FAQ

What is the difference between selective mutism and 'extreme shyness'?

Extreme shyness and selective mutism can be thought of as being on a continuum with selective mutism being a more severe condition. Shy children are generally able to respond when they are asked questions, even though it may be quietly and with very few words. Children with selective mutism have specific situations or people (particularly at school) where they are not able to respond verbally at all.

How can I find out if my child is just 'shy' and will grow out of their condition?
Some (but not all) cases of selective mutism can resolve spontaneously and these children will eventually start talking in those situations where they had been mute. If this does happen, it is usually in preschool or in the first year of school. It is difficult to distinguish those cases that may resolve spontaneously from those that won't, although an important factor appears to be how well the child's parents and teachers intuitively help the child to gradually face their fear of communicating, without placing too much pressure on them to do so. If the child's condition is not talked about and there are little opportunities for them to socialise and communicate with peers and adults, then there is a greater chance that the mutism will persist.

Even when selective mutism does resolve without intervention, these children tend to remain socially anxious and may also develop other anxieties or emotion regulation difficulties. They will generally find it difficult to talk in front of groups, ask for help, contribute to discussions, and be assertive. Treatment is therefore beneficial for all cases of selective mutism as it can help your child learn about their anxiety and be comfortable communicating in all situations. Once children with selective mutism enter their second year of school the mutism becomes more entrenched. Therefore, the older the child, the less likely the mutism will resolve without treatment.

Is it possible that my child is just being stubborn?
Children with selective mutism can often look stubborn, particularly when you know that they can talk without any difficulty in some situations. They may not become anxious unless they are asked to talk, so they often look very relaxed and can smile, laugh, sometimes make other noises, and join in activities just like other children. Despite this appearance, and the fact that many children with selective mutism are strong-willed, these children do want to talk, but don’t because they are too afraid to do so. When adults interpret a child’s selective mutism as defiance, they are more likely to place consequences on the child for not talking, show frustration, or pressure the child to talk. However, such approaches will worsen the mutism. By understanding that the child is extremely anxious about talking, adults are more likely to help the child face this fear in a gradual way and the child is more likely to be better able to attempt tasks.

My child gets very upset if I talk about the fact that they don't talk. Would it be better not to talk about it?

Anxious children will typically avoid anything that makes them feel anxious – including acknowledging or discussing their anxiety or difficulties talking. This is not a reason to avoid talking about it, as their anxiety is likely to worsen over time. Children need support to learn to understand and talk about their anxiety and other feelings in order to manage them. Although this may be difficult for them and you, wIth time and support from the psychologist, your child's distress will gradually lessen and they will find it helpful to talk about their worries. During the first session which only the parents attend, the psychologist can talk with you about how to best explain treatment to your child, and why they will be attending.

What does treatment involve?

The Selective Mutism Clinic uses Cognitive Behavioural Therapy (CBT) because research and our experience has shown this is the most effective treatment for selective mutism. CBT addresses children's avoidance of talking by helping them to gradually confront and practise increasingly more difficult forms of non-verbal and verbal communication. This is done at a pace that the child can cope with. Children with selective mutism also have particular anxious beliefs about how other people might respond or think about them if they heard them speak (e.g., 'they might tell everyone that I talked', 'they might think my voice sounds funny'). CBT helps them to start to think in a more helpful and rational way about talking.

The program requires parents and teachers to be committed to implementing strategies both within and outside of school, both of which are extremely important. Parents will be given skills to help their child gradually increase their communication with extended family, friends, in public places and in other settings. The Clinic implements an intensive school or preschool program and provides the classroom teacher and other relevant school personnel with regular phone consultations to support them to implement this program (i.e., a 45-minute phone consultation and follow-up email every 6-8 weeks). Your family will be seen by one of our Clinical Psychologists who are all registered psychologists and have at least Masters or Doctorate level training in Clinical Psychology as well as specialised training and experience in treating selective mutism.

How long will treatment take?
Selective mutism is one of the more severe anxiety disorders in children. It therefore takes some time for a child to learn to talk freely and spontaneously to everyone in all situations. Our experience shows that it takes approximately 12-24 months for selective mutism to resolve with an intensive treatment program. However, there are various factors that will impact on the rate of progress. These factors include the age of the child when they first present to treatment, the severity of the condition, the commitment of families and schools to implement the treatment program, and the existence of co-occurring anxieties or other behavioural problems. A child in preschool will often take less time than the above estimate (e.g., 6-12 months), and a child in high school will generally require longer treatment.