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by Dr. Becky Spelman on 01/12/2020

What is Selective Mutism?

People with SM generally also have Social Anxiety, and may have developed SM as a way to deal with their anxiety. In most cases, no specific trauma is associated with the condition, but in others, the SM appears to have been triggered by a particular traumatic event. Sufferers find themselves unable to speak in particular situations, or to particular people, even when there are significant negative consequences for them.

They may also show other maladaptive behaviours, such as an inability to look others in the eye, difficulty expressing their feelings, and profound feelings of social embarrassment. In other circumstances, they are able to speak normally, and there is no physical reason for their mutism, but nonetheless they are completely unable to speak in particular situations.

Sometimes, children whose speech abilities have developed normally to a certain age regress or stop speaking, even becoming completely silent in the environments that cause them anxiety, and becoming increasingly socially isolated in consequence.

Although some people with an autism spectrum disorder have SM, people with SM are not necessarily on the spectrum. To provide the best possible treatment, great care must be taken with a diagnosis, including ruling out conditions that may initially appear to present with similar symptoms, as well as the possibility that a speech impediment is present.

Diagnosis and Treatment

Most people with SM respond well to treatment, but sadly, too many are inaccurately thought at first to be merely surly or difficult, and may even be punished at school or in the other environments that cause them anxiety, rather than provided with the help they need. Punishment and negative reinforcement almost invariably make the condition worse and can lead to maladaptive coping mechanisms, such as picking at their fingernails or chewing their hair.

Without treatment, SM can contribute to the development of a range of psychological disorders, making timely identification and treatment of the condition particularly important.

Once a child has been given a diagnosis of SM (ideally as early as possible, which for many is in effect when they have started school), various treatment approaches can be offered, including positive reinforcement when the child verbalises responses in the context of speaking with someone they are comfortable with, but in an environment (such as a classroom) that normally causes them anxiety. They can be taught social strategies that help them to manage situations that cause them anxiety, and their parents or care-givers can also be provided with strategies that will help to boost the child’s self-esteem and diffuse feelings of anxiety. In limited circumstances, and for a limited period of time, anti-anxiety medication might also be used to reduce the child’s overall anxiety levels, making it easier for them to start to speak.

Who can I speak to further about Selective Mutism Therapy in London?

If you would like to talk to someone about selective mutism, please get in touch with us at the Private Therapy Clinic by telephone at: +4402038820684 or book online.


  • Johnson, Maggie and Wintgens, Alison, (2016),The Selective Mutism Resource Manual: 2nd Edition (A Speechmark Practical Sourcebook)
  • Vecchio, J. L.; Kearney, C. A. (2005),“Selective Mutism in Children: Comparison to Youths with and Without Anxiety Disorders”,Journal of Psychopathology and Behavioral Assessment. 27: 31–37.
  • Yeganeh, R.; Beidel, D. C.; Turner, S. M. (2006),“Selective mutism: More than social anxiety?”,Depression and Anxiety, 23 (3): 117–123

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