Supporting adults and teenagers with Selective Mutism, and their parents



Selective Mutism was featured on BBC's Victoria Derbyshire programme on 15th July 2015. The full video can be viewed here: There is an online article which accompanied the programme featuring "Selective Mutism in Adults" which can be viewed here: I think Sabrina did extraordinarily well to take part in this programme, and I hope she receives the respect and admiration she deserves for doing so.

Selective Mutism was also featured on BBC Radio 4 on 10th February 2015. The programme is still available to listen to here: Jane appeared in this programme.

For parents, friends and relatives of children / adults with SM: Please take part in the Afasic 'Zip It!' challenge this spring to help raise much needed funds toward's Afasic's work. The challenge is to stay silent and use only non-verbal methods of communication for a period that you decide (it could be 5 minutes, an hour, a morning, a day etc). For more information and to register go to

What is Selective Mutism?

Selective Mutism (SM) is a severe situational anxiety disorder which affects both children and adults. The condition generally starts in early childhood but can, if not treated early enough, continue into adulthood. Children and adults with SM are often fully capable of speaking (though many have masked speech problems / delays), but cannot speak in certain situations because they are phobic of initiating speech.

As a phobia of communication, a child or adult with SM will be mute (it is an instinctual response which can feel inexplicable even to himself / herself) in the presence of a given collection of people or indeed an individual person. The pattern of speech-related anxiety varies depending upon the person's life-experience. The pattern can be quite general - encompassing the whole school environment. Or it can be more specific - for instance with a grandparent, parent or step-parent. As such, role can, sometimes, be involved. Or it can be a complex mixture of both.

The mean age of onset of Selective Mutism is between 2.7 and 4.1 years of age, which is long before the mean age of onset of Social Anxiety Disorder, which generally develops during adolescence. SM often first becomes apparent when a child enters a communal environment outside the family home for the first time - for instance when a child begins playgroup or school. While SM has a very early mean age of onset, sometimes SM (either absolute silence or extreme reticence) can last for a child’s entire time at school - until the day they leave at 16 or 18. Generally, but not always, it contributes to academic underachievement, school refusal, and a torrid school life, etc. despite children with SM often being of 'above-average intelligence'.

School is not the only situation in which muteness can occur, however. SM being an education-only issue is a stereotype, thus incorrect. Many children (including those primarily mute at school) may also not be able to talk to certain relatives (e.g. grandparents or aunties or uncles etc.) In rarer cases, some children with SM may not be able to talk to their parents or step-parents either. This was the case for me.

Children and adults with SM do not choose to be silent in the situations in which they cannot speak. They genuinely cannot speak because attempting speech rouses too much anxiety. Almost all children and adults with Selective Mutism would love to be able to speak in every situation they cannot. They are not making their difficulties up, being difficult, rude, antisocial, or anything else.

Busting myths and stereotypes

As probably the least understood / least researched / most misunderstood anxiety disorder of all, there are many myths and stereotypes surrounding Selective Mutism.

Myth 1: Selective Mutism only affects young children

While SM ordinarily begins in young childhood it can persist, in much the same form, through adolescence into adulthood. SM often does not just disappear when a child reaches 18. My own research estimates there to be around 1 in 2400 young adults with SM and an unknown number of older adults - the vast majority of whom receive no support at all. There is a profound gap in mental health services for this condition - for not only adolescents with SM but adults too - not least because the severity of this condition is underestimated. One should remember that while SM in young children may seem to be quite innocuous and low-impact, Selective Mutism can develop into / contribute to serious psychiatric problems in teenage and adult life. Selective Mutism is best and most easily tackled when a child is young.

Myth 2: Selective Mutism is always caused by childhood mistreatment

There are many reasons for this anxiety disorder becoming embedded in a young person's life - including no reason whatsoever. The majority of parents who have children with SM are lovely people, who are as flummoxed by their child developing SM as everyone else. Many children with SM seem to be predisposed to developing anxiety. Many young people (males and females alike) also have sensory-processing issues, autism, and / or hearing or speech problems as well as SM. On the other hand many young people simply have SM on its own. Including my own research there is no evidence to suggest that children (or adults) with SM are more likely to have experienced mistreatment in childhood. As a statistical population (just as with a population of children with blonde hair or green eyes) it is suggested that children with SM are simply equally likely to have experienced mistreatment.

