Better Care

Selective Mutism

Selective mutism (selective speaking) is an anxiety-based mental health disorder which usually starts in early childhood. It occurs when a child speaks comfortably in some situations but consistently does not speak in other situations. They may present with a blank facial expression, appear ‘frozen’ when expected to speak, look embarrassed or anxious or avoid eye contact.

For unknown reasons, selective mutism appears to be more prevalent amongst girls and more cases are reported from migrant and multi-lingual families.

A child may be diagnosed with selective mutism if they persistently do not speak in specific social situations (eg. at school) but are able to speak in other, more familiar situations. This should have been happening for at least a month beyond the first month at a new setting, should not be due to any other reason (eg. failure to speak due to lack of knowledge of the language or a communication difficulty such as stammering) and should be impacting upon their educational, social and emotional development.

It is important to understand that children with selective mutism want to speak but find themselves physically unable to do so due to their anxiety.

With support, the prognosis for recovery is good, however in some cases it may continue through a child’s life and sometimes into adulthood.

Speech and language therapy

If you are worried that your child has selective mutism, you can refer to speech and language therapy using the referral form on this website.

The speech and language therapy service is commissioned to work with children with speech, language and communication difficulties who meet our service criteria, children with selective mutism who do not have any additional speech and language difficulties therefore will not meet the criteria for therapy. We will carry out a speech and language therapy assessment to:

  • confirm the nature of the child’s presenting speech, language and communication difficulties in collaboration with parents and the child’s setting to identify whether there is a role for speech and language therapy to manage the child’s speech, language and communication difficulties.
  • provide appropriate advice and support to the family and setting.
  • signpost to other services e.g. Forward Thinking Birmingham (mental health services for 0-25 year olds). As selective mutism is an anxiety-based mental health disorder it is likely that the child will benefit from psychological support.

What can you do to help?

  • avoid bribing or putting pressure on a child to speak as this is likely to make things worse.
  • let the child know you understand that they sometimes have difficulty speaking. Show patience and reassure the child that they can start to talk when they feel ready to but until then to just have a good time and do what they feel able to.
  • respond warmly and naturally to any attempts to communicate e.g. through gesture or whispering.
  • if the child does talk to you, do not draw any attention to it just respond naturally. If the child looks upset that she/he spoke, simply say ‘I heard your voice and that’s ok. You can speak again when you are ready.’
  • comment on what you are doing rather than asking direct questions. This will help the child to feel relaxed and as if she/he is in a conversation without any pressure to answer.
  • use “I wonder…” phrases rather than questions “I wonder if you did painting again today”.....pause, rather than “did you do painting?”
  • encourage children to use non-verbal communication e.g. nodding, pointing or waving to communicate. With older children, provide pen and paper so he/she can write answers down if she/he does not feel ready to talk but wants to communicate with you.


Useful resources and signposting