My child is able to talk but does not talk in some places (e.g. nursery or school)

Look at these points and see if this describes your child:

• they do not speak in specific social situations in which you would expect them to speak (for example at school), despite speaking in other situations
• this not-speaking in certain situations has lasted at least one month (not only the first month at school when children are becoming more relaxed)
• the not-speaking is not because the child lacks knowledge of, or ease with, the spoken language required in a particular social situation
• lack of communication is not explained better by another communication disorder (please note: even if your child has other communication difficulties you may feel that the amount of communication differs significantly in different situations)
• sometimes they may not even nod or gesture or move when asked a question in certain places or with certain people

If some or all of these points relate to your child, it could be Selective Mutism.

Selective Mutism is classified as an anxiety disorder relating to communication. Approximately 1% of the population has anxiety about communication and although they want to, they can’t physically speak in some situations. A part of our brains which reacts to fear, has caused a reaction of ‘fight, flight or freeze’. This is like the phobic reaction we may have to something that others do not find scary. This anxiety is now given the term ‘Selective Mutism’ as it describes a silence in some situations. It used to be termed ‘Elective Mutism’ but now we recognise that the child is not choosing (electing) to be silent and is not controlling the situation.

Selective Mutism is different to shyness and the earlier that caregivers notice this behaviour the quicker you may support your child in those situations. The child’s brain can calm down by gradually moving through a hierarchy of small brave steps to speaking in situations they can’t speak in yet.

Some people become silent after a traumatic event. They were not silent before. This is not the same as Selective Mutism which is an involuntary phobia. If your child has stopped talking or communicating after a traumatic event, please make a referral via your GP to specific Child and Adolescent Mental Health Services or the Primary Mental Health Team.

Children with Selective Mutism:

• speak comfortably in at least one setting, most often at home with one or both parents, and sometimes with other family members 
• often look blank or expressionless when anxious and may find it difficult to make eye contact
• may not show emotions (smile, laugh or show true feelings), although some do
• are extremely anxious outside their ‘safe’ environment, although this is often well concealed; in school they’re likely to be feeling anxious most of the time
• may move stiffly or awkwardly when anxious, or if they think they are being watched
• find it extremely difficult to answer the register, say hello, goodbye or thank you
• find it difficult to make what appear to be simple choices (for example, ‘pick a colour’, ‘choose a partner’, ‘find a space’) fearing that they don’t know the ‘correct’ response 
• can be very slow to respond to a question and if they do may whisper
• can be very sensitive to noise, touch or crowds
• may have other anxieties, for example, eating in front of others or using the school toilet
• may react in ‘fight’ or ‘flight’ mode and appear to have behavioural problems when frustrated or anxious about their inability to communicate.

Knowledge and awareness about Selective Mutism worldwide is growing all the time. Children were previously thought shy or quiet and the condition was left untreated. Depending on where you live you may find that the service provision or person delivering a service differs depending on various factors.

Involvement from most NHS Speech and Language Therapy Services will be advisory where there is a trained member of staff. Children will also be directly supported if they are experiencing speech and language difficulties as well as Selective Mutism. Alternatively many parents find the information they need from the website leaflets.

It could be psychology services, school or Speech and Language Therapy that give the primary advice and support. In some areas of the UK it is parents that are raising awareness. Regardless of who takes the initial lead, services should then work together to support any child who is impacted by their communication anxiety.

If you live within the Cardiff and Vale area and are concerned that your child may have Selective Mutism, please contact us to enquire about current provision as the role of the Speech and Language Therapy Service is currently being developed in Cardiff and Vale.

Please also speak to your school and mention that you have heard about Selective Mutism and would like this to be considered further.

Early intervention is key and it is never harmful to implement strategies. Please see the Selective Mutism videos section below for some tips on supporting a child who appears to have anxiety with their communication in some situations.