What is Selective Mutism? A Clinical Psychology Podcast Episode.

As someone with a background in both trauma and special educational needs, selective mutism is nothing new. A fair number of children with special educational needs and trauma backgrounds can develop selective mutism so they become so anxious that they cannot speak. Sometimes their selective mutism is restricted to one particular setting, like a school or in front of a particular person, but it can be generalised too. Also, when I was struggling with the worst effects of my post-traumatic stress disorder after my rape in 2024, there were two occasions when I became so overwhelmed and anxious that I was mute for a few hours. Therefore, in this clinical psychology podcast episode, you’ll learn what is selective mutism, what causes it and how is selective mutism treated. Also, I’ll discuss the practical implications for aspiring and qualified clinical and educational psychologists too. If you enjoy learning about child mental health, psychotherapy and educational psychology, then this will be a great episode for you.

Today’s psychology podcast episode has been sponsored by CBT For Anxiety: A Clinical Psychology Introduction to Cognitive Behavioural Therapy For Anxiety. Available from all major eBook retailers and you can order the paperback and hardback copies from Amazon, your local bookstore and local library, if you request it. Also available as an AI-narrated audiobook from selected audiobook platforms and library systems. For example, Kobo, Spotify, Barnes and Noble, Google Play, Overdrive, Baker and Taylor and Bibliotheca.

What is Selective Mutism?

Selective mutism is a rare childhood anxiety disorder that causes a child to become unable to speak in certain situations and/ or to certain people when they’re exposed to a particular trigger. Also, selective mutism is not a form of shyness even though a person with the condition can appear very shy, and it’s flat out wrong to assume that selective mutism is a choice. It is not. The child just cannot speak.

For me, the two times that I was rendered mute was really annoying, because I was struggling with my mental health and then because I was so overwhelmed and anxious, I just couldn’t speak. It’s really annoying as an adult, and I imagine it’s similar for children, because you really want to speak but you physically can’t. This means that you need to text, write down what you want to say and it’s just so annoying.

Equally, drawing on my past experience as a special educational needs teaching assistant, there were students who couldn’t speak at school, but they could speak perfectly fine at home. The professionals at the school believed this was because the school environment was so anxiety-inducing for the child that it triggered their selective mutism, and their selective mutism extended to anyone connected with the school environment.

I mention the above point because I supported another child who’s selective mutism was limited to only the physical place of the school. Since if the child went outside with teachers, other students or other individuals connected to the school, then they could talk fine to members of the public. Yet as soon as the child returned to a physical educational setting, their selective mutism would be triggered.

A final note from my experience is that selective mutism can develop over time for children, because when I spoke to other staff members about children with selective mutism, they all remembered when the children had been able to speak at school. Yet over time as the children found school more overwhelming, they developed selective mutism.

Moreover, selective mutism typically has an onset between 3 and 6 years old and most children who develop selective mutism will also go on to develop social phobia or social anxiety disorder. As well as children with the condition might appear cautious and timid in new situations, and they might experience separation anxiety when they’re away from a caregiver.

Additionally, selective mutism is important for clinical psychologists to be aware of for two main reasons. Firstly, you might be working in a child and adolescent mental health service and a child with selective mutism comes into your therapy room. If this happens, then it’s important that you understand the symptoms, causes and treatment options so you can best support the client. And I would also add that typically when we think about selective mutism, we get it mixed up with mutism in general. This means that we can forget that just because a child can talk to us fine in a therapy session, their selective mutism gets triggered in other settings. This is why it’s important to bear in mind the truth about selective mutism and become more aware of the condition.

On the other hand, selective mutism is important for educational psychologists to become aware of because a lot of their work is done in schools and other educational settings. Especially when it comes to students with special educational needs. As a result, if you go into a SEN school and support a student with selective mutism then you need to understand the condition, explore the treatment options that you and the school can provide the student with and most importantly, you’ll likely have to provide some kind of Continued Professional Development to the SEN staff so they understand what the child is experiencing. Since unfortunately, some staff members might believe that the student is just choosing not to speak, they’re attention-seeking or another myth. It’s the job of an educational psychologist to counteract this false belief.

Also, an aspiring or qualified educational psychologist might go into a school for one reason, observe a class or overhear a conversation and end up learning or suspecting another child has selective mutism. You’re only going to be able to do this and fill in the needed documentation and make the referrals, if you have a deeper understanding of the condition.

That’s why this podcast episode will be useful to educational and clinical psychologists.

What Causes Selective Mutism?

Children with selective mutism typically have anxiety disorders in their family history and the neurological basis for the condition is believed to be a sequence of events in the amygdala. This area of the brain is in charge of receiving danger signals from the child’s environment. Therefore, the anxiety that a situation causes a child is perceived to be dangerous so this causes a communication shutdown, and selective mutism often co-exists with other conditions like autism, developmental delays, sensory processing difficulties and obsessive-compulsive disorder.

