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What is Selective Mutism?

Selective Mutism is an anxiety-related disorder, according to the DSM-5 (the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition). Students with this disorder are only able to speak in “select” situations and environments where they are extremely comfortable and to “select” individuals.

Selective Mutism Is Not: 

• Autism
• defiance 
• misbehavior
• a student “choosing” to not speak
• disrespect
• something you can talk a student out of, stop by telling the student to “just speak”, or discipline out of someone
• shyness
• an intelligence disorder
• a communication disorder (speech, articulation, or language disorder)

Defining “Who” These Silent Children Are

There is a text depended upon by parents, therapists and educators that is looked upon as the selective mutism “bible”, of sorts: Selective Mutism: An Assessment and Intervention Guide for Therapists, Educators and Parents by Aimee Kotrba, PHD. 

You can purchase a copy for about $20. The information in this article is a summary of some of the information in the book, but this is just the very tip of the iceberg. If you are working with a child who has been diagnosed with selective mutism, or who you think may be affected, this is the best resource available (and we don’t receive anything for saying so - that’s our honest opinion). 

Many parents, educators, adults who were formerly diagnosed with selective mutism as children, counselors, and diagnosticians disagree with the term “selective”. There is no choice involved in this disorder. This may be the most important thing for educators to understand about this disorder and working with students affected by it.

Selective mutism doesn’t have a traumatic onset but occurs directly from anxiety. As that anxiety grows, it silences the child. 

It is not silence as a result of Autism or any communication disorder, although children may have both selective mutism and autism. About 1 in 100 children is affected by the disorder (for a comparison set you may already be familiar with, the CDC in 2018 found that about 1 in 59 children are affected by Autism).

Girls are about twice as likely to be affected as boys. 

Although some children are able to develop successful coping strategies as they grow and mature, many do not and can grow to become nearly silent, isolated adults. It is vital that children with selective mutism receive professional intervention with a knowledgeable therapist as soon as possible.

Many children don’t really show signs of selective mutism until they enter school, depending on their earlier experiences with extended family members and the community. If a child has only been with his or her parents or guardians, the underlying anxiety and symptoms may not be apparent until they first enter school.

It is absolutely crucial to discuss concerns about selective mutism with parents as soon as possible as early intervention has been proven to be an important key to successful remediation for these children.  The earlier they are able to be seen, diagnosed, and treated, the more positive the outcome is likely to be. 

Kotrba lists the following as attributes that are fairly consistent among children with selective mutism: 

• difficulty responding or beginning verbal conversations
• difficulty with nonverbal communication
• average to advanced intelligence
• sensitive, observant, and intuitive 
• frequently “freeze” when anxious, responding to anxiety-inducing situations as physical threats
• poor eye contact
• extensive time taken when responding to questions
• may find “polite” and greeting words the most difficult to produce
• do not respond well to receiving any kind of attention

Students with selective mutism vary in their ability to communicate and with whom they are able to communicate. Some can only speak to their immediate family members. Some can whisper to selected school staff, while others can speak to some classmates. 

Kotrba classifies these children into five types, arranged by how frequently they communicate, with whom (or how many) they communicate, and where they are most comfortable communicating. Each of these subcategories varies from none, one/limited, or most/typical. 

It’s important to respect the boundaries of these children, allowing them to determine and lead the teacher with whom, where, and how often they are comfortable communicating to begin with. Students may be unable to communicate at all - not even nonverbally - with the teacher in the beginning, but with proper care and scaffolding, there are ways to make communication more probable. 

Ways to Help 

The most beneficial way to help students with selective mutism is through behavioral intervention by desensitization - slowly facing the fear by taking small, manageable, systematic steps toward it. 

Although you may accept any communication, in the beginning, be sure not to leave students exactly where they are without challenging them to further communication levels. Once they are comfortable with one form of communication and are ready to move on, it’s important to broaden their skill set. 

Unfortunately, the biggest challenge to building these skills is the unintentional “rescuing” done by well-meaning adults and other children.

Because selective mutism is an avoidance tactic that children use to keep themselves emotionally safe, one of the worst things to do is to feed into the cycle of asking questions, feeling uncomfortable, and rescuing the child by answering for them or taking the need to respond away. This unwittingly reinforces the avoidance of speaking.

On the other hand, you cannot completely remove the opportunity to speak. In order for children to learn and grow, they have to have the chance and reason to speak. 

Here are 3 ways to increase the probability of these children eventually speaking.  

1. Build Rapport

One strategy used with students who are having behavioral issues is called “2 by 10”. You spend 10 minutes a day with the child doing whatever they love most, whether you’re playing a board game they enjoy, coloring together, putting a puzzle together, playing with a favorite toy, or looking at books. 

