.

What is the difference between autism and selective mutism?

There are similarities between selective mutism and autism, but what distinguishes them is that autism has difficulties in all social situations, whereas someone who does not speak functions socially in some social contexts.

How can selective mutism be treated?

Treatment may include Cognitive Behavioural Therapy, relaxation exercises and social skills training.

What are the long-term effects of untreated anxiety?

Untreated anxiety can lead to depression and other mental health problems.

Can a speech therapist help with selective mutism?

If you are a parent, you can seek help from a speech therapist. This treatment involves gradually desensitizing the child to social interactions, encouraging them to take up space and initiate conversations.

Can you have other mental health problems at the same time?

Selective mutism is considered an anxiety disorder, and often, there can be co-morbidity with social anxiety, generalized anxiety disorder (GAD), separation anxiety, agoraphobia, panic disorder or specific phobias.

How much does a treatment at Lavendla cost?

At Lavendla, our therapists set their own prices. The first meeting usually focuses on getting to know each other, defining the existing challenges and then setting up a plan for how you will work together to achieve the goals.

Where can I go if I need help?

At Lavendla, we have experienced psychologists and therapists who specialise in CBT and can help you.

What does treatment for selective mutism involve?

Seeking help is a big step towards better health; deciding to control how you feel is a positive thing. Here is an overview of the steps usually involved in CBT treatment.

Step 1: An initial assessment session

During the first meeting with a psychologist, an assessment will be done to review your mental and physical health and how your symptoms manifest.

Step 2: Goal setting

During this part of therapy, you set both short- and long-term goals for the therapy

Step 3: Planning for treatment

Define which areas of your life are most affected by your well-being and plan how you would like to change them.

Step 4: Treatment with different techniques and tools

This is the start of the treatment phase, which involves exercises to give you tools to overcome and work through the problem you are suffering from.

Step 5: Monitoring and evaluation

Treatment progress is regularly monitored, and the plan is adjusted if needed.

Step 6: Ending and looking ahead

As the therapy ends, it is time to reflect on the progress and monitor the results.

If you or someone close to you is seeking professional help, do not hesitate to book a session with one of our psychologists or therapists.


Written by Samantha Pieterse

Sr. Samantha Pieterse is a registered psychiatric nurse who is deeply committed to mental health and well-being. Samantha brings a unique and valuable perspective to her role as an editor for Lavendla South Africa. She has worked in Government and Private mental healthcare institutions in Gauteng and her expertise ensures that the articles on our website are accurate and accessible. Samantha is dedicated to enhancing mental health awareness and education in South Africa.