Selective Mutism
Selective Mutism (SM) is a childhood anxiety disorder near and dear to my heart. If you have no idea what that is, you're certainly not alone... I didn't either! If you're like me, however, and have or work with shy children, take a look at this video I made during my graduate coursework. SM is a complex condition, and no two children are alike. My goal with this video was to raise awareness about Selective Mutism, promote early detection in preschool children, and encourage people to think carefully about whether "just shy" is the most helpful description of their young child.
Resources
Selective Mutism Association: Many types of resources for parents and professionals, including free Webinars and a printable Educator Toolkit
Selective Mutism University: Excellent free online training from Kurtz Psychology. Covers important concepts including "PRIDE" skills, and simple interventions that parents can begin right at home even as they wait for evaluation by a professional.
Selective Mutism Center: Holistic, evidence-based treatment approach called S-CAT, and an expert-led podcast from Dr. Shipon-Blum, called "Unspoken Words".
Selective Mutism University: Excellent free online training from Kurtz Psychology. Covers important concepts including "PRIDE" skills, and simple interventions that parents can begin right at home even as they wait for evaluation by a professional.
Selective Mutism Center: Holistic, evidence-based treatment approach called S-CAT, and an expert-led podcast from Dr. Shipon-Blum, called "Unspoken Words".
Parents Don’t Know What They Can’t Hear: The Selectively Mute Gifted Child
By Laura G. Neher
"You should consider having her repeat the year instead of advancing to Pre-K. The social expectations may be too high and make the situation worse."
At an unusual loss for words, I stared in disbelief. The preschool director was talking about a child that, if born in fall instead of spring, I might have used as an example for why states should adopt early Kindergarten entrance policies! How could my precocious daughter have come to be viewed, after 8 months of preschool, as a great candidate to be held back due to perceived social and emotional immaturity?
Sure, we’d known since mid-toddlerhood that she was less talkative around people outside the home. But the pediatrician had never appeared alarmed when my daughter hid behind the chair and froze. And wasn’t it possibly normal for a 3-year-old to gesture awkwardly and make little noises instead of answering, when questioned by a stranger? Seeking to protect her from distress, we would often swoop in and answer for her or innocently agree with others: ‘she drank the shy juice’. We didn’t realize we were making it worse.
Then one day she came home from preschool with a deep bite mark on her arm. When pressed for details, she admitted not saying a single word about it to anyone! That was the last straw: on a whim, I emailed her teachers a link to videos of my daughter at home. They were stunned, having come to know a completely different child than the motor-mouthed, zany, bilingual one we knew. Our journey with Selective Mutism (SM) began that night when I Googled ‘why doesn’t my child talk at school’.
Selective Mutism (SM): Social Communication Anxiety
SM is an anxiety disorder that typically begins between the ages of 3 and 5 and results in a child being persistently unable to speak in a socially appropriate manner in certain environments but not others (American Psychiatric Association, 2013). Children with SM will talk, even precociously, with some family and perhaps one or two close friends or classmates. But they will consistently display one or more of following behaviors when expected to talk in other situations, beyond the first month or two of school or the first hour of meeting someone:
Roughly one out of every 150 children develop SM, and their verbal behavior will often depend on the specifics of the situation and setting, which makes it perplexing and frustrating. It is easy for others to assume the child is simply defiant, unintelligent, or even an abuse victim as had often been assumed in the past (Muris & Ollendick, 2021a). But instead, these are some of the most important risk factors for parents to consider:
As a student of gifted education with a strong interest in twice-exceptionality, I was intrigued but not surprised at the absence of research on 2e students with SM. After all, SM is nowadays admittedly less common than many other conditions with rising rates, such as ADHD and Autism Spectrum Disorder (ASD). But I couldn’t stop thinking about and evaluating our experiences. Here are some of my lessons learned.
Sure, we’d known since mid-toddlerhood that she was less talkative around people outside the home. But the pediatrician had never appeared alarmed when my daughter hid behind the chair and froze. And wasn’t it possibly normal for a 3-year-old to gesture awkwardly and make little noises instead of answering, when questioned by a stranger? Seeking to protect her from distress, we would often swoop in and answer for her or innocently agree with others: ‘she drank the shy juice’. We didn’t realize we were making it worse.
Then one day she came home from preschool with a deep bite mark on her arm. When pressed for details, she admitted not saying a single word about it to anyone! That was the last straw: on a whim, I emailed her teachers a link to videos of my daughter at home. They were stunned, having come to know a completely different child than the motor-mouthed, zany, bilingual one we knew. Our journey with Selective Mutism (SM) began that night when I Googled ‘why doesn’t my child talk at school’.
