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Fear of Talking (Selective Mutism)



  • Selective mutism is a severe fear that keeps your child from speaking in public.
  • Treatment may include therapy, medicines, and learning ways to manage stress.
  • Your support and understanding can help your child deal with his or her fears.


What is selective mutism?

Selective mutism is a severe fear that keeps your child from speaking in public. Your child may fear that saying anything when other people are around will make them look foolish and feel embarrassed. The fear stops your child from doing things such as making friends, playing, and doing well in school.

Selective mutism is more than being shy. Shy children usually relax around others after a few minutes. A child with selective mutism is always tense and cannot speak in some settings.

What is the cause?

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.
  • A child is more likely to have this disorder if other family members have had problems with selective mutism, social anxiety, or other anxiety disorders. It is not known if this is caused by genes passed from parent to child. It is not caused by abuse or trauma.

The disorder is more common in girls than boys. It often starts before age 5 but may not be noticed until your child starts school.

What are the symptoms?

Symptoms may include:

  • Not speaking in social situations where talking is expected, such as school or play groups, but being able to talk at home to family members or friends
  • Refusals by your child to take part in school or social activities

These symptoms may confuse you because your child may be outgoing at home. Your child may talk easily on the phone to others but not be able to talk to them face to face.

How is it diagnosed?

Your child's healthcare provider will ask about your child's symptoms and medical history and examine your child. The provider will make sure that your child does not have a medical illness or a speech, hearing, or learning problem that could cause the symptoms.

You may want to contact a mental health therapist who specializes in working with children and teens. The therapist will ask questions, watch your child, and may do some tests.

How is it treated?

There are several ways to treat selective mutism. The first step is usually to help you and your child learn about the disorder. Usually, the sooner your child gets treatment, the more your child will improve over time.

Cognitive behavior therapy (CBT) helps your child learn what causes your child to feel afraid to talk and how to control the fear of rejection. CBT might also include social skills training, role-playing, and relaxation methods.

Exposure and response prevention therapy (ERPT) helps your child face fears by exposing your child to the things your child fears. ERPT helps your child practice new ways of responding. Your child learns ways to control the body's response to anxiety such as trying breathing exercises.

A speech-language therapist can work with your child to help learn ways to relax and speak more easily.

Sometimes medicine may be used along with therapy. Your child’s healthcare provider will work with you and your child to select the best medicine and dosage for your child. Your child may need to take more than one type of medicine.

How can I help my child?

  • Support your child. Let your child talk with you about any scary feelings. Your support and understanding can help your child deal with his or her fears.

    Let your child watch you talking in a relaxed way in a lot of different situations such as with friends, at school events, and while ordering at restaurants. Try to avoid putting pressure on your child to speak to get something your child wants. Do not say tell your child that he or she can't have it unless your child says it first. Praise your child for any efforts and for any improvements, however small.

    Encourage your child to speak in settings where your child feels comfortable. Usually that means in small groups of people that your child knows. If your child is more comfortable at home, it may be helpful to invite friends over often to give your child more chances to talk with others.

  • Work with your child’s teachers, principal, and counselors at school. Teachers may be able to work with your child such as letting your child make a tape recording of a report at home instead of talking in front of the class.
  • Help your child learn ways to manage stress. Teach your child to practice deep breathing or other relaxation techniques when feeling stressed. Help your child find ways to relax. Some examples include taking up a hobby, listening to music, playing, watching movies, reading a book, or taking walks.
  • Take care of your child’s health. Make sure your child eats a variety of healthy foods and gets enough sleep and physical activity every day. Talk to your child about the risks of smoking, using e-cigarettes, drinking alcohol, and using drugs.
  • Check your child’s medicines. To help prevent problems, tell your child’s healthcare provider and pharmacist about all the prescription and nonprescription medicines, natural remedies, vitamins, and supplements your child takes.
  • Contact your healthcare provider or therapist if you have any questions or your child’s symptoms seem to be getting worse.
  • Get emergency care if your child has thoughts of suicide or self-harm, violence, or harming others.

For more information, contact:

Developed by Change Healthcare.
Pediatric Advisor 2022.1 published by Change Healthcare.
Last modified: 2021-12-07
Last reviewed: 2019-02-18
This content is reviewed periodically and is subject to change as new health information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.
© 2022 Change Healthcare LLC and/or one of its subsidiaries
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