Your child chatters nonstop at home: jokes at dinner, stories in the bath, questions at bedtime. Then the teacher says they haven't said a word at school all term. If that sounds familiar, you may have come across the term selective mutism. This post summarizes what the American Speech-Language-Hearing Association (ASHA), the Selective Mutism Association, and published research say about it: what it is, what it isn't, and when to ask for help.
What is selective mutism?
ASHA describes it this way: "Selective mutism is a complex anxiety disorder that affects pragmatic language."[1] (Pragmatic language is the social side of communication: using language with other people in everyday situations.) The Selective Mutism Association similarly calls it "an anxiety disorder characterized by an individual’s inability to speak" in certain social situations, "despite the ability to speak comfortably in other settings."[2]
The name can be misleading. "Selective" sounds like a choice, but ASHA is clear that "individuals with selective mutism do not elect where to speak but are more comfortable speaking in select situations."[1] A 2010 review describes the classic picture: "In the home with parents and siblings, the child tends to engage in normal conversation," while speech may be much reduced or absent at school or with less familiar people.[3]
Formal diagnostic criteria, summarized by ASHA, describe a consistent failure to speak in specific social situations where speaking is expected, even though the child speaks in other situations. The pattern has to interfere with school or social communication, last at least a month, and not be better explained by another condition.[1]
How common is it, and when does it start?
Selective mutism is uncommon. According to ASHA, "Most prevalence estimates for selective mutism range between 0.2% and 1.6%," and it notes that prevalence "can be somewhat higher among immigrant children, language-minority children," and some other groups.[1] The Selective Mutism Association puts it at "about 0.7% (approximately 1 in 140) of school-aged children," and says it is "slightly more common among girls than boys."[2]
"The onset of selective mutism typically occurs between 3 and 6 years of age," according to ASHA.[1] The Selective Mutism Association gives "an average age of onset of 5 years."[2] Because many children speak normally at home, the 2010 review notes it is "most often discovered after the child enters school."[3]
Isn't my child just shy, or being stubborn?
Lots of children are slow to warm up in new places, and that's normal. Selective mutism is different because the silence is consistent, lasts over time, and gets in the way of school and friendships.[1, 2] Only a professional can sort out which is which for your child.
It also isn't defiance, even though it can look that way. ASHA explains that children avoid speaking to protect themselves from anxiety, and that these behaviors "are a method of self-protection but may be interpreted as deliberately oppositional."[1] The 2010 review adds that "oppositional characteristics are not observed in a majority of children with selective mutism."[3]
Signs can change from setting to setting. ASHA notes that at home, a child may talk with some family members but not others, or go quiet when visitors come over. At school or in the community, a child might freeze, show little facial expression, cling to a parent, or seem withdrawn, and some children use gestures or other nonverbal communication with people they're comfortable with.[1] The Selective Mutism Association adds that children "may struggle to make eye contact and often present as behaviorally inhibited."[2] A 2025 systematic review found that children in the studies it examined "displayed various symptoms in addition to mutism, including fear, motor freezing, and avoidance behavior."[4]
Learning a new language? Children who are learning English may go through "a brief silent period in which they are quiet and speak little," which is a typical part of learning a second language.[1] ASHA notes that multilingual children with true selective mutism "present with mutism in both languages, in several unfamiliar settings."[1] If your child is quiet at school but chatty with family in your home language, that's useful information to share with an SLP. For more on dual-language learners, see our post on raising a bilingual child.
What causes selective mutism?
"No single cause of selective mutism has been identified," says ASHA.[1] It lists several factors that may play a part together, including anxiety (such as social anxiety or separation anxiety), genetics, family and environmental influences, and a shy or timid temperament.[1] Researchers are still working this out. The 2025 review found that "social and unspecific anxiety were the most frequently assessed and consistently identified symptoms," but cautioned that this "does not necessarily indicate clinical significance or etiological causality."[4] In other words, anxiety is strongly linked to selective mutism, but the research doesn't yet show exactly how it develops.
