Understanding Selective Mutism in Teenagers: A Closer Look

Written by Dr Lucy Russell DClinPsyc CPsychol AFBPsS
Dr Lucy Russell Clinical Psychologist Founder of They Are The Future
Author: Dr Lucy Russell, Clinical Psychologist

If you’re the parent of a teenager with this selective mutism, it can be challenging to understand its causes, symptoms, and treatments.

By breaking down this complex topic, I hope to give you a valuable insight into how to best support teenagers with selective mutism.

Selective mutism is a relatively unknown anxiety condition, which affects around 1% of children globally. It is characterized by a persistent inability to speak in certain situations, even though the child is capable of speaking normally in other contexts. 

Selective mutism can affect all ages, but it is not well understood in teenagers.

I’ll explore what selective mutism is, its causes, and the symptoms teenagers may experience.

I will also explain how selective mutism is diagnosed and the potential impact it can have on a teenager’s life. Finally, I’ll discuss various treatment options available for teenagers with selective mutism and how to seek professional help.

Key Takeaways

  • Selective mutism is a relatively unknown anxiety condition that affects around 1% of children globally.
  • It is characterized by a persistent inability to speak in certain situations, even though the child is capable of speaking normally in other contexts.
  • It is not well understood in teenagers.
  • Parents can support teenagers with selective mutism by seeking professional help, developing communication skills, engaging in social activities, and providing positive reinforcement.
  • It is essential to understand the impact of selective mutism on the whole family and to offer ongoing support.
close up of anxious teen boy wearing hoodie

What is Selective Mutism?

Selective mutism is a complex anxiety disorder that affects a small percentage of teenagers. It is characterized by a persistent inability to speak in specific social situations, despite being able to speak freely in other situations.

Selective mutism is not caused by a lack of knowledge or an inability to communicate but rather due to intense anxiety and fear.

There is no one specific cause of selective mutism. Instead, it is believed to be the result of a combination of factors, including:

Possible Causes of Selective MutismDescription
Shyness or social anxietyTeenagers with selective mutism may have a heightened sensitivity to social situations and may feel overwhelmed by social scenarios.
Trauma or stressful life eventsLingering effects of traumatic experiences can lead to the development of selective mutism in teenagers, because they have heightened sensitivity to threat and danger.
Genetic predispositionChildren and teenagers with a family history of anxiety disorders may have a higher risk of developing selective mutism.
Speech and language issuesSome teenagers with selective mutism may also have speech and language difficulties, which can contribute to their inability to speak in certain situations. Fear of “getting it wrong” or being ridiculed may be a factor here.

Selective mutism is not a sign of disobedience or deliberate refusal to speak. It is a genuine condition that requires professional attention and support.

Symptoms of Selective Mutism in Teenagers

As selective mutism often affects teenagers and older children differently from younger ones, it is crucial to recognize the symptoms of this anxiety disorder specific to teenagers.

Selective mutism is characterized by a consistent failure to speak in certain social situations where speech is expected, despite speaking normally in other settings.

In teenagers, these situations often involve social interactions that cause anxiety, resulting in the following symptoms:

  • Avoiding eye contact: Teenagers with selective mutism may avoid eye contact as a way of managing their anxiety in social settings.
  • Failing to initiate or respond to greetings: They may not initiate or respond to greetings from others, leading to difficulties in building and maintaining social relationships.
  • Difficulty expressing oneself: Teenagers with selective mutism may struggle to express their emotions or provide necessary information, leading to confusion and misunderstandings.
  • Freezing or appearing extremely tense: In particularly anxiety-provoking situations, teenagers with selective mutism may freeze or appear extremely tense, which can be misinterpreted as rudeness or defiance.

It is important to note that these symptoms are not indicative of shyness or a lack of motivation to communicate.

Rather, they are caused by the overwhelming anxiety and fear that teenagers with selective mutism experience in certain social situations.

teenage girl sitting on a bench

Selective Mutism in Teenagers vs. Younger Children

While the symptoms of selective mutism are similar in both older and younger children, there are some common differences worth noting.

