Mutism | SLP Graduate Programs and the Study of Mutism (2023)

One of the more disconcerting situations you might run into as a speech-language pathologist is working with someone who simply doesn’t speak.

Mutism can be a tricky diagnosis to make. Sometimes the culprit is purely physical: damage to the brain and/or speech muscles can leave a person mute. Sometimes the culprit appears to be emotional or mental. Other times, you’ll run into some combination of the two.

Neurogenic Mutism

Neurogenic mutism is a lack of speech due to underlying damage to the brain. The mutism can be short or long term, static or progressive—it all depends on the region of the brain affected and the level of damage sustained.

As a speech-language pathologist, you may find yourself working with patients like 6-year old Xavier, who woke up after brain surgery unable to communicate with his family.

“He didn’t eat or drink and the worst part [was that] he didn’tspeak,” writes Xavier’s mom, Bec, on the Facebook page she created to follow his journey.

The form of neurogenic mutism Xavier faced is known as cerebellar mutism. Researchers aren’t exactly sure what specific damage causes cerebellar mutsim, but current thinking is that surgery to remove tumors may result in lesions on the cerebellum that affect speech.

While Xavier woke up from surgery unable to speak, some patients with this form of mutism don’t lose their ability to speak until 1-6 days post-operation, something that could be even more troubling to parents and family.

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Causes of Neurogenic Mutism

Neurogenic mutism can be caused by:

  • Surgery
  • Dementia
  • Traumatic Brain Injury
  • Seizures
  • Other nervous system diseases
  • Medications

Neurogenic mutism is often a manifestation of extreme forms of other speech disorders, including:

  • Aphasia
  • Apraxia
  • Dysarthria

Treatment of Neurogenic Mutism

When treating someone with neurogenic mutism you will be one of multiple healthcare professionals that make up the team of therapists and specialist, so expect to work along side other therapists, including PTs and OTs, as well as a neurologist.

Initial treatment often involves medication to support brain function, and speech therapist might not be called in until the individual shows solid attempts at trying to speak.

From there, you will need to assess whether or not the individual’s speech problems fall into one of the standard categories such as extreme dysarthria or extreme aphasia and make your treatment plan accordingly. Depending on the situation, you may also be called on to treat swallowing issues.

Long-Term Results

It’s difficult in the early days to know what sort of recovery an individual will make; the type and severity of brain damage can influence this, as well as whether or not the damage is due to a progressive, degenerative disease like dementia.

With some patients your goal will be to get them back to being able to speak as well as they did before their injury or the on-set of the causal disorder. For others, your goal will be to help them find ways to communicate even as their speech continues to deteriorate.

(Video) Understanding and Managing Selective Mutism

For those like Xavier, who suffer from cerebellar mutism, simply recovering simple words and phrases can take weeks or months. These patients often show signs of apraxia or aphasia and need continuing treatment for months or years.

“It took almost 5 months before Xavier started making real progress,” writes Bec. “[It] made us extremely happy to hear his beautiful voice again.”

Psychogenic Mutism, Also Known as Selective Mutism

Twenty-six-year-old Hannah is only able to speak with her parents. In other situations like school, where she’s interacting with a larger group of people who she is less familiar with, her words get stuck, and even though she wants to speak, nothing comes out.

“It isn’t me. I know who I am and I’m not shy or quiet,” Hannah shared with researchers at the University of Huddersfield during a recent study. “When I’m with my parents I can be myself but around everyone else it’s like it [selective mutism] takes over. I can get the words in my head but something won’t let me say them and the harder I try the more of a failure I feel like when I can’t.”

With selective mutism, a person suddenly stops speaking, but without any injury to the brain. These individuals can speak in some circumstances but not others, or with some people but not others. Psychogenic mutism most often shows up in children, but it can also appear later in life.

Unlike small children who are simply shy in certain circumstances, psychogenic mutism is a pervasive problem that interferes with someone’s ability to lead a normal life and without intervention, most won’t simply grow out of it.

Types of Psychogenic Mutism

Over the years, the way psychogenic mutism has been classified, and the terms used to describe these classifications and different aspects of the disorder, have shifted and evolved. Even today there isn’t total agreement across fields regarding how to classify psychogenic mutism. The most common “types” of classifications you will hear of include:

  1. Elective Mutism: A person chooses not to speak as a result of psychological issues.
  2. Selective Mutism: A person wants to speak, but in certain circumstances finds that they can’t
  3. Total Mutism: A person doesn’t speak under any circumstance.

