Mutism, Selective

National Organization for Rare Disorders, Inc.

Skip to the navigation


It is possible that the main title of the report Mutism, Selective is not the name you expected.

Disorder Subdivisions

  • None

General Discussion

Selective mutism is a rare psychiatric condition primarily occurring during childhood. It is characterized by the failure to speak in certain social situations. The ability to speak and understand spoken language is not impaired, and may be exhibited in more familiar environments. Symptoms include excessive shyness and social anxiety.


Selective mutism is a rare psychiatric disorder characterized by persistent failure to speak

in specific social situations (e.g., school, with playmates, or when strangers are present) where speaking is expected. Affected individuals may communicate by gesturing, nodding their heads, uttering sounds or one-syllable words, or whispering. However, individuals with selective mutism usually talk normally at home and appear to have typical language skills - although they may have subtle language difficulties in areas such as grammar when compared to other children their age.

Symptoms may also include fear of social embarrassment, clinginess and anxiety. Individuals with selective mutism are also more likely to have anxiety disorders such as social phobia.

Individuals with selective mutism may be excessively shy, socially isolated, and withdrawn. In some cases, selective mutism lasts only a few weeks or months. However, some cases have been reported to continue for several years.

Symptoms of selective mutism usually become noticeable between the ages of two and four years. However, the diagnosis may not be apparent until the child has entered school or other social situations. Functioning in school and social situations may be impaired. Individuals with selective mutism are commonly compliant, reticent, and almost "frozen" around strangers.


The exact cause of selective mutism is unknown. Some research suggests a genetic

influence or "vulnerability" to selective mutism that interplays with environmental factors. Particular personal and family characteristics may contribute to the appearance of selective mutism. Individuals with selective mutism may come from families in which there is a history of anxiety disorders and/or shyness. The term "selective" means that these children fail to speak in some social settings. The cause is not due to an underlying physical abnormality.

Affected Populations

Selective mutism is recorded to affect less than one percent of children in the United States. This disorder appears slightly more common in females than in males. The percent of affected population is unknown due to undiagnosis and misdiagnosis.

Standard Therapies


The diagnosis of selective mutism may be confirmed by an extensive medical evaluation

to rule out other possible causes. The evaluation should include hearing tests to assure that the child is not hearing impaired. A child with selective mutism has the ability to

understand and speak spoken language but will not speak in some social situations. The Selective Mutism Questionnaire for parent or teacher may aid in diagnostic screening.


Treatment of selective mutism consists of behaviour management and psychotherapy (such as cognitive behavioural therapy and family therapy). A multi-modal approach is often recommended. The therapies that may be effective in treating selective mutism are counter-conditioning, modeling, shaping (successive approximations), and contingency management. Counter-conditioning involves developing new behaviors that are not compatible with the undesirable behaviors. Modeling includes demonstration of the appropriate behaviour and can also effectively include self-modeling. Self-modeling may involve repeatedly watching digitally edited video/audio recordings of the child exhibiting the desired behaviour, i.e. talking in social situations. Shaping is a method for developing complex behaviors by progressively reinforcing simple behaviors that will eventually lead to the desired complex behavior. Bribery and consequences should be avoided to meet this end. Contingency management consists of providing positive reinforcement to the child when something has been done correctly and consequences when an inappropriate behaviour has occurred.

Investigational Therapies

Use of the drug fluoxetine and other selective serotonin reuptake inhibitors (SSRIs) is being studied for the treatment of selective mutism. More studies are needed to determine the long-term effectiveness of drugs for the treatment of selective mutism. Early evidence is promising and suggests that SSRIs are most effective when paired with behaviour management therapies.

Information on current clinical trials is posted on the Internet at

All studies receiving U.S. government funding, and some supported by private industry,

are posted on this government web site.

For information about clinical trials being conducted at the NIH Clinical Center in

Bethesda, MD, contact the NIH Patient Recruitment Office:

Tollfree: (800) 411-1222

TTY: (866) 411-1010


For information about clinical trials sponsored by private sources, contact:

Contact for additional information about selective mutism:

Evdokia Anagnostou, MD

Child neurologist

Clinician Scientist, Bloorvew Research Institute

Assistant professor, Department of Pediatrics

University of Toronto

Phone: 416-753-6005

Fax: 416-753-6046




Black B, Leonard HL, Rapoport JL. Specific phobia, panic disorders, social phobia, &

selective mutism. In: Weiner JM. Ed. Textbook of Child and Adolescent Psychiatry, 2nd

Edition. Washington: American Psychiatric Press. 1997:491-506.


Nowakowski ME, Tasker SL, Cunningham CE, et al. Joint attention in parent-child dyads involving children with selective mutism: a comparison between anxious and typically developing children. Chil Psychiatry Hum Dev. 2011;42(1):78-92.