These differences do not apply to all children and teens with selective mutism but are common.

Teenagers & Older ChildrenYounger Children
Mutism is often limited to certain situations or peopleMutism is often present in most social situations
May use gesture, nodding, or whispering instead of speechMay freeze or become inconsolable when expected to speak
May have an increased awareness of their mutismMay not be aware of their mutism or its impact

Recognizing the specific symptoms of selective mutism in teenagers can help you seek appropriate support to help them manage their anxiety and improve their quality of life.

Diagnosing Selective Mutism in Teenagers

Diagnosing selective mutism in teenagers requires a thorough assessment by a mental health professional with experience in treating anxiety disorders.

Although there is no specific medical test for selective mutism, a diagnosis can be made based on the criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).

The DSM-5 defines selective mutism as a persistent failure to speak in specific social situations where speaking is expected, despite speaking in other situations.

The failure to speak interferes with educational or occupational achievement or with social communication, and lasts for at least one month.

Additional factors that can contribute to a diagnosis of selective mutism include:

  • The mutism is not due to a lack of knowledge of, or comfort with, the spoken language required in the social situation.
  • The mutism is not due to a communication disorder, such as stuttering, and is not better accounted for by another mental disorder.
  • The mutism is not related to a lack of motivation or defiance.

It is essential to note that selective mutism is often co-morbid with other anxiety disorders, such as social anxiety disorder.

Therefore, a comprehensive evaluation of the teenager’s mental health is necessary to determine the appropriate diagnosis and treatment plan.

TAKE THE QUIZ!

Consulting a Mental Health Professional

If you suspect your teenager has selective mutism, you should consult with your doctor or a mental health professional.

Mental health professionals trained in diagnosing and treating anxiety disorders can provide a comprehensive evaluation and formulate an appropriate treatment plan.

Speech-language pathologists (speech and language therapists), clinical psychologists, family therapists, and educational professionals may also be involved in the assessment process to assess aspects like the teenager’s communication skills, family dynamics, and academic performance.

Understanding Anxiety

If anxiety is driving your child’s selective mutism, you need to understand how it works in the body and mind, so you can best support your child.

If you want to deepen your understanding about anxiety so you feel clear on exactly which steps will help for your child, consider our mini-course, Knowledge is Power!

Knowledge is Power: Understanding Anxiety in Children course

Understanding the Impact of Selective Mutism on Teenagers

Selective mutism can have a significant impact on teenagers’ lives, contributing to social isolation, low self-esteem, poor academic performance, and limited social relationships.

Social IsolationLow Self-Esteem
Teenagers with selective mutism may struggle to socialize with peers, leading to feelings of loneliness and isolation.Being unable to communicate effectively with others can cause low self-esteem and low confidence around friendships, which can further perpetuate social isolation and anxiety.

It’s also common for teenagers with selective mutism to experience academic difficulties, such as trouble participating in class or presenting in front of others.

The difficulty with social communication skills may affect a teenager’s ability to form and maintain relationships, both with peers and family members. This can further contribute to social isolation and a sense of disconnection from others.

Treatment Options for Selective Mutism in Teenagers

When it comes to treating selective mutism in teenagers, there is no one-size-fits-all solution.

However, there are several evidence-based treatment options that have proven to be effective in helping teenagers overcome this condition.

In this section, we will discuss these treatment options, including cognitive-behavioral therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs).

a teenager and therapist in a modern room

Cognitive-Behavioural Therapy

Cognitive-behavioural therapy (CBT) is a type of talking therapy that focuses on identifying and adapting unhelpful thought patterns and behaviours. It has been proven to be effective in treating selective mutism in teenagers by helping them gradually confront and sit with their anxiety in social situations.

You will need to find a therapist who is highly trained and is experienced in working with selective mutism in teenagers. Often this will be a child clinical psychologist. All clinical psychologists are trained to a very high level and are qualified to deliver CBT.