In older literature, you’ll find that selective mutism was essentially considered elective mutism, but we now understand they are two distinct issues.

As a speech language pathologist your focus will be on those in the second category, selective mutism. You may, however, work with patients in the selective mutism category who go through periods of total mutism.

Causes of Psychogenic Mutism

It’s hard to pin down one specific root cause for psychogenic mutism, and experts disagree (sometimes passionately) on this question. Some of the more common triggers suggested include:

(Video) A silent child: Learning about selective mutism

  • Stress
  • Sudden life change
  • Feeling threatened

There are some common risk factors, however, that seem to show up among these patients:

  • History of Anxiety or Anxiety Disorders
  • Extreme Shyness
  • Social Anxiety Disorder
  • Sensory Processing Disorder
  • Auditory Processing Disorder
  • Obsessive Compulsive Disorder
  • Reduced Opportunities for Social Interaction
  • Bilingual or Multilingual Environment

In the past researchers thought that trauma caused selective mutism. Current research, however, suggests that while trauma may induce total mutism it doesn’t relate to selective mutism.

Traumatic mutism generally looks more like a child who witnesses a death or experiences other trauma and then stops speaking in all circumstances.

Bilingualism and Selective Mutism

You might find yourself working with a child who has lived overseas or lives in a bilingual family. When acquiring a new language it’s common for young children to go through a “silent period”, and this isn’t something to worry about.

However, incidents of selective mutism tend to be higher among bilingual children and those with immigrant backgrounds. Diagnosing selective mutism can be a little tricky when working with a bi- or multi-lingual child, but experts suggest looking for the following markers:

  • Mutism is prolonged
  • Mutism isn’t proportionate to the level of second language knowledge and exposure
  • Mutism is present in both languages
  • Mutism is concurrent with shy or anxious behavior

Treating Selective Mutism

The first and primary treatment for children with selective mutism is behavioral. Their primary treating practitioner will likely be someone from the behavioral health sciences, however you as an SLP play an important role as a member of the child’s recovery team.

Usually, SLP’s will focus on the following areas:

  • Augmentative and Alternative Communication (AAC) – Providing technology or other simple tools and devices that a child uses to help them communicate their needs. AAC also includes teaching gestures that the child can use to communicate.
  • Shaping – Reinforcing any attempts the child makes at communication. This might involve using AAC, pointing, gesturing, whispering or sound production. As the child moves up the ladder of communication towards speaking, larger positive reinforcers are given.
  • Self-Modeling – Taking video of the child speaking in one of their familiar, comfortable settings (maybe at home, with family) and then showing them the video to help increase their confidence in their ability to speak.
  • Stimulus Fading – When a child masters each level of communication (i.e., speaking with you, the SLP), SLP’s gradually increase the number of individuals in the room, and then slowly increase their proximity to the child and involvement in the conversation.

Keys to Remember

Professors Ruiz, Klein, and Armstrong of LaSalle University offer the following suggestions for working with children diagnosed with selective mutism:

  • Initially don’t direct speech to the child.
  • Reduce eye-contact and focus on the child.
  • Don’t call attention to talking or not talking.
  • Don’t talk about the child to parents or other therapists in front of the child.
  • Never coerce or trick the child into speaking.
  • Reduce the amount of people around and the expectations placed on the child.
  • Any type of communication, including whispering, is better than no communication.
  • When asking a question, wait 5 seconds, and then if there is no reply ask again by providing direct choice options or yes/no questions.

Co-occurring Disorders

(Video) Selective Mutism: Tips for Parents | R. Lindsey Bergman, PhD - UCLA Cares Center

Your patient may have lapsed into selective mutism in part because of anxiety over an undiagnosed speech problem. It’s important in working with the child to watch for signs of other speech disorders and begin treating those as well as the mutism. In these cases, as the child overcomes the co-occurring disorder (i.e., apraxia, aphasia, etc.) their confidence will increase and the selective mutism may naturally begin to decrease.

Specializing in Treating Mutism

There is no one governing body that certifies practitioners in treating mutism, but there are a handful of options you can pursue if you want to improve your ability to treat those with various forms of mutism.

Specializing in Neurogenic Mutism

Because neurogenic mutism is a neurological disorder you may want to consider pursuing board certification from the Academy of Neurologic Communication Disorders and Sciences (ANCDS).