Selective Mutism (SM): Social Communication Anxiety
SM is an anxiety disorder that typically begins between the ages of 3 and 5 and results in a child being persistently unable to speak in a socially appropriate manner in certain environments but not others (American Psychiatric Association, 2013). Children with SM will talk, even precociously, with some family and perhaps one or two close friends or classmates. But they will consistently display one or more of following behaviors when expected to talk in other situations, beyond the first month or two of school or the first hour of meeting someone:
- Resisting eye contact; a “deer-in-headlights” look or rigid posture.
- Gesturing instead of verbalizing.
- Speaking through an intermediary.
- Quietly whispering, perhaps only one or two words, even if interested in and playing alongside peers.
Roughly one out of every 150 children develop SM, and their verbal behavior will often depend on the specifics of the situation and setting, which makes it perplexing and frustrating. It is easy for others to assume the child is simply defiant, unintelligent, or even an abuse victim as had often been assumed in the past (Muris & Ollendick, 2021a). But instead, these are some of the most important risk factors for parents to consider:
- Family history of anxiety, particularly social anxiety.
- Shy, slow-to-warm temperament.
- Highly sensitive to environment.
- Bilingual (though children actively learning a second language may be temporarily silent in a that new language environment in the beginning).
- Subtle speech and language disorders: easy for parents to miss.
As a student of gifted education with a strong interest in twice-exceptionality, I was intrigued but not surprised at the absence of research on 2e students with SM. After all, SM is nowadays admittedly less common than many other conditions with rising rates, such as ADHD and Autism Spectrum Disorder (ASD). But I couldn’t stop thinking about and evaluating our experiences. Here are some of my lessons learned.
Giftedness Might Mask Selective Mutism
Trap #1: The gifted loner stereotype. From classroom photographs, I knew my daughter frequently engaged in complex figurine play in a corner by herself, and teachers mentioned hearing her speaking to herself in German. Many parents may hear or observe that gifted children play or prefer to play alone when not around peers with similar abilities or interests. But my daughter’s class was filled with bright children, she was equally fluent in both languages, and she exhibited problems with both children and highly engaging adults.
The Takeaway: Don’t fall prey to stereotypes; think critically about possible root causes.
Trap #2: Overexcitabilities. I had also used Dabrowski’s concept of Overexcitabilities (OEs) a bit naively to rationalize her behaviors. It was tempting to envision her ‘shutdown’ in certain environments, particularly loud or chaotic ones like preschool, as a manifestation of sensory and emotional excitability rather than an indication of something to be investigated further. I knew she’d lie on the floor and suck her thumb. I now understand why some clinicians take issue with the way OEs are presented in popular gifted literature. I also came to understand that most children typically identified as gifted (in contrast to those who are highly gifted) may not necessarily exhibit any particular OE more strongly than the broader population except for, perhaps expectedly, intellectual overexcitability (Winkler & Voight, 2016).
The Takeaway: Overexcitabilities should not be used as an reason to ignore behaviors that are significantly impairing a child.
Trap #3: But when she does talk… WOW! Our preschool teacher eventually admitted that when my daughter did speak, her rigid posturing and extreme pausing was followed by very rapidly and anxiously blurted speech. But what came out of her mouth was so sophisticated and elaborate that the teacher was impressed and assumed no real problem was present. Another child’s family mentioned that their gifted child chattered away non-stop in detail about preschool activities during their afternoon drive home, leading them to believe (given the absence of teacher feedback) that there was no real problem.
The Takeaway: A young child with SM may not be completely mute in school… yet. Don’t be afraid to ask teachers detailed questions about your child’s verbal behavior.
But Selective Mutism Might Also Mask Giftedness
Trap #1: Assuming what can’t be heard. If left untreated, gifted children with SM may become too anxious to demonstrate the extent of what they are capable of in school, particularly in larger groups and without accommodation. Some children become impossible to assess verbally at all in school. Teachers conducting gifted referrals can easily miss exceptional reasoning that is masked by withdrawn, nonverbal behavior, particularly when universal ability screening isn’t implemented. Alternative gifted identification criteria such as motivation may be similarly difficult to accurately and unbiasedly evaluate. Some children may be so anxious that they have accidents rather than ask to use the bathroom, which certainly doesn’t improve a teacher’s perception. SM falls under the category of anxiety disorders, and a 504 accommodation plan put in place early can help promote progress when paired with in-class interventions and therapy.
The Takeaway: Help teachers ‘see’ and ‘hear’ your child. Consider showing videos of your child at their best when engaged in self-selected tasks. Consider that a label like ‘selective mutism’ can be more helpful than damaging labels like ‘slow’ or ‘stubborn’.
Trap #2: The professional mime. One gifted six-year-old (who did not experience the broader social anxiety that 80% of SM children do), had become stunningly adept at communicating what she was thinking in school using gesture, writing, and facial expressions. Other children even understood her. Her teacher called her a professional mime and heavily resisted accepting that the child may be both anxious and intellectually gifted, versus simply stubborn. This hindered the child’s progress for more than a year because suggested accommodations and school interventions were not followed.