CBT involves gradually exposing teenagers with selective mutism to anxiety-provoking situations, helping them build confidence in their ability to communicate effectively. By working with a therapist, teenagers can learn coping skills and strategies to manage their anxiety and increase their comfort in social situations.

CBT for selective mutism in teens is generally an individual therapy rather than a group setting. It tends to last between 6 to 20 sessions. The treatment plan is personalized to each individual’s needs, and progress is regularly monitored and adjusted as needed.

There are specific behavioural techniques which can be effective for selective mutism in teenagers.

Specific Therapeutic Techniques For Overcoming Selective Mutism in Teenagers

Stimulus Fading

Intensive treatment is often necessary for teenagers with selective mutism. One of the most effective methods is known as stimulus fading, where the individual is gradually exposed to increasingly challenging social environments.

Stimulus fading involves starting in a comfortable and familiar environment and slowly progressing to more anxiety-provoking situations. This gradual exposure allows the teenager to develop their social communication skills and build confidence in a supportive environment.

Steps involved in stimulus fadingDescription
Step 1The teenager communicates comfortably in a familiar environment, such as their home or with close family members.
Step 2The teenager is gradually introduced to a new social environment, such as a family friend’s home, with familiar people present. The goal is to facilitate communication and social interaction in a new setting.
Step 3The teenager is exposed to more challenging social environments, such as school or extracurricular activities, with a supportive adult present. This allows them to build their social communication skills with new people in a safe and controlled setting.
Step 4The teenager gradually increases their exposure to more challenging social situations, such as social outings or large group activities, with a gradual decrease in adult support.

It is important to note that the treatment process can be lengthy and requires patience and persistence.

Shaping

Shaping is another behavioural therapeutic technique often used for selective mutism in teenagers.

It involves gradual steps towards the desired behaviour.

For instance, a teen may start by communicating non-verbally, like nodding. Over time, they progress to whispering a word, then speaking softly, and eventually conversing more openly.

This approach allows teenagers to build confidence in their voice, ensuring they feel safe and understood.

Take, for example, a teenager who only feels comfortable making eye contact or using gestures. The next step could be whispering to a trusted person. As the teenager gains confidence, they might then speak a full sentence, and later, contribute to a group discussion.

Each achievement is celebrated, reinforcing the teenager’s progress and building their self-esteem.

Motivational Interviewing For Selective Mutism in Teens

Motivational interviewing is a collaborative technique designed to explore and strengthen a teenager’s intrinsic motivation to change.

For some teenagers with selective mutism, the barrier to speaking isn’t solely anxiety but a lack of internal drive to communicate.

The motivational interviewing technique involves open-ended questions, reflective listening, and affirmations, aiming to uncover and enhance their own motivations to speak. The therapist explores the pros and cons of change versus maintaining the status quo.

By discussing the advantages and disadvantages of both scenarios, the teenager can gain a clearer understanding of their own desires and reservations. This reflective process often highlights discrepancies between current behaviors and broader life goals or values, creating a stronger internal drive for change.

Obviously if the teenager isn’t able to communicate verbally with the therapist, alternative methods of communication can be used such as writing or gesture.

Motivational interviewing isn’t suitable for all teenagers with selective mutism. If a teen’s selective mutism stems primarily from intense fear or other causes and they have a strong desire for change, it’s not needed. Instead, it’s best applied when there’s a clear need to bolster intrinsic motivation to communicate.

Selective Serotonin Reuptake Inhibitors

Selective serotonin reuptake inhibitors, or SSRIs, are a type of medication commonly used to treat anxiety disorders. They work by increasing the levels of serotonin in the brain, which can help regulate mood and reduce anxiety symptoms.

SSRIs may be used in combination with CBT or occasionally as a standalone treatment for selective mutism in teenagers. I would always advise CBT as the first line treatment, but there may be occasions when SSRIs are beneficial to reduce the baseline level of anxiety so that the teenager can make progress.

SSRIs don’t get to the root of the problem, and the anxiety may return when the teen stops taking them.