In order to be eligible for this certification, you’ll need to fulfill the following requirements:

  • Be a fully certified CCC-SLP
  • Have five years of clinical experience with neurologic communication disorders
  • Submit your CV or resume with three letters of recommendation from health care professionals familiar with your skills
  • Complete the Board Certification Candidacy Application and pay applicable fees

The certification process involves submitting two case studies, giving an oral presentation, and taking part in a discussion following your presentation. The reviewers will then give you a “Pass” or notify you that your work “Does not meet standards”.

Specializing in Treating Selective Mutism

There is no industry standard certification for treating selective mutism, but there are a handful of organizations that offer information, webinars, and educational opportunities to grow in this area.

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(Video) 2017 Workshop | Treating Social Anxiety and Selective Mutism in Early Childhood | Jami Furr, Ph.D.

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What kind of doctor treats selective mutism? ›

A pediatrician, speech-language pathologist, and a psychologist may work together to diagnose and treat the condition. Your child might need a set of different types of treatment. With treatment, most children overcome selective mutism.

What is the best therapy for selective mutism? ›

The most research-supported treatment for selective mutism is behavioral and cognitive behavioral therapy. Behavioral therapy approaches, including gradual exposures, contingency management, successive approximations/ shaping, and stimulus fading, are successful in the treatment of childhood anxiety.

Do Slps work with selective mutism? ›

A certified speech-language pathologist (SLP) generally has the appropriate training and skills to help treat children with communication deficits related to selective mutism (SM). Treatment requires knowledge of the disorder and information about the child's speech and language skills.

What is the DSM 5 criteria for selective mutism? ›

Selective mutism is defined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), as an anxiety disorder, “characterized by a consistent failure to speak in social situations in which there is an expectation to speak (e.g., school) even though the individual speaks in other situations.

What is selective mutism now called? ›

Selective Mutism, sometimes called Situational Mutism, is an anxiety-based mental health disorder which usually commences in early childhood.

What psychological disorder is diagnosed most often with selective mutism? ›

Social Anxiety Symptoms: Over 90% of children with Selective Mutism have social anxiety.

How to overcome mutism? ›

In order to reach this stage, therapies used in the treatment of selective mutism in both children and adults include:
  1. Cognitive behavioural therapy (CBT)
  2. Desensitisation.
  3. Shaping.
  4. Positive reinforcement.
  5. Family therapy.
  6. Medication for selective mutism.

What is the gold standard treatment for selective mutism? ›

Selective Mutism is more common than you think, and Cognitive Behavioral Therapy (CBT) is the gold standard in Selective Mutism Treatment for Children, providing very specific, step-by-step techniques and guidelines for helping your child break from their shell.

What should you not do with selective mutism? ›

This will help their anxiety fade away over time. However, children with selective mutism should never be coaxed or pushed to speak. The pace of treatment should be very gradual and children shouldn't be asked to do something that is too difficult for them.

Does selective mutism qualify for an IEP? ›

All children and teens diagnosed with Selective Mutism qualify for a 504 plan and IEP as school staff members are needed to aide in facilitation of communication. Meet with the school before the start of the school year to develop accommodations/interventions.

Is selective mutism a special educational need? ›

As with all special educational needs (SEN), early intervention is crucial. We have found that children with selective mutism can deteriorate quickly because the difficulty with speaking causes further anxiety which exacerbates the mutism.

Is selective mutism a form of autism? ›

Some professionals falsely view selective mutism as a form of autism or a learning disability. Children with learning disabilities or autism may demonstrate symptoms of the disorder, but selective mutism is not commensurate to an autism or learning disability diagnosis.

Is selective mutism a mental health issue? ›

Selective mutism is an anxiety disorder where a person is unable to speak in certain social situations, such as with classmates at school or to relatives they do not see very often. It usually starts during childhood and, if left untreated, can persist into adulthood.

What type of disability is mutism? ›

Mutism and Selective mutism

Selective mutism a complex anxiety disorder which enables a child the inability to speak or communicate effectively in social settings. Mutism is the inability to speak, which could be the result or in coordination with a congenital deafness or brain damage.

Is selective mutism a Neurodiverse? ›

It is a paralyzing feeling that makes you unable to speak, communicate, or even move in many situations, even sometimes when the person feels comfortable in a situation. While selective mutism is rare, it is not uncommon for neurodivergent people, especially those on the autism spectrum.