In addition, children with selective mutism, especially teenagers, can develop mood disorders, like depression and agoraphobia, so a person has a fear of leaving home.

I’ll skip the practical implications for educational and clinical psychologists in this section because there’s a lot more content in the next section.

What are the Symptoms of Selective Mutism?

In terms of symptoms of selective mutism, children with the condition can show stiffness, awkward body language and a lack of facial expressions. Also, children who are comfortable in a situation might still be mute but they will have more relaxed physical characteristics, and as I mentioned earlier, a child with selective mutism might be able to speak in some situations or with some people but not others.

For instance, it can be normal for children with the condition to be able to speak perfectly fine at school, with loved ones or with close friends, but not at school or in other social settings where there is a pressure to communicate with others. Also, some children with the condition can use nonverbal communication, like moving their hands or nodding their head, whilst other children can appear frozen.

Some other signs of selective mutism can include a child appearing insecure, clingy, embarrassed, rude, stiff or they avoid eye-contact. In terms of relationships with close others, the child might be aggressive or angry, and in preparation for school or attending another event where there is the expectation of speaking, the child might experience headaches, stomach aches, diarrhoea or feel nauseous.

Finally, for a child to be diagnosed with selective mutism, they need to have been mute for at least a month and this doesn’t include the child’s first month of school.

Something I want to add here is that if you work with children with selective mutism then you can hear from parents about how disruptive, aggressive and loud they are when they get home, and I’ll connect this to another point in a moment. This could be because all day the child has been silent, unable to communicate and there probably has been a growing pressure inside them so when they get home and they feel safe enough to communicate then they might “explode” in a way and want to get everything out of themselves that they’ve been suppressing all day.

This is another useful reminder about the importance of treatment and supporting children with selective mutism, because whilst it is great that they feel safe enough and their anxiety decreases once they’re home. It probably would be overwhelming, and maybe even a little distressing for their parents and siblings, to see their child being loud, aggressive and angry because they’ve been building up all their frustration all day at not being able to communicate. Therefore, this is another argument for the importance of professionals in educational settings, because by supporting students to lessen their anxiety in the school, it can have larger benefits for the family social system in addition to the school system.

A final point I want to make at the end of this section is a reminder about how individual symptoms do not mean that a child has selective mutism. For example, if a child avoids eye contact, they remain expressionless and socially awkward. For me, those symptoms suggest autism and this is further confused because children can be mute because of autism, not because of selective mutism. This is why it’s important for clinical and educational psychologists to have a deeper understanding of selective mutism so they can further inform their assessments and ensure that the child can get the right support.

How Is Selective Mutism Treated?

If a child is diagnosed with selective mutism then it’s best for the child to receive behavioural or family therapy as soon as possible because the condition is unlikely to go away on its own. When I was a SEN teaching assistant, I occasionally worked with 15- and 16-year-old students with selective mutism and they had had the condition for 10 years. As well as treatment for selective mutism generally involves helping the child to develop skills to better manage their anxiety and “unlearn” their dependence on their mute behaviour as a coping mechanism.

Another treatment option can include anti-anxiety and anti-depressant medication too, but long-time listeners of The Psychology World Podcast are probably well aware of my feelings on medication as supported by Read and Moncrief (2022).

Furthermore, it’s important for children to receive treatment for their selective mutism because if they don’t, then there’s a very real risk that their selective mutism will follow them into adulthood. This means that their work, their school life, their relationships and other domains of functioning are likely to be impaired, and this harms other developmental milestones too.

Nonetheless, I will caveat here and say that there is a problem with special educational need schools in the UK, and probably elsewhere. There is a lack of funding for professionals within SEN schools and because of this lack of funding, senior management doesn’t seem as interested in hiring professionals. A lot of SEN schools prefer to simply hire unqualified teaching assistants who cannot support students instead of professionals, because they’re cheaper and teaching assistants are disposable in my experience. This annoys me because there are a lot of brilliant children who need specialist support but because there’s a shortage of professionals, like educational psychologists, and there isn’t the money or drive from senior management to hire them, there are so many children just falling through the cracks.

One senior manager once told me that their school will never be a mental health and special educational needs school. Something that continues to annoy me to this day because you cannot separate the two, as selective mutism clearly shows. Selective mutism can happen in children with special educational needs because of negative mental health caused by anxiety. If you do not treat the anxiety then you cannot support the child with special educational needs to the best of your abilities.

Anyway, this argument is part of a larger debate that goes beyond the scope of this podcast episode, but this is why educational and clinical psychologists are so important. As well as in an ideal world, every single school would have an educational psychologist on-site.

In terms of what schools and educational psychologists can do to support children with selective mutism, they can support a child by not pressuring them to speak because this can increase their anxiety and stress levels. Schools can allow time for speech therapy and counselling so the child can get the support that they need, and they can allow for smaller class sizes, because these tend to be less anxiety-inducing and overwhelming for children with selective mutism.

