Selective mutism

Selective mutism is most common in children under age 5. The cause, or causes, are unknown. Most experts believe that children with the condition inherit a tendency to be anxious and inhibited. Most children with selective mutism have some form of extreme social fear (phobia).

Parents often think that the child is choosing not to speak. However in most cases, the child is truly unable to speak in certain settings.

Some affected children have a family history of selective mutism, extreme shyness, or anxiety disorders, which may increase their risk for similar problems.

This syndrome is not the same as mutism. In selective mutism, the child can understand and speak, but is unable to speak in certain settings or environments. Children with mutism never speak.

Symptoms include:

• Ability to speak at home with family
• Fear or anxiety around people they do not know well
• Inability to speak in certain social situations
• Shyness

This pattern must be seen for at least 1 month to be called selective mutism. (The first month of school does not count, because shyness is common during this period.)

There is no test for selective mutism. Diagnosis is based on the person's history of symptoms.

Teachers and counselors should consider cultural issues, such as recently moving to a new country and speaking another language. Children who are uncertain about speaking a new language may not want to use it outside of a familiar setting. This is not selective mutism.

The person's history of mutism should also be considered. People who have been through trauma may show some of the same symptoms seen in selective mutism.

Treating selective mutism involves behavior changes. The child's family and school should be involved. Certain medicines that treat anxiety and social phobia have been used safely and successfully.

You can find information and resources through selective mutism support groups.

Children with this syndrome can have different outcomes. Some may need to continue therapy for shyness and social anxiety into the teenage years, and possibly into adulthood.

Selective mutism can affect the child's ability to function in school or social settings. Without treatment, symptoms may get worse.

Contact your health care provider if your child has symptoms of selective mutism, and it is affecting school and social activities.

Bang JY, Feldman HM. Language development and communication disorders. In: Kliegman RM, St. Geme JW, Blum NJ, et al, eds. Nelson Textbook of Pediatrics. 22nd ed. Philadelphia, PA: Elsevier; 2025:chap 53.

Kim RK. Anxiety disorders, obsessive-compulsive disorder, and posttraumatic stress disorder. In: Kliegman RM, St. Geme JW, Blum NJ, et al, eds. Nelson Textbook of Pediatrics. 22nd ed. Philadelphia, PA: Elsevier; 2025:chap 38.

Thom RP, Prince JB, Rubin DH. Child and adolescent psychiatric disorders. In: Stern TA, Wilens TE, Fava M, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 3rd ed. Philadelphia, PA: Elsevier; 2025:chap 39.

Updated by: Fred K. Berger, MD, addiction and forensic psychiatrist, Scripps Memorial Hospital, La Jolla, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.