The Takeaway: Parents must be prepared to help educate others about SM. It is a poorly-understood condition. Consider printing the Selective Mutism Educator Toolkit (see Resources) and involving a psychologist to help explain the condition if possible.
Trap #1: The gifted loner stereotype. From classroom photographs, I knew my daughter frequently engaged in complex figurine play in a corner by herself, and teachers mentioned hearing her speaking to herself in German. Many parents may hear or observe that gifted children play or prefer to play alone when not around peers with similar abilities or interests. But my daughter’s class was filled with bright children, she was equally fluent in both languages, and she exhibited problems with both children and highly engaging adults.
The Takeaway: Don’t fall prey to stereotypes; think critically about possible root causes.
Trap #2: Overexcitabilities. I had also used Dabrowski’s concept of Overexcitabilities (OEs) a bit naively to rationalize her behaviors. It was tempting to envision her ‘shutdown’ in certain environments, particularly loud or chaotic ones like preschool, as a manifestation of sensory and emotional excitability rather than an indication of something to be investigated further. I knew she’d lie on the floor and suck her thumb. I now understand why some clinicians take issue with the way OEs are presented in popular gifted literature. I also came to understand that most children typically identified as gifted (in contrast to those who are highly gifted) may not necessarily exhibit any particular OE more strongly than the broader population except for, perhaps expectedly, intellectual overexcitability (Winkler & Voight, 2016).
The Takeaway: Overexcitabilities should not be used as an reason to ignore behaviors that are significantly impairing a child.
Trap #3: But when she does talk… WOW! Our preschool teacher eventually admitted that when my daughter did speak, her rigid posturing and extreme pausing was followed by very rapidly and anxiously blurted speech. But what came out of her mouth was so sophisticated and elaborate that the teacher was impressed and assumed no real problem was present. Another child’s family mentioned that their gifted child chattered away non-stop in detail about preschool activities during their afternoon drive home, leading them to believe (given the absence of teacher feedback) that there was no real problem.
The Takeaway: A young child with SM may not be completely mute in school… yet. Don’t be afraid to ask teachers detailed questions about your child’s verbal behavior.
But Selective Mutism Might Also Mask Giftedness
Trap #1: Assuming what can’t be heard. If left untreated, gifted children with SM may become too anxious to demonstrate the extent of what they are capable of in school, particularly in larger groups and without accommodation. Some children become impossible to assess verbally at all in school. Teachers conducting gifted referrals can easily miss exceptional reasoning that is masked by withdrawn, nonverbal behavior, particularly when universal ability screening isn’t implemented. Alternative gifted identification criteria such as motivation may be similarly difficult to accurately and unbiasedly evaluate. Some children may be so anxious that they have accidents rather than ask to use the bathroom, which certainly doesn’t improve a teacher’s perception. SM falls under the category of anxiety disorders, and a 504 accommodation plan put in place early can help promote progress when paired with in-class interventions and therapy.
The Takeaway: Help teachers ‘see’ and ‘hear’ your child. Consider showing videos of your child at their best when engaged in self-selected tasks. Consider that a label like ‘selective mutism’ can be more helpful than damaging labels like ‘slow’ or ‘stubborn’.
Trap #2: The professional mime. One gifted six-year-old (who did not experience the broader social anxiety that 80% of SM children do), had become stunningly adept at communicating what she was thinking in school using gesture, writing, and facial expressions. Other children even understood her. Her teacher called her a professional mime and heavily resisted accepting that the child may be both anxious and intellectually gifted, versus simply stubborn. This hindered the child’s progress for more than a year because suggested accommodations and school interventions were not followed.
The Takeaway: Parents must be prepared to help educate others about SM. It is a poorly-understood condition. Consider printing the Selective Mutism Educator Toolkit (see Resources) and involving a psychologist to help explain the condition if possible.
Gifted & SM & ASD… OH MY!
Possible links between SM and ASD are complex and just beginning to be investigated (Muris & Ollendick, 2021b). Though there’s no research on this topic as it relates to giftedness, my observations lead me to wonder whether gifted children with SM might run a higher risk of being misdiagnosed with ASD instead of SM, especially since ASD now incorporates what used to be called Asperger’s Disorder. Gifted children may be much more likely to exhibit behaviors and traits that overlap significantly with ASD or with ASD + SM together, than with SM alone.
Possible links between SM and ASD are complex and just beginning to be investigated (Muris & Ollendick, 2021b). Though there’s no research on this topic as it relates to giftedness, my observations lead me to wonder whether gifted children with SM might run a higher risk of being misdiagnosed with ASD instead of SM, especially since ASD now incorporates what used to be called Asperger’s Disorder. Gifted children may be much more likely to exhibit behaviors and traits that overlap significantly with ASD or with ASD + SM together, than with SM alone.