In addition, schools can allow the child with the condition to sit near the teacher or a friend because this can help reduce their anxiety and concerns, also schools can allow hand gestures as well as nonverbal communication, and teachers need to be aware of bullying.

In my experience, some of the things that I’ve done in the past to support children with selective mutism is sit them away from the louder members of the class that were causing them anxiety, so they could relax a little. And it’s also useful to remember the student's likes and dislikes so when you interact with them, you’re not adding to their anxiety. For example, with one particular student I used to support, they didn’t like anyone sitting next to them or near them so when I was supporting them with their work, I always remembered to sit on the other side of the table and even then, I wasn’t right up close to the table, I allowed there to be some space between me and the student. This helped the student to relax and I didn’t end up adding to their anxiety.

As a result, if you’re a teaching assistant or aspiring educational psychologist working in education, then if you have a child with selective mutism in your class then it can be useful for  you to consider how your own actions and those of other students and your peers can influence the anxiety of that particular student. Not only might this allow you to benefit the student with selective mutism, but you’ll be developing your reflective skills too. A skill set that is flat out critical if you want to become a qualified educational psychologist in the future.

Finally, a side note on class sizes. When I was working in special educational needs, class sizes are naturally smaller with only about 15 students per class, so this can be helpful and less overwhelming. Yet depending on the other needs of the student, class size isn’t as important because again, I’ve worked with other students with special educational needs who can thrive in a class of around 30 students and conversations with other professionals informed me that the root cause of this student’s anxiety wasn’t the classroom size or other students. It was the school environment itself. Therefore, this is a useful reminder that we can know the general facts and ways to support a student with a particular condition, like selective mutism, but our work must always be individualised and it’s important to get to know a student or client. This allows us to get to know their unique triggers, fears, anxieties and hopes for the future.

As much as our workload might make us want to generalise in our clinical work, it’s important that we always put the client first and foremost, like the vast majority of professionals do.

Clinical Psychology Conclusion

This was another episode that was a lot of fun for me to research, write about and reflect on, because I’ve had two periods of selective mutism in my life. It is so frustrating, annoying and looking back they were funny in a sad kind of way. And a minor side note, people with selective mutism who speak more than one language can actually still speak the other language at times in an environment where they’re typically a selective mute. For example, if a child can speak English and French, if they’re selectively mute at school, then they might still be able to communicate in French but not English. I mentioned this because when I had my selective mute experiences, I could still talk in French but not English.

Anyway, after working in SEN education and learning more about my own trauma, it was a lot of fun to investigate selective mutism more and consider how aspiring and qualified clinical and educational psychologists can support individuals with the condition.

As a brief reminder, selective mutism is a rare childhood anxiety disorder that causes a child to become unable to speak in certain situations and/ or to certain people when they’re exposed to a particular trigger. Also, selective mutism is not a form of shyness even though a person with the condition can appear very shy, and it’s flat out wrong to assume that selective mutism is a choice. It is not. The child just cannot speak.

Nonetheless, as we’ve seen in today’s episode, with the right support and treatment, a child can overcome their selective mutism to develop more adaptive coping mechanisms, reduce their anxiety and most importantly, thrive.

I hope you enjoyed today’s clinical psychology podcast episode.

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Have a great day.

Clinical Psychology References and Further Reading

Driessen, J., Blom, J. D., Muris, P., Blashfield, R. K., & Molendijk, M. L. (2020). Anxiety in children with selective mutism: a meta-analysis. Child Psychiatry & Human Development, 51(2), 330-341.

https://www.psychologytoday.com/us/conditions/selective-mutism

Iimura, D., Tsujita, N., Aoki, M., & Hagihara, H. (2025). Meta-analysis of behavioral treatments for selective mutism: findings from selective mutism questionnaire (SMQ) and school speech questionnaire (SSQ). Child and Adolescent Psychiatry and Mental Health, 19(1), 40.

Koskela, M., Ståhlberg, T., Yunus, W. M. A. W. M., & Sourander, A. (2023). Long-term outcomes of selective mutism: a systematic literature review. BMC psychiatry, 23(1), 779.

Muris, P., & Ollendick, T. H. (2021). Current challenges in the diagnosis and management of selective mutism in children. Psychology research and behavior management, 159-167.

Poole, K. L., Cunningham, C. E., McHolm, A. E., & Schmidt, L. A. (2021). Distinguishing selective mutism and social anxiety in children: a multi-method study. European child & adolescent psychiatry, 30(7), 1059-1069.

Steains, S. Y., Malouff, J. M., & Schutte, N. S. (2021). Efficacy of psychological interventions for selective mutism in children: A meta‐analysis of randomized controlled trials. Child: care, health and development, 47(6), 771-781.

White, J., & Bond, C. (2022). The role that schools hold in supporting young people with selective mutism: a systematic literature review. Journal of research in special educational needs, 22(3), 232-242.

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