Selective mutism: when a child talks at home but not at school

Selective mutism means a child can talk, and does talk in some places, but cannot speak in others. Most often they chat at home and go silent at school or with adults they don’t know well. It is not shyness, rudeness or a choice. The child is frozen by anxiety. It is classed as an anxiety disorder and is closely linked to social anxiety. It can be treated, usually with gentle, step-by-step practice that involves parents and school.

What it looks like

• Talks normally with family at home, but is silent at nursery or school.
• May whisper, nod, point or write instead of speaking.
• Often looks stiff, blank or “frozen” when expected to talk.
• May speak to some children but not to adults, or the other way round.
• Has gone on for more than a month, and not only in the first weeks at a new school.

Many children with selective mutism are bright, funny and chatty at home. That contrast is often what confuses teachers and relatives.

How it links to social anxiety

In a review of 22 studies with 837 children, 80 in 100 children with selective mutism also had an anxiety disorder. 69 in 100 had social anxiety. For many children, not speaking is the way they avoid the feared moment: being heard, looked at or judged.

This matters for how you respond. Like other avoidance, silence brings quick relief. That relief makes it more likely next time.

What helps

Small, planned steps towards speaking. Treatment usually works on a ladder of steps, easiest first. For example:

1. The child talks to a parent at school, with nobody else nearby.
2. The same, with a teacher across the room.
3. The teacher comes closer, without asking anything.
4. The child answers a yes/no question from the teacher through the parent.
5. The child answers the teacher directly in a whisper.
6. The child answers in a normal voice in a small group.

Each step is repeated until it feels easy. Praise effort, not just words.

Parents and school working together. The best-studied approaches combine behavioural steps with help from parents and teachers. A review of treatments found that these combined approaches did better than waiting. But there were only 5 randomized trials, and they were small and different from each other. So the evidence is promising but limited.

Not taking over. When a child is silent, adults often answer for them, or stop asking. This is kind, but it can keep the silence going. Helping an anxious child avoid things, called accommodation, is linked to more severe anxiety. The size of the link differed depending on how many children in a study had selective mutism or separation anxiety. See how parents can help.

What not to do

• Don’t bribe, beg or force speech (“say hello or no sweets”). Pressure raises anxiety.
• Don’t label the child in front of them (“she doesn’t talk”).
• Don’t punish silence.
• Don’t stop all non-verbal ways of joining in. Pointing and writing let the child take part while they build up to speaking.

Getting help

Talk to your child’s doctor and school. Ask for an assessment by someone who knows selective mutism, such as a child psychologist or a speech and language therapist.

Expect the assessment to look different. UK guidelines (NICE) note that children with possible selective mutism may be unable to speak at all during assessment. Professionals should accept information from parents and let the child answer by writing, drawing or speaking through a parent.

It is worth acting early rather than waiting. Older children and teenagers can improve too. Treatment for related social anxiety is covered in therapy for children and teens.