May 9, 2017

Diagnosis: Selective Mutism

Understanding this often misunderstood condition


A conversation with child psychologist Kristen Eastman, Psy.D


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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.


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


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