Selective Mutism (SM) is an anxiety disorder and phobia: the fear of others hearing your voice. My son was diagnosed when he was four years old. Fortunately, by the time he was eight, he had largely conquered SM. Now in his mid-teens, he’s not the chattiest in public, but few would ever suspect that he was unable to utter a single word outside of the home for five years.
Sadly, many of the students with diagnoses of SM who I have supported in speech and language therapy, have been older teens. They have continued their lives literally frozen in fear at the prospect of others hearing them speak and, as is often the case with SM, even in fear of others seeing them move be it walking out of a room, eating lunch or playing sports.
Selective Mutism can be debilitating and especially mortifying for teenagers at a time when they are establishing their identity and trying to fit in with their peers. For SM is in no way ‘selective’ – there’s a campaign to change its name to Situational Mutism – for the person is NOT choosing to be silent, in fact often they desperately want to join in, but their fear physically stops them.
SM should be called ‘situational’ because most people are able to speak in at least one setting – usually at home. In fact, families report that at home, some don’t stop talking and, like my son, can be quite the extrovert. Usually, the child will have no additional speech or language difficulties, though “an estimated 40% of autistic people have comorbid anxiety disorders including SM” (Muris & Ollendick, 2021), so they might need extra support to develop social communication skills.
There is also the lesser known ‘low-profile SM’ whereby people speak just enough to deflect attention, knowing that not speaking at all – ironically – attracts the attention they are desperate to avoid. For SM creates a cycle which is difficult to break – as soon as a child is known as ‘the one who doesn’t speak,’ others stop trying to include them, often out of the kindness of not wanting to make them feel uncomfortable.
Sadly, this can do more harm than good. The most beneficial thing others can do is to identify and reduce the factors that are helping to maintain the young person’s SM. The more a child continues to avoid speaking or isn’t given the opportunities by others to speak (including when others speak for them), the stronger their fear of speaking becomes.
A 17-year-old I supported moved to a new school to make a fresh start; where no one would know them as ‘the person who doesn’t speak’. Eventually as they built up trust with me, they shared that they were desperate to join in – socially, in sports, and in lessons and were desperate to make friends. However out of respect for this student, other students reported not wanting to make them feel uncomfortable by talking to her or asking her to join in. Some teachers too would avoid giving her a chance to answer questions and engage in discussions, again in an attempt to protect her. So, with her consent, I shared advice with staff, not only with teachers but to anyone she might encounter at school, to encourage them to give her opportunities to talk – even just to say ‘hello’ or ‘goodbye’. She knew she’d largely not be able to respond, but at least she would have a chance to try. By responding ‘hello’, even just one small word per week, she could help desensitise her fear of speaking in small steps: which is the essence of SM therapy.
If you have a student who rarely or never speaks, you can help them by providing subtle opportunities to join in. This is very different to putting someone on the spot and expecting an answer, but the distinction is not an easy one to make and will take practice.
Tips on how to do this:
Try not to rescue someone by speaking for them – this can reinforce their fear – instead, suggest that they write their answer down or gesture
Ask closed questions so that they can answer with a nod/shake or point to a yes/no
Offer choices – perhaps on a whiteboard to point to
Ensure that all alternatives come with regular reminders that they are temporary measures until they feel able to speak
- Try not to give ‘opt outs’ from activities and situations – always offer a chance to participate, even if participation requires speech. If they don’t move/speak after you have counted to five slowly (in your head), just quietly move on to the next student
- Don’t draw any attention towards them in front of the class, even praise can sometimes cause anxiety
- Provide more opportunities for the student to work 1:1 with the staff and peers they feel most comfortable with – to reduce anxiety
- Never ask direct questions – instead use ‘commentary-style’ talking (e.g., “I like the way you have written that…”), with the odd rhetorical question thrown in e.g., “I wonder whether you have proof-read your work?”
- Provide the individual with opportunities to respond to your commentary by leaving little gaps between comments
Other adjustments and classroom strategies
- Provide alternative forms of testing and participation where speaking is usually required, e.g., written answers, non-verbal communication, audio or videotaping at home
- Give clear, specific instructions of classroom tasks and the plan for the day as being prepared about what is coming next reduces anxiety.
- Where possible, give advanced warnings about any changes to schedules, e.g., tests or outings
- Check-in regularly to see whether the student has understood and whether they need anything – they can write down or gesture their answer or point to alternatives
- Let the child choose their seat so they feel less conspicuous
- Provide alternative forms of participation in school performances (my son always preferred to be ‘behind the scenes’).
- Give them the option to get changed for PE in a private space
- Students with SM often find unstructured times at schools the most difficult so try to ensure that someone they trust (be it a peer or a staff member) are at break at the same time and offer low pressure opportunities for inclusion such as board games or inviting them to sit with peers to eat lunch or watch a film
- Offer students the chance to email questions or share their feelings with teachers during or after the lessons
Useful Links
For further information, please see the ‘SMIRA’ website.