Myth 3: People with Selective Mutism can't be mute everywhere all the time

Selective Mutism is a poor name for this condition. It should, perhaps, be called Situational Mutism rather than Selective Mutism. In fact all situations can eventually become triggers (as they were, for a period, for me.) Children and adults with SM don't wilfully 'select' those they are mute with. They have instinctual speech 'rules' about who can and cannot be spoken to that can last for years or even decades. The 'rules' sometimes have a tendency to spread, however, and some young adults with SM may eventually become mute in all situations because their system of 'rules' has, progressively, become so entrapping that they cannot face speaking anywhere or to anyone. In my own experience I had five different types of speech rule (which may well be recognisable by every sufferer of this condition): With certain people I was compelled (it was my instinct) to be mute every single time I encountered them; Those who had never heard me speak would never hear me speak, even if I had known them for years; With a few exceptions, anyone related or associated with anyone who I could not speak to could not be spoken to either; Those who did not know I was mute in other situations could never be allowed to find out about my muteness; and Those who only knew me as mute could not discover I could speak in other situations. Above all, one should realize that SM is far from simple and far from easy to escape. It can become a hellish trap!

What children and adults with Selective Mutism need

Appropriate support. Appropriate services. Compassion and understanding - rather than judgement! Imagine being unable to speak (due to anxiety) yet constantly being told you are rude! Compounding the distress that SM can cause, SM of engenders very little sympathy or support because it is often wrongly perceived to be a choice - namely a 'refusal to talk' - when in fact it is a phobia of initiating speech. Hence not only do people with SM suffer due to a condition they have not asked for - something that is happening to them, which is entirely beyond their control - they are also often judged harshly as being difficult, uncooperative, rude, dumb, standoffish, or even stuck up. They need support and, at key times, supportive intervention, not criticism or judgement. Bear in mind that Selective Mutism is something that a child or adult with SM feels he or she can no more help than any other person can help breathing. They are not being wilfully mute. They are entirely trapped by a complex system of anxieties and 'rules' at the heart of which is a phobia of initiating speech.

Where to seek help

For parents: If your child is under 18, parents may be able to access speech therapy (contact your local speech therapy department directly or perhaps via your GP.) Additionally, children may be referred to CAMHS for psychological help. CAMHS are particularly relevant if your child is a little older and develops other issues such as depression. CAMHS may attempt to provide CBT, however this can be entirely innappropriate for many SM children, as CBT is a talking therapy. Therapeutic approaches to SM are much more effective if emphasis is taken away from speech, at least to be begin with. You may also wish to liaise with your child's school's SENCO and teachers. Very small changes to a child's school or college environment can make a world of difference. Arm yourself with literature - for instance from SMIRA's website and also Maggie Johnson's booklet which succinctly explains SM and can be downloaded from here (also available in Welsh courtesy of Afasic Cymru) - when interacting with the school or college. They may not have encountered SM before. You may also be able to find a private speech therapist via On their website you can enter a postcode and search for a therapist who specializes in Selective Mutism. Afasic and Afasic Cymru also provide local meet-ups for parents and youth groups where children with SM are welcome.

For adults with SM: The options are much narrower, unfortunately. If you are an adult yourself and can speak to therapists, you may find some benefit in accessing a talking therapy such as counselling or CBT. In general, therapists working with adults will have not have encountered SM before, and you might find yourself educating them. You may be able to access talking therapies through IAPT Services / your GP. You may benefit most by interacting online with other adult sufferers of SM. You are welcome to contact Jane or myself (Carl).

For children with SM: If you are a child and are in need of immediate support please contact Childline. They can help you with issues such as unhappiness at school or home, and bullying. And, best of all, you can contact them via e-mail. You do not have to telephone them. Older children / teenagers may also be able to find mutual support in the various facebook groups for this condition. As ever though, please be safe online. People may not be who they appear to be. Never arrange to meet anyone you may encounter online.

For everyone: Of particular interest may be Rosie's magazine on Selective Mutism which can be found at Finding Our Voices ( Rosie is always looking for contributions to the magazine - help if you can!

Further reading / videos

Selective Mutism diagramLeon's storySelective Mutism video 1Selective Mutism video 2Selective Mutism video 3Selective Mutism video 4Selective Mutism video 5Selective Mutism video 6

©2012-2015 Carl Sutton / iSpeakOther Selective Mutism websites