“She’ll grow out of it, don’t worry,” was the refrain 5-year-old Brittany’s mother kept hearing regarding her child who never opened her mouth to speak in public. In striking contrast, Brittany was a chatterbox with her immediate family at home. “She will overcome her shyness in kindergarten,” the mother was assured. But when summoned to the school to discuss a “problem” regarding Brittany, the mother, full of her own anxiety, watched her daughter stand motionless and speechless by the side of the playground while the other children talked and played.

This case illustrates an often misdiagnosed disorder in children – selective mutism (SM) – a severe form of social anxiety in which extreme anxiety inhibits the child from voluntarily speaking. Brittany’s behavior, as well as her mother’s reaction, typifies a family with a child afflicted with the disorder.

Beyond Shyness

Compounding the difficulty in diagnosis is that children affected with selective mutism have the ability to speak and understand language. They develop age-appropriate skills in areas of learning and behavior, and speak normally in at least one environment, typically at home with immediate family members. And yet, in specific environments – such as school or social events – or with select people, the child afflicted with selective mutism consistently does not speak. This inability to speak interferes with functioning in educational and/or social settings, which later may impair academic, occupational, and/or social achievement.

In most instances, the child’s silence is attributed to “intense shyness,” with the assumption that it will eventually be outgrown. This is the most common mistake made about children with selective mutism. In other cases, the child is labeled as being “just stubborn,” as if not speaking were deliberate.

Because it is complex with unclear origins, it is difficult for parents to find appropriate help. Left untreated, SM and its debilitating anxiety can work its way into the personality, creating avoidant and dependent characteristics manifested in adulthood by social phobia, depression, relationship tribulations, career dysfunction and substance dependence.

Lost Efforts

The typical scenario in a school environment is referral of the selectively mute child to speech therapy. In most cases, this is unproductive, since the problem is not a speech disorder, but rather an anxiety disorder.

Well-meaning teachers usually learn to accommodate the problem by investing in the belief and attitude that the child will never speak – so why bother to treat the child like a regular student? Regarding verbal performance, expectations become minimized or non-existent. This attitude reduces the discomfort of the teacher, but turns into an “enabling” accommodation which exacerbates the problem.

In some cases, school psychologists attempt to treat the child by facilitating reward-based strategies. These backfire because the attention placed on the SM child fosters negative pressure.

Empowering Actions

I define selective mutism as an addiction to the avoidance of speaking. Parents must be educated about the signs and symptoms of selective mutism and institute “empowering, non-enabling” parenting strategies as early as possible. Parents can be more productive by learning how to advocate on behalf of their child with the school, ensure that school personnel are well-informed of the condition, and become familiar with the Special Education 504 plan.

Medication should only be used when “corrective parenting” strategies are in effect or if the child remains overly inhibited or paralyzed with speech. The objective of medication is to create a sense of calmness in the brain. The longer term objective is to not need medication.

Successful Treatment

To hear firsthand why Selective Mutism persists in spite of the best intentions of parents and teachers, visit " target="_self" a library of free interviews with real people who have resolved social anxieties , including with parents of children who suffered from selective mutism. Hear what’s required to break the cycle of enabling its perpetuation. Learn how to differentiate between positive and negative accommodation of Selective Mutism and what’s involved in a successful treatment process.