It’s also important to note that SSRIs can have side effects, such as nausea, headaches, and insomnia.

Therefore, they are only be prescribed by a mental health professional who can monitor their effectiveness and adjust the dosage as necessary.

Working with Speech-Language Pathologists (Speech and Language Therapists)

Speech-language pathologists (speech and language therapists) may work alongside other professionals to support communication and social interaction in teenagers with selective mutism.

These interventions may include role-playing, conversation practice, and social skills training.

Speech-language pathologists can also work with teenagers to gradually increase their exposure to anxiety-provoking situations and facilitate positive social interactions. Just like clinical psychologists, they may use specific behavioural techniques such as stimulus fading and shaping.

They can help teenagers learn to communicate their needs and feelings effectively and build confidence in their ability to interact with others.

Working with Family Therapists

Family therapists aim to understand family dynamics that might contribute to challenges like selective mutism. They collaborate with families to build a nurturing environment for teenagers.

Their expertise offers strategies to nurture positive social bonds, engage in inclusive activities, and establish a reassuring space for teens to hone communication.

Family therapists also recognise the strain selective mutism might place on family members. They provide vital support and resources to ensure everyone navigates this journey together.

“Seeking professional help should be done sooner rather than later. Early intervention can increase the likelihood of successful treatment outcomes and improve long-term outcomes.”

dad and teen daughter with family therapist

Individualized Treatment Plans For Selective Mutism in Teenagers

It’s crucial to develop a personalized treatment plan for selective mutism that takes into account your teenager’s unique needs and circumstances. You and your teenager should be fully involved in the planning and treatment process.

This plan should include a combination of evidence-based treatments, such as CBT and SSRIs, as well as strategies for promoting communication and social skills outside of therapy.

The mental health professional working with your teenager will regularly monitor and adjust the treatment plan to ensure its effectiveness and to address any emerging challenges or setbacks.

Parent Strategies for Supporting Teenagers with Selective Mutism

In this section, I will provide guidance on some practical steps you can take at home to help your teenager with selective mutism.

Encourage Social Activities

For teenagers with selective mutism, stepping into social settings can be deeply challenging. Yet, these interactions play a crucial role in developing their confidence in communication.

Gently encourage your teen to engage in activities they genuinely love, be it sports, arts, or crafts. Participating in such familiar and enjoyable settings can ease their anxiety.

Over time, taking part in these experiences consistently will help make communication less intimidating for them.

Positive Reinforcement

Positive reinforcement can be a powerful tool for encouraging teenagers with selective mutism to communicate.

Praising your child for their efforts, no matter how small they may be, may give them motivation to continue to progress.

A note here though. Ideally, you want your teenager to be internally motivated to overcome their selective mutism.

Does your teen have this internal motivation?

Do they want things to get better?

If not, that’s okay. External rewards (positive reinforcement such as praise) may be helpful whilst they develop this internal motivation.

teen and parent on a sofa serious

Practise Communication Skills

Work with your child to develop their communication skills, but at their pace. You can encourage them to practise various types of communication with you, such as reading aloud, role-playing, and role-playing social interactions.

Don’t force it, however. If you don’t go at your child’s pace they may feel under too much pressure, which can make their anxiety even worse.

Be patient and understanding, and allow your child to communicate at their own pace.

Create a Comfort Zone

Teenagers with selective mutism often feel most comfortable in familiar surroundings.

Creating a comfortable space in your home, where your child feels safe and relaxed, can provide a foundation for them to develop their social communication skills.

Once you have that safe place, you can work towards moving outside the comfort zone when your teen is ready.

For example, your teen may spend the morning in their “safe zone” in their bedroom. This may contain calming and regulating equipment like a sensory hammock or a calming box. With your support, they may then aim to get out of their comfort zone by visiting the local shop. After this, they can return to their comfort zone for a while to regulate their nervous system.

Selective Mutism in Teenagers: Supporting the Whole Family

When it comes to selective mutism in teenagers, it not only affects the individual but also the whole family.

