Selective Mutism

Signs

Tick any that feel familiar. This is not a diagnosis, only a clinician can assess you.

• Speaks at home but not at school or with others
• Freezes or looks anxious when expected to speak
• Avoids situations where speaking is expected
• Communicates with gestures or whispers
• Silence lasting at least a month, not just the first weeks at a new school

How people often describe it

• “My child talks at home but not at school”
• “I freeze and cannot speak in some places”
• “My child stays silent with strangers”
• “Speaking in class feels impossible”

People who live with selective mutism may also notice social anxiety, anxiety or separation anxiety. If any of these sound familiar, mention them to your clinician so your plan can cover them.

Selective mutism is not shyness or defiance

A child with selective mutism wants to speak. Often they talk freely at home, but in places such as school or with unfamiliar people, anxiety makes speaking feel impossible and they freeze. Parents and teachers can read the silence as stubbornness, rudeness or shyness. Pressure to speak then adds to the anxiety and can make it worse. Ordinary shyness tends to ease as a child warms up; selective mutism does not, and it starts to affect learning and friendships.

How it can look different at home and at school

The pattern is usually specific to place and people. A child may chat at home, whisper to one friend, nod or point in class, and say nothing to the teacher. Some children also look frozen or expressionless when they are expected to speak. Many parents first hear about it from the school, and are surprised, because the child talks easily at home.

Details that help a clinician: does your child speak to any classmate, in the playground, to a relative on the phone, or to a few people at home but not to visitors? These small exceptions show what is possible and where to start.

What helps at school and at home

• Do not force, bribe or ask your child to speak in front of others, and do not draw attention to the silence.
• Accept nodding, pointing or writing at first, and stay calm and warm when your child does try.
• Use small, planned steps at the child’s own pace, for example from gestures, to whispering, to one word with one trusted person, then to more people and places.
• Share the same plan with the teacher, so home and school respond in the same way.

Treatment is mainly behavioural, working gradually on speaking in the situations a child finds hardest. If anxiety is severe, a psychiatrist can also discuss whether medicine has a place; this is a decision made with you after a full assessment.

What a psychiatrist asks before and during the consultation

Expect questions about when the silence began, where and with whom your child speaks, and which languages are used at home and at school. A child learning a new language can go quiet for a while, which is different from selective mutism, so the clinician checks for this. They will also ask about hearing, speech and development, other worries such as separation anxiety, and any family history of anxiety. A short note from the teacher is useful to bring.

In teenagers and adults

Some young people and adults also find speaking in particular settings very hard, for example at college, at work or on the phone. The same principles apply, adapted to the person: small steps, no forcing, and a plan that fits their daily life. A video consultation lets them start from the comfort of home.

When to get help soon

How it is diagnosed

A psychiatrist meets the parents and the child, and often hears from the school. They check how and where the child speaks, and whether language, hearing or developmental differences are involved.

Treatment and support

• CBT-based therapy for children, with no pressure to speak
• Gradual steps, from comfortable non-verbal communication towards speech
• Guidance for parents on responding without pressure
• Close working with teachers

How Mindly helps

Mindly's psychiatrists work with parents and, with consent, the school to plan small steps. All care is online, by video.

You can talk to a psychiatrist online, read what a first online consultation involves and see how pricing works before you book. Related reading: anxiety treatment online and is it anxiety or stress.

What to expect

1. Free pre-consultation callWe take your history and details, and match you with the right clinician.
2. First consultationA video call in your language, with a clinician who already has your report.
3. Your planYour clinician agrees a plan with you: therapy, medicine or both, as suits you.
4. Follow-up reviewsRegular check-ins, and your plan is adjusted as you recover.
5. Staying wellSupport to keep you well and catch early signs of a setback.

Common questions

Clinicians with a focus in this area

• Dr. Samarth S ShettyPsychiatrist
• Dr. Nevedita DasPsychiatrist - Telepsychiatry & Evidence-Based Care
• Ms. Kamakshi SabharwalClinical Psychologist
• Ms. Janvi KhokharClinical Psychologist
• Dr. Pooja RaniPsychiatrist

Meet all our clinicians

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• Chennai
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• All services
• Questions about online care

Sources

• iCall TISS
• WHO fact sheet: Mental disorders
• National Mental Health Survey of India, 2015-16: summary (NIMHANS)

Related conditions

• Child & Adolescent Anxiety
• Social Anxiety Disorder (Social Phobia)
• School Refusal
• Generalised Anxiety Disorder
• Panic Disorder
• Agoraphobia
• Specific Phobias
• Separation Anxiety Disorder