Speech and language can be part of the picture, too. ASHA notes that "expressive–receptive and receptive language disorders may coexist with selective mutism."[1] The 2010 review reported that "many children with selective mutism have premorbid speech and language problems (38%)," meaning those problems were present before the mutism.[3] This is one reason a speech-language evaluation can be helpful.
What can I do at home?
It's natural to want to coax words out, or to answer for your child when they freeze. ASHA's guidance points the other way: "Avoid speaking for the child, justifying the child’s silences, or pressuring the child to speak."[1] It explains: "This “rescuing” behavior may discourage the child’s future speech attempts."[1] ASHA's other practical suggestions for communication partners include:[1]
- Using the words "‘words’ or ‘voice’ rather than ‘talk’ or ‘speak’" when encouraging communication.
- "Offer choices or options to respond instead of open-ended or yes/no questions," and give your child time to respond.
- Keeping the conversation going even when your child doesn't answer out loud, and noticing small steps forward.
ASHA also stresses consistent expectations across home and school, so it helps to keep your child's teacher in the loop.[1] Our parent training services work with families on everyday communication strategies.
Who helps, and what does support look like?
According to the Selective Mutism Association, "Professionals in many fields including clinical psychologists, clinical social workers, and speech-language pathologists" may have expertise in diagnosing and treating selective mutism.[2] ASHA says SLPs "play an integral role in the screening, assessment, diagnosis, and treatment of individuals with selective mutism," and that "a diagnosis made by an interdisciplinary team ensures that a full differential diagnosis was completed."[1] An assessment usually includes a "hearing screening to rule out hearing loss as a possible contributing factor."[1]
ASHA describes behavioral approaches that SLPs and other professionals may use, such as stimulus fading, which "involves gradually increasing exposure to a fear-evoking stimulus" (for example, slowly adding a new person to a comfortable conversation), and "reinforcing attempts and approximations to communicate (i.e., shaping)."[1] ASHA also notes that medication "may be prescribed by the individual’s treating pediatrician or psychiatrist" in some cases.[1]
It's worth being honest about the evidence. The 2010 review noted that "the literature on selective mutism consists primarily of small sample populations and case reports."[3] The 2025 review notes that, according to earlier research, "the chances of remission increase when treatment is initiated early in the disorder’s course," and ASHA notes that "selective mutism in childhood may persist into adolescence and adulthood."[1, 4] Every child is different, so what support looks like and how it goes is a conversation to have with your child's care team.
If you're wondering about your child, a speech-language evaluation is one place to start, and our social communication services focus on the social side of language. Families elsewhere in Arizona can ask about telehealth.
The bottom line
Selective mutism is an anxiety disorder in which a child speaks comfortably in some places, often at home, but consistently can't speak in others, such as school.[1, 2] It isn't a choice or defiance, it usually begins between about 3 and 6 years old, and it can occur alongside speech and language difficulties.[1, 3] Pressure to talk tends to backfire, and a team that may include an SLP, a psychologist, and your pediatrician can help sort out what's going on.[1, 2] If your child's silence at school has lasted a month or more, or is getting in the way, it's reasonable to ask.
Sources
- American Speech-Language-Hearing Association (n.d.). Selective Mutism (Practice Portal). ASHA.
- Selective Mutism Association (n.d.). What Is Selective Mutism?.
- Wong, P. (2010). Selective mutism: A review of etiology, comorbidities, and treatment. Psychiatry (Edgmont), 7(3), 23–31.
- Kleinheinrich, J., & Vogel, F. (2025). What can we learn from the previous research on the symptoms of selective mutism? A systematic review. Behavioral Sciences, 15(11), 1485.
Articles from Speech Me Therapy, a pediatric speech-language therapy practice in North Phoenix serving Scottsdale, Paradise Valley, and families across Arizona by telehealth. Our posts summarize published guidance from professional and public health organizations; sources are listed at the end of every article.