But here’s the problem: clinicians in the USA are not supposed to diagnose ASD and SM together. They’re currently considered mutually exclusive (American Psychiatric Association, 2013)! Parents should be aware of this when filling out forms like the Behavioral Assessment System for Children (BASC) Parent Rating Scales, which many questions about ‘how this child has behaved recently’. Also, a clinician who doesn’t use best practices for communicating with an SM child may not only find it difficult to assess the child, but may witness unusual autistic-like behaviors that are shockingly magnified. Hyperaware and hypersensitive in the first psychologist’s office (who didn’t have SM training), my daughter appeared even more rigid than at school. Her intensity of focus on certain objects of interest in the playroom was viewed through the lens of ASD rather than giftedness and anxiety.
The Takeaway: Talk to clinicians about your child’s cognitive gifts and associated traits. Ask how you should fill out rating scales when there are extreme variations in behavior that depend on environment.
Conclusion
You may already be familiar with twice-exceptionality, but I’m willing to bet the term Selective Mutism didn’t ring a bell. I heard the same things over and over from parents in therapy: “I wish people hadn't tried to convince us he would just grow out of being shy”, “Why did we wait a year?”, “I worry teachers won't see how incredibly smart she is.” We did not hold our daughter back a year, but many other parents might have reasonably yielded to that suggestion without understanding the possible negative cognitive, social, and emotional consequences for their gifted child. Instead, we put our name on every wait list for professionals with a track record of success with SM, which were relatively few. In the meantime, we started down the path of self-education thanks to the wealth of training available from Selective Mutism University. Our daughter exhibited surprising improvement with techniques we implemented at home even before formal treatment. We can see the light at the end of the tunnel, our daughter is proud of her ‘brave talking’ skills, and we remain optimistic. Please, ask questions and don’t wait!
EXTRA: Early Intervention Tips
Even though there are genetic predispositions to SM, adults can and do have the power to reduce a child’s communication anxiety without promoting nonverbal behavior. Here are some simple preventative and early intervention tips to reduce the probability of symptoms escalating, particularly for 3- to 5-year-olds who are just beginning to show symptoms:
Resources
Selective Mutism University (excellent free training): https://selectivemutismuniversity.thinkific.com/courses/
Selective Mutism Association: https://www.selectivemutism.org/
Selective Mutism Association’s Toolkit for Educators: https://www.selectivemutism.org/wpcontent/uploads/2021/08/SMA_Educator_ToolKit_SinglePages.pdf
References
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.).
Bergman, R. L, Gonzales, A., Piacentini, J., & Keller, M. L. (2013). Integrated behavior therapy for children with Selective Mutism. Behavior Research and Therapy, 51(10), 680–689. https://doi.org/10.1016/j.brat.2013.07.003
Muris, P., & Ollendick, T. H. (2021a). Current challenges in the diagnosis and management of Selective Mutism in children. Psychology Research and Behavior Management, 14, 159-167. https://doi.org/10.2147/PRBM.S274538
Muris, P., & Ollendick, T. H. (2021b). Selective Mutism and its relations to Social Anxiety Disorder and Autism Spectrum Disorder. Clinical Child and Family Psychology Review, 24(2), 294–325. https://doi.org/10.1007/s10567-020-00342-0
Winkler, D., & Voight, A. (2016). Giftedness and overexcitability: Investigating the relationship using meta-analysis. Gifted Child Quarterly, 60(4), 243–257. https://doi.org/10.1177/0016986216657588
Selective Mutism University (excellent free training): https://selectivemutismuniversity.thinkific.com/courses/
Selective Mutism Association: https://www.selectivemutism.org/
Selective Mutism Association’s Toolkit for Educators: https://www.selectivemutism.org/wpcontent/uploads/2021/08/SMA_Educator_ToolKit_SinglePages.pdf
References
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.).
Bergman, R. L, Gonzales, A., Piacentini, J., & Keller, M. L. (2013). Integrated behavior therapy for children with Selective Mutism. Behavior Research and Therapy, 51(10), 680–689. https://doi.org/10.1016/j.brat.2013.07.003
Muris, P., & Ollendick, T. H. (2021a). Current challenges in the diagnosis and management of Selective Mutism in children. Psychology Research and Behavior Management, 14, 159-167. https://doi.org/10.2147/PRBM.S274538
Muris, P., & Ollendick, T. H. (2021b). Selective Mutism and its relations to Social Anxiety Disorder and Autism Spectrum Disorder. Clinical Child and Family Psychology Review, 24(2), 294–325. https://doi.org/10.1007/s10567-020-00342-0
Winkler, D., & Voight, A. (2016). Giftedness and overexcitability: Investigating the relationship using meta-analysis. Gifted Child Quarterly, 60(4), 243–257. https://doi.org/10.1177/0016986216657588