Family members, especially immediate family, can feel frustrated, confused, and isolated. It may be harder to do certain activities as a family that you used to enjoy.

Some wider family members may not understand your teen’s selective mutism and may be critical. They may even criticize your parenting style. It can help to learn about the condition in depth so that you feel empowered to respond confidently to any criticism in a fully informed way.

If family life is more difficult for you at the moment, try to simplify your weekly schedule if you can, to give yourself some time and space. Try to make some small changes which will foster a calm home environment, for your benefit and your teen’s.

Try to find one person in your network who fully understands and that you can confide in regularly. Some local areas offer support groups which may be hugely beneficial for you. Your doctor or your child’s school may be able to signpost you.

If your teenager has siblings who are affected, try to ring-fence a little bit of quality 1-1 time with them regularly. This will help them feel heard and valued, and protect your relationship.

Family Support StrategiesBenefits:
Simplify family life is possible. Foster a positive and calm environment.Helps reduce anxiety and stress for everyone.
Spend 1-1 time with siblings.Helps your teenager’s siblings feel heard and valued even though family life may be difficult.
Learn and understand the condition.Can help you feel empowered and help you respond to others who don’t understand selective mutism.
Seek support from a someone in your network or a support group.Provides a safe space for sharing experiences, knowledge, and advice.

Selective Mutism in Teenagers: Summary

Selective mutism in teenagers is a complex anxiety condition that requires understanding, professional support, and specialized interventions. By recognizing the potential causes, symptoms, and impacts on teenagers’ lives, we can provide appropriate treatment and support for long-term success.

Although treatment options such as cognitive-behavioral therapy can be very effective, the treatment plan must be individualised to your teenager’s specific needs. It must take into account the underlying reasons for the selective mutism, and how motivated your teenager is to overcome it.

Selective Mutism in Teenagers: Frequently Asked Questions

What is selective mutism?

Selective mutism is a condition in which people consistently fail to speak in certain social situations despite being capable of speaking in other contexts.

What causes selective mutism in teenagers?

The exact cause of selective mutism is unknown, but it is believed to be a combination of genetic, environmental, and developmental factors. Very often, it is driven by high underlying anxiety. For example, the teenager may be deeply afraid of saying the wrong thing, being ridiculed or becoming the centre of attention.

What are the symptoms of selective mutism in teenagers?

Symptoms of selective mutism in teenagers include a reluctance or refusal to speak in specific social situations, anxiety in social settings, and severe difficulty initiating or participating in conversations.

How is selective mutism in teenagers diagnosed?

Selective mutism in teenagers is diagnosed by a mental health professional using criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

What is the impact of selective mutism on teenagers?

Selective mutism can impact teenagers’ lives by causing social isolation, low self-esteem, difficulties in academic performance, and challenges in forming social relationships. It can also contribute to depression.

What are the treatment options for selective mutism in teenagers?

Treatment options for selective mutism in teenagers may include cognitive-behavioral therapy and selective serotonin reuptake inhibitors. Often, clinical psychologists will work alongside other professionals such as speech-language pathologists (speech and language therapists) and family therapists.

How can I seek professional help for my teenager with selective mutism?

It is important to consult with a mental health professional via your doctor or healthcare provider.

How can selective mutism in teenagers be overcome?

Overcoming selective mutism in teenagers often involves intensive treatment, stimulus fading techniques, and gradually exposing the teenager to social environments at their own pace.

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Dr Lucy Russell is a UK clinical psychologist who works with children and families. Her work involves both therapeutic support and autism assessments. She is the Clinical Director of Everlief Child Psychology, and also worked in the National Health Service for many years.

In 2019 Lucy launched They Are The Future, a support website for parents of school-aged children. Through TATF Lucy is passionate about giving practical, manageable strategies to parents and children who may otherwise struggle to find the support they need.

Lucy is a mum to two teenage children. She lives in Buckinghamshire with her husband, children, rescue dog and three rescue cats. She enjoys caravanning and outdoor living, singing and musical theatre.


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