Selective mutism

Also called SM, Situational mutism

A child who talks freely at home and can't speak at school isn't choosing silence; it's an anxiety condition, and pressure to talk is the thing that makes it worse.

What it is

Selective mutism is an anxiety condition in which a person who speaks comfortably in some settings, usually at home with close family, is physically unable to speak in others, usually school, with strangers, or in public. The Health A-Z covers it as selective mutism.

"Selective" misleads people into thinking the child selects. They don't. When the expectation to speak arrives, so does a freeze response; the throat tightens and nothing will come. Many people who've had it describe it as being unable to speak, not unwilling.

Who it can help

Mostly children, often noticed when they start nursery or school, though it persists into adulthood for some. It's more common in bilingual children and in autistic children, which makes assessment matter because the plan differs.

It's not shyness that passes in a few weeks, it's not defiance, and it's not DLD, though a child can have both.

How it works

Anxiety about speaking is maintained by every experience of being expected to speak and failing, and relieved by every escape from that expectation. So the child's world quietly organises itself around not talking, and the silence sets. Treatment reverses this with tiny, planned steps: "sliding in", where a person the child talks to sits with them while a new person is gradually introduced, or a ladder from whispering to a parent, to speaking with the door open, to a single word to a teacher.

The rule for everybody around the child is: remove the pressure. No asking them to say hello, no rewards for talking, no drawing attention when they do. Warm, low-demand contact where speech isn't expected is what lets the anxiety subside enough for words to come.

In the meantime the child needs a way to communicate that isn't speech: pointing, writing, a card, a thumbs up, a symbol board. Providing it isn't giving up on talking. It stops the isolation.

Getting started

Tell the school what you've seen and ask for a named adult who'll build a relationship through play and shared activities with no talking expected. Agree a non-speech way for the child to ask for the toilet, help and a drink today, such as a card or a small choice board.

At home, keep the talking going and record the child at ease, so professionals can hear that speech is fine. Don't tell relatives to "make them talk".

Ask the GP or school for a referral; in most areas the route is speech and language therapy, sometimes with child mental health services. Ask specifically for someone who knows selective mutism.

Where to get help

SMIRA, the Selective Mutism Information and Research Association, is the UK charity and has resources for parents and schools. NHS speech and language therapy or CAMHS via the GP or school; the RCSLT describes the therapy route. Speech and Language UK runs a parent helpline.