About SM
Selective mutism (SM) is a childhood anxiety disorder defined by the child’s persistent inability to speak in specific social settings and with some people. Children with SM are typically able to verbally communicate in settings where they feel comfortable (e.g., at home, with caregivers and siblings). However, they are unable to speak or effectively communicate in environments where speaking is expected (e.g., in school, in public and with extended family).
The prevalence of SM in the population is approximately 1-2%. Children are commonly diagnosed between the ages of 3-6 and referred for therapeutic support when they begin attending school unaccompanied. It is possible for children to have common comorbidities alongside SM.
Children with SM often appear to be paralysed with fear when unable to communicate verbally, and they may use nonverbal communication such as gestures, pointing, and nodding in setting when they are unable to speak. SM impacts social and emotional development, and performance at school (e.g., children may be unable to ask questions or have difficulty accessing the curriculum). SM stymies a child’s ability to advocate for themselves and may put a child at greater risk if ever in an emergency situation.
Effective treatment for SM consists of two primary domains - cognitive behavioral / behavioral therapy and medication based interventions. A combined treatment approach yields the greatest response to treatment, however, therapy is the first line of treatment. Children may be referred for psychopharmacological intervention if they are not responding to treatment as expected, or if their presentation is complex.
