May 9, 2017

Diagnosis: Selective Mutism

Understanding this often misunderstood condition

650×450-GettyImages-585583408

A conversation with child psychologist Kristen Eastman, Psy.D

Advertisement

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy

What is Selective Mutism or SM?

Selective mutism, or SM, is the inability to talk in select social settings (school, in public) despite normal talking in comfortable settings (at home). It often overlaps with other signs of (usually social) anxiety. Communication varies from setting to setting and person to person. Difficulties are indeed “selective” and thus often misunderstood.

What does SM look like?

  • Child does not respond
  • Avoids eye contact
  • Frozen posture
  • Expressionless or “deer in headlights” face
  • May cling to or hide behind parent to avoid talking

What are common myths about SM?

There are three main myths: 1) “It’s rare.” SM isn’t as rare as once thought. This belief has led to missed opportunities for early diagnosis. 2) The child is “choosing” not to talk. SM has been reclassified as an anxiety disorder. It’s not a behavior disorder. The child is not being stubborn. 3) “It’s just shyness.” Shy kids function. Kids with SM freeze up and do not function in select social settings.

What red flags should pediatricians watch for?

Take note if a child cannot readily talk to you/your staff, stops talking to a parent when you enter the exam room, or appears frozen/expressionless and is unresponsive.

Advertisement

What should the pediatrician do if SM is suspected?

Ask the parent the following:

  • Is this typical behavior?
  • Where/with whom does the child talk comfortably?
  • Where/with whom does the child freeze up and/or shut down?
  • To what extend does this inter fere with the child’s functioning?
  • Is the parent or teacher concerned?

When in doubt, refer for a proper evaluation. Early intervention is critical and will allow for a much better prognosis.

Refer: 330.888.4000

Advertisement

Related Articles

CQD-4408858-breastfeeding
December 19, 2023
A New Policy Update on Breastfeeding: What All Clinicians Need To Know

Cleveland Clinic physicians offer their insights

23-CHP-3988710 CQD Szugye – Breastfeeding Medicine Clinic
September 11, 2023
7 Clinical Takeaways for Providers Caring for Lactating Parents and Breastfeeding Infants

Increasing support for breastfeeding patients

22-CHP-3060258 CQD-Mudd-CARE Line-650×450
August 24, 2022
The CARE Line: What To Know About Cleveland Clinic Children’s Telephone Consultation Program

Program has facilitated nearly 300 consults across 25 departments in less than a year

22-CCC-2636467-CQD-Hero-650×450
January 21, 2022
No Level of Lead Is Safe in a Child’s Body

Though completely preventable, lead poisoning remains a public health threat

650×450-COVID-Sick-Child
March 18, 2021
Unique Aspects of COVID-19 in Children

Differences in infection rates, management, outcomes and transmission

650×450-Speech-Therapy
February 9, 2021
Ultrasound Technology Valuable in Remediating Common Articulation Disorder

Helps patients visualize proper tongue placement

Ad