Selective Mutism

September 8, 2010 at 2:54am

We recently received a question on selective mutism.


What is selective mutism?

A condition in which a person with normal verbal skills refuses to speak in particular settings.


Are there typical settings where a person won't talk?

Often it is a school setting.


Will a person talk in some settings?

Yes, the "selective" piece is that the person won't talk in some settings but will talk in others.


What are the causes?

It may be a symptom of social phobia- fear in social settings.  There does seem to be an anxiety component.



Treatments for anxiety are recommended.  This would include approaches such as cognitive therapy, counseling and anti-anxiety medications such as the selective serotonin reuptake inhibitors (such as sertraline, paroxetine, etc).  I refer you to our book on Mental Wellness (Woodbine, 2006) for much more in-depth information on therapies and medications.



There are other treatments such as:


Stimulus fading: the person is in a relaxed setting with someone they talk to freely and gradually a new person is introduced to the setting (someone that they have difficulty talking to)


Shaping : support, encourage, and reinforce all efforts by the person to communicate (eg gestures, whispering, etc) until audible speech is achieved.


Self-modeling technique: have child watch videotapes of himself or herself performing the desired behavior (e.g., speaking effectively at home) to promote self-confidence and carry over this behavior into the classroom or setting where mutism occurs


More commonly what we see in people with Down syndrome is a complete lack of talking (all settings) or whispering.  (This is not common in our patients but is more common than selective- occurring only in some settings).  This may be related to anxiety, depression, physical illness, and others.  It is sometimes associated with Obsessional Slowness.  I refer you to our Mental Health book for more information on Obsessional Slowness (




This is a link to an article describing selective mutism in a 15 year old with DS.