Selective mutism

Toggle: English / Spanish


Selective mutism is a condition in which a child can speak, but then they suddently stop speaking. It most often takes place in school or social settings.


Selective mutism is most common in children under age 5. 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. However in most cases, the child is truly unable to speak in certain settings.

Some affected children have a family history of selective mutism, extreme shyness, or anxiety disorders, which may increase their risk for similar problems.

This syndrome is not the same as mutism. In selective mutism, the child can understand and speak, but is unable to speak in certain settings or environments. Children with mutism never speak.


Symptoms include:

  • Ability to speak at home with family
  • Fear or anxiety around people they do not know well
  • Inability to speak in certain social situations
  • Shyness

This pattern must be seen for at least 1 month to be selective mutism. (The first month of school does not count, because shyness is common during this period.)

Exams and Tests

There is no test for selective mutism. Diagnosis is based on the person's history of symptoms.

Teachers and counselors should consider cultural issues, such as recently moving to a new country and speaking another language. Children who are uncertain about speaking a new language may not want to use it outside of a familiar setting. This is not selective mutism.

The person's history of mutism should also be considered. People who have been through trauma may show some of the same symptoms seen in selective mutism.


Treating selective mutism involves behavior changes. The child's family and school should be involved. Certain medicines that treat anxiety and social phobia have been used safely and successfully.

Support Groups

You can find information and resources through selective mutism support groups.

Outlook (Prognosis)

Children with this syndrome can have different outcomes. Some may need to continue therapy for shyness and social anxiety into the teenage years, and possibly into adulthood.

Possible Complications

Selective mutism can affect the child's ability to function in school or social settings. Without treatment, symptoms may get worse.

When to Contact a Medical Professional

Call your health care provider if your child has symptoms of selective mutism, and it is affecting school and social activities.


Bostic JQ, Prince JB, Buxton DC. Child and adolescent psychiatric disorders. In: Stern TA, Fava M, Wilens TE, Rosenbaum JF, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 2nd ed. Philadelphia, PA: Elsevier; 2016:chap 69.

Rosenberg DR, Ciriboga JA. Anxiety disorders. In: Kliegman RM, Stanton BF, St Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics. 20th ed. Philadelphia, PA: Elsevier; 2016:chap 25.

Simms MD. Language development and communication disorders. In: Kliegman RM, Stanton BF, St Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics. 20th ed. Philadelphia, PA: Elsevier; 2016:chap 35.

Version Info

  • Last reviewed on 2/21/2016
  • Timothy Rogge, MD, Medical Director, Family Medical Psychiatry Center, Kirkland, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission ( URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- 2013 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.