You would use this strategy daily for 2 weeks, Monday through Friday. During this time, you don’t correct any misbehavior, but focus on enjoying time with the child and following their lead. It really does wonders! The low need for confrontation helps both of you relax and focus on finding the fun in your relationship.

This strategy can work with selective mutism, as well. It may take a longer length of time to build rapport to the point that they are comfortable enough to communicate with you, but every little bit helps. 

Play is an excellent starting point, and some play can involve speech “slipping out” due to the casual way responses sometimes do. If a child does speak to you during this time, don’t draw attention to it. Just continue playing. When you’re done with your time together,  you can mention that you are thankful for hearing their voice. Keep it casual, and play it cool.

Any time you make a big deal about communication, you are likely to stress them back into their silence. 

Other ways to build rapport are by allowing them to gain confidence by using silent interactions they are comfortable with. Eventually, your goal with be to elicit verbal communication, but offering them nonverbal, silent ways to interact will help them be more comfortable with you, the classroom setting, and the total environment. 

You can also use them as a classroom helper. Most students with selective mutism are very well behaved children - they do not want to stand out in any way, and calling attention to themselves through misbehavior would definitely cause them problems. They are typically observant, which is very helpful.

Kotrba mentions that even following directions is a way of communicating, and it’s a great place to begin. Just be sure your instructions are given as quietly and nonchalantly as possible. Also, be sure to let them know how much you value their help, but make sure you convey that in a calm, quiet manner so you won’t draw unwanted attention. 

The wonderful thing about students with selective mutism is that they are likely to be paying attention to you all the time. They are watching for cues. You can sometimes signal a request to them across a crowded lunchroom or playground, and they will understand what you want or need and do their best to carry out your request. They move stealthily by nature and are sort of like ninjas once they are comfortable with

2. Use Forced-Choice Questions

Once you’ve gained some rapport and the student shows signs of being ready to speak with you or communicate verbally, a helpful tool Kotrba suggests is that of “forced-choice” questions. These are multiple-choice questions you would ask the child in order to elicit a verbal response. 

While open-ended questions are desireable in most aspects of education, they are pits of accidental reinforcements for avoiding speech when it comes to these students. Offering them forced-choice questions lowers the stress level and requirement for students.

When using forced-choice, steer clear of yes or no questions, because those can be answered with a nod or shake of the head. Instead, give three or four choices, making sure that their probable response is one of the choices.

For example, you could ask, “Is your favorite color pink, blue, both, or neither?” 

You could ask, “Which thing do you like to do best at school - reading, math, lunch, recess, or something else?”

If you ask a question and the student freezes, always wait five seconds, then try again. You may try rephrasing the question to offer different choices (perhaps they like pink, but their favorite is actually purple - they may not be able to express that yet, so adding purple to the question may help). 

Be sure that when you ask a question, it’s not with an audience. The fewer people around, the better. If they’ve been able to speak to you in the presence of one or two friends, then it should be ok to try speaking with them again.

If they cannot answer by saying a word, ask them just to make the first sound in the word. If they can’t make a sound, try asking them to blow a little air out and make an environmental noise (like a “ding!” or “beep!”) when you say the right answer. 

Be clear about what you expect. If they are able to speak to you, ask them to use their “real” voice - not a whisper, not a noise, not a sound, but by saying a real word in their real voice. If they are unable to do that, it’s ok. Don’t rescue them by completely removing the request. Make responding differently an option. 

Once the child has responded, reflect or restate their response. If they’ve indicated their favorite color is purple, you might say something like, “Ah, yes. Your favorite color is purple. I remember now.” 

Then reinforce their responding by thanking them or complimenting them. This might just be a simple thumbs-up, pat on the back, a whispered “good job”, or “thank you for letting me know”. Try not to respond to excitedly or emotionally. Don’t draw attention to their responding. 

3. Accept and Offer Minimal Eye Contact

Don’t stare a student with selective mutism down, even if they are a quiet talker. Try to avoid using much eye contact as it can be pretty intimidating. Follow the student’s lead. 

Rather than talking with them face-to-face, you may even consider sitting side-by-side to minimize the expectations and pressure to use eye contact. 

Conclusion

Students with selective mutism will flourish in a kind, consistent environment with a teacher who is supportive and is careful to respect their boundaries and let them lead in communication. Their avoidance needs to be carefully challenged, and one of the most important things an early childhood educator can do is discuss the possibility of getting a child assessed and helped as soon as symptoms arise. 

Giving these students access to their voice is one of the great privileges of teaching.