Is selective mutism part of ADHD? ›

Restricted Speech

Selective mutism, meanwhile, causes children to display symptoms that may lead to alarm bells ringing for an indication of autism or even ADHD.

Is being mute a disability? ›

Blind, deafness and mute are physical disabilities and as such could limit how you handle your financial and medical affairs.

What is the difference between Aspergers and selective mutism? ›

Kids with Asperger's are also often very resistant to changes in routine, and respond with tantrums or meltdowns whereas kids with selective mutism internalize their emotions, fears, and needs. The real defining factor is the presence or absence of social aptitude and emotional reciprocity.

What is the root cause of selective mutism? ›

The cause, or causes, are unknown. Most experts believe that children with the condition inherit a tendency to be anxious and inhibited. Most children with selective mutism have some form of extreme social fear (phobia). Parents often think that the child is choosing not to speak.

What kind of trauma causes selective mutism? ›

Posttraumatic stress theory.

Posttraumatic stress disorder (PTSD) with dissociative features has also been associated as a potential precursor of selective mutism.

How many people in the US are diagnosed with selective mutism? ›

Selective mutism affects approximately 1% of children being seen in behavioral health settings (American Psychiatric Association [APA], 2000).

What is the most common cause of muteness? ›

Neurological damage or problems with development of the area of the brain involved in speech production, Broca's area, may cause muteness. Trauma or injury to Broca's area, located in the left inferior frontal cortex of the brain, can cause muteness. Muteness may follow brain surgery.

How do you talk to someone with mutism? ›

Allow for hesitation. Re-ask questions if needed. Accept nonverbal communication (e.g., pointing, nodding, gesturing) without an expectation for speech. Accept the child's level of communication as the first step to securing comfort.

Can trauma cause mutism? ›

Traumatic experiences, like witnessing a shooting or experiencing relationship abuse, can also contribute to selective mutism in adulthood, Scharfstein says.

How long does it take to overcome selective mutism? ›

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.

Which SSRI is best for selective mutism? ›

Furthermore, SSRIs are effective for the treatment of obsessive–compulsive disorder and major depression in children, as well as for SADs in adults. Previous research has demonstrated the efficacy of fluoxetine, sertraline and fluvoxamine in the treatment of selective mutism and anxiety disorders.

Is selective mutism a chemical imbalance? ›

The exact cause of this disorder is not known. The brain makes chemicals that affect thoughts, emotions, and actions. Without the right balance of these chemicals, there may be problems with the way your child thinks, feels, or acts. A child with this disorder may have too little or too much of some of these chemicals.

Do parents cause selective mutism? ›

Selective mutism is related to shyness, social anxiety and inhibited temperament (e.g., fearful of new experiences, slow to adapt to new situations). There is some evidence to indicate a genetic link between children with selective mutism and anxiety in their parents or family members.

How do you comfort someone with selective mutism? ›

How to open up a conversation about selective mutism and how to help with the important people in your child's life
  1. Explain what selective mutism is and isn't. ...
  2. Encourage warm up time. ...
  3. Encourage brave talking. ...
  4. Set expectations for out-of-town visits. ...
  5. Incorporate games and activities. ...
  6. Establish a quiet space.

Is there a cure for selective mutism? ›

The good news is that selective mutism is very treatable with the right care. Kids with SM respond best to behavioral therapy that is focused on helping them learn to speak in new settings, during new activities and with new people.

Can kids grow out of selective mutism? ›

With appropriate handling and treatment, most children are able to overcome selective mutism. But the older they are when the condition is diagnosed, the longer it will take.

Does selective mutism count as disability? ›

It's not a learning disability, although it may co-exist with one. Selective mutism is also not a speech or language disorder, or mental illness. It tends to run in families who have members with anxiety disorders, shyness, or even Selective mutism itself.

How do you accommodate students with selective mutism? ›

Teachers can help students with selective mutism by:
  1. developing warm, supportive relationships, even if the interactions are nonverbal.
  2. easing anxiety in the classroom by pairing them up with a buddy.
  3. using small-group instruction and activities.

Can you have selective mutism and not be autistic? ›

As we've seen, it's possible for kids to show signs of both conditions. If your child has ASD, selective mutism won't be the only symptom.

How is selective mutism different from autism spectrum? ›

Autism is pervasive – it impacts the way a person sees, interacts with and experiences the world. It isn't turned on and off. Selective mutism is a severe anxiety disorder where a person is unable to speak in certain social situations, such as with classmates at school or to relatives they don't see very often.

