Selective mutism


Selective mutism is a condition in which a child who is fluent with language frequently fails to speak in certain situations where language is expected.

It typically occurs in school or social settings. This pattern of mutism must be observed for at least one month (but the first month of school does not count, as excessive shyness is common during this period).

Parents often think that the child is refusing to speak, but usually the child is truly unable to speak in particular settings.

Causes, incidence, and risk factors 

Most experts believe that there are environmental, biological, interpersonal, and anxiety-related factors that cause selective mutism. Most children with this condition have some form of extreme Social phobia.

Some affected children have a family history of selective mutism, extreme shyness, or Anxiety disorders that may increase their risk for similar problems. This condition is most common in children under age 5.


  • Failure to speak in specific social situations  
  • Shyness  
  • Fear of people  
  • Speaks at home with family

Signs and tests 

The essential element of selective mutism is that the child has the ability to both comprehend and speak, but fails to speak in certain settings or environments. This syndrome differs from mutism. Children with mutism never speak.

Cultural issues, such as recent immigration and bilingualism, should be noted. Children who are uncomfortable with a new language may be reluctant to use it outside of a familiar setting. This is not necessarily selective mutism.

Current treatment combines behavior modification, family participation, and school involvement. Certain medications that address symptoms of anxiety and social phobia (extreme social shyness) have been used safely and successfully.

Support Groups 

For additional information and resources, see selective mutism support groups.

Expectations (prognosis) 
The prognosis for this syndrome varies. However, continued therapy and intervention for shyness and social anxiety into adolescence and adulthood may be required.

The mutism can affect the child’s ability to function in social or educational settings. Without treatment, symptoms may become more severe.

Calling your health care provider 
Call your health care provider if your child displays the symptoms of selective mutism, and it is interfering with education and causing social problems.

Johns Hopkins patient information

Last revised: December 3, 2012
by Martin A. Harms, M.D.

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