Vecchio J, Kearney CA. Treating youths with selective mutism with an alternating design of exposure-based practice and contingency management. Behav Ther. 2009;40(4):380-92.

Viana AG, Beidel DC, Rabian B. Selective mutism: A review and integration of the last 15 years. Clin Psyc Review. 2009;29:57-67.

Bergman RL, Keller ML, Piacentini J, et al. The development and psychometric properties of the Selective Mutism Questionnaire. J Clin Child Adolesc Psychology 2008; 37:456-64.

Manassis K, Tannock R. Comparing interventions for selective mutism: A pilot study. Can J Psychiatry. 2008;53(10):700-3.

Manassis K, Tannock R, Garland J, et al. The sounds of silence: Language, cognition, and anxiety in selective mutism. J Am Acad Child Adolesc Psychiatry. 2007;46(9):1187-95.

Cohan SL, Chavira DA, Stein MB. Practitioner review: Psychosocial interventions for children with selective mutism: A critical evaluation of the literature from 1990-2005. J Child Psych and Psychiatry. 2006;27:341-55.

Berger I, Jaworowski S, Gross-Tsur V. Selective mutism: a review of the concept and

treatment. Israel Med Assoc J: Imaj. 2002;4:1135-37.

Kumpulainen K. Phenomenology and treatment of selective mutism. CNS Drugs.


Kristensen H. Non-specific markers of neurodevelopmental disorder/delay in selective

mutism a case-control study. Eur Child Adolesc Psychiatry. 2002;11:71-78.

Bergman RL, Placentini J, McCracken JT. Prevalence and description of selective

mutism in a school based sample. J Am Acad Child Adolesc Psychiatry. 2002;41:938-46.

Kristensen H, Torgersen S. MCMI-II personality traits and symptom traits in parents of

children with selective mutism. J Ab Norm Psychology. 2001;110:648-52.

Gordon M. Mutism: elective or selective, and acquired. Brain Devel. 2001;23:83-87.

Stein MB, Chavira DA, Jang KL. Bringing up bashful baby. Developmental pathways to

social phobia. Psychiatric Clin North Am. 2001;24:661-75.

Stein MT, Rapin I, Yapko D. Selective mutism. J Devel Behav Pediatr. 2001;22(2


Kristensen H, Multiple informant's report of emotional and behavioral problems in

a nation-wide sample of selective mute children and controls. Eur Child Adolesc

Psychiatry. 2001;10:135-42.

Remschmidt H, Poller M, Herpetz-Dahlmann B, et al. A follow up study of 45 patients

with elective mutism. Eur Arch Psychiatry Clin Neurosci. 2001;251:284-96.

Anstendig KD. Is selective mutism an anxiety disorder? Rethinking the DSM-IV

classification. J Am Acad Child Adolesc Psychiatry. 2000;39:249-56.

Kristensen H. Selective mutism and comorbidity with developmental disorder/delay,

anxiety disorder, and elimination disorder. J Am Acad Child Adolesc Psychiatry.



Connolly SD, Suarez L, Sylvester C. Assessment and treatment of anxiety disorders in children and adolescents [published online ahead of print January 12, 2011]. Curr Psychiatry Rep. 2011. Accessed March 10, 2011.


National Mental Health Consumers' Self-Help Clearinghouse

1211 Chestnut Street

Suite 1207

Philadelphia, PA 19107-6312


Tel: (215)751-1810

Fax: (215)636-6312

Tel: (800)553-4539



Mental Health America

2000 N. Beauregard Street, 6th Floor

Alexandria, VA 22314-2971


Tel: (703)684-7722

Fax: (703)684-5968

Tel: (800)969-6642

TDD: (800)433-5959



National Alliance on Mental Illness

3803 N. Fairfax Drive

Suite 100

Arlington, VA 22203-

Tel: (703)524-7600

Fax: (703)524-9094

Tel: (800)999-6264

TDD: (703)516-7227



NIH/National Institute of Mental Health

Health Science Writing, Press and Dissemination Branch

6001 Executive Boulevard

Room 8184, MSC 9663

Bethesda, MD 20892-9663

Tel: (301)443-4513

Fax: (301)443-4279

Tel: (866)615-6464

TDD: (301)443-8431



Selective Mutism Foundation, Inc.

PO Box 13133

Sissonville, WV 25360-0133




Genetic and Rare Diseases (GARD) Information Center

PO Box 8126

Gaithersburg, MD 20898-8126

Tel: (301)251-4925

Fax: (301)251-4911

Tel: (888)205-2311

TDD: (888)205-3223


For a Complete Report

This is an abstract of a report from the National Organization for Rare Disorders, Inc.® (NORD). Cigna members can access the complete report by logging into For non-Cigna members, a copy of the complete report can be obtained for a small fee by visiting the NORD website. The complete report contains additional information including symptoms, causes, affected population, related disorders, standard and investigational treatments (if available), and references from medical literature. For a full-text version of this topic, see