What are the different types of mutism? ›

The most common “types” of classifications you will hear of include:
  • Elective Mutism: A person chooses not to speak as a result of psychological issues.
  • Selective Mutism: A person wants to speak, but in certain circumstances finds that they can't.
  • Total Mutism: A person doesn't speak under any circumstance.

What is the difference between shy and selective mutism? ›

Shy children are typically capable of answering questions, even though they may speak more softly than other children or use fewer words. Kids with Selective Mutism, on the other hand, cannot respond at all in certain situations (such as when they're at school or surrounded by unfamiliar people).

What is the difference between social anxiety and selective mutism? ›

Kids with social anxiety feel anxious in response to social or performance situations. This anxiety leads to significant distress, interferes with a child's ability to function, and often contributes to avoidance behaviors. Social mutism causes children to stop speaking in specific social situations.

What happens in the brain with selective mutism? ›

Brain Studies

Studies show that children with selective mutism have a low threshold of excitability in a portion of their brain called the amygdala, which explains most of the behavioral issues these children exhibit. The amygdala senses potential danger by processing signals from the sympathetic nervous system.

Is selective mutism a form of social anxiety? ›

In current classification systems, selective mutism (SM) is included in the broad anxiety disorders category. Indeed, there is abundant evidence showing that anxiety, and social anxiety in particular, is a prominent feature of SM.

Do mute people get disability benefits? ›

Even though the SSA allows those who have suffered a speech injury to collect disability, individuals will have to prove that their condition is severe enough to warrant benefits.

Is mutism a mental illness? ›

Mutism is defined as an inability or unwillingness to speak, resulting in the absence or marked paucity of verbal output. It is a common presenting symptom seen in various disorders, including psychiatric as well as medical disorders.

Is mutism a symptom of schizophrenia? ›

Defined as an absence or reduction of speech, either voluntary or avolitional, mutism is typically associated with catatonia, usually in schizophrenia, but also depression, bipolar disorder, intoxication, and neurological conditions.

Is selective mutism physical or mental? ›

Selective Mutism is a complex childhood anxiety disorder characterized by a child's inability to speak and communicate effectively in select social settings, such as school. These children are able to speak and communicate in settings where they are comfortable, secure, and relaxed.

What is the opposite of selective mutism? ›

In contrast to selective mutism, it was thought someone who was electively mute may not speak in any situation, as is usually shown in books and films. Elective mutism was often attributed to defiance or the effect of trauma.

Where can I get diagnosed with selective mutism? ›

If you suspect your child has selective mutism and help is not available, or there are additional concerns – for example, the child struggles to understand instructions or follow routines – speak to a GP and ask them to refer you to a local specialist service for a formal diagnosis.

Can a doctor diagnose selective mutism? ›

Diagnosis of selective mutism is mostly on the basis of the patient's clinical history. A speech-language pathologist (SLP) plays a key role in the diagnosis of the condition. A child who shows signs of selective mutism should be taken to an SLP, apart from a pediatrician and a child psychologist.

Can selective mutism be treated with medication? ›

A group of drugs called selective serotonin reuptake inhibitors (SSRIs) are widely used to treat selective mutism. Fluoxetine is an SSRI mostly used and reduces symptoms in 75% of affected children. Drugs used in treating anxiety disorders are also used in the treatment of some cases of selective mutism.

Should selective mutism be treated? ›

Experts don't know how many children with selective mutism will grow out of the disorder. But what we do know is that treating it becomes much harder the older a child is, so it is extremely important not to put off treatment.

Can trauma cause selective mutism? ›

Posttraumatic stress disorder (PTSD) with dissociative features has also been associated as a potential precursor of selective mutism. Although it is an uncommon explanation for selective mutism, several cases of children who experienced severe abuse and trauma fit the classification of selective mutism.


1. Selective Mutism Awareness in Schools
(St George's University Hospitals NHS Foundation Trust)
2. Integrated Behavioral Approach to Treating Selective Mutism
(Professor Hartung)
3. Selective Mutism 101
(Selective Mutism Association)
4. My Journey Through Silence: A Young Adult's Perspective on Selective Mutism
(Selective Mutism Association)
5. What are the Executive Functions and Are They Important in Selective Mutism and Childhood Anxiety
(Selective Mutism Association)
6. SPP 45: Selective Mutism
(School Psyched Podcast)
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