Selective Mutism in adults (A Comprehensive Guide)

Selective Mutism in adults

The world has seen a lot of disabilities in terms of physical ones and also mental disabilities.

Some of these disabilities are well-known for ages but some of these disabilities are rather new.

Language and communication disorders have been classified in the Diagnostic and Statistical Manual of Disorders.

They are now classified separately as compared to before when they were under the domain of childhood disorders.

One of the communication disorders which is rather new and rare is known as selective mutism.

We are going to discuss selective mutism in this article. Selective mutism is often considered as a childhood disorder which is true to an extent but it is not always true because adults can also suffer from selective mutism.

It is mainly called so because it is diagnosed in childhood mostly when a child starts going to school.

Not many people know what happens to selective mutism (SM) when the child goes into adolescence or becomes an adult.

Selective mutism rarely goes away if it is not treated properly.

People don’t just grow out of it because there are many people who are trying to get over it but can’t.

Let’s discuss complications of selective mutism in adults but before that, we have to know what selective mutism is?

Selective Mutism in adults (A Comprehensive Guide)
  • What is Selective mutism in adults?

Selective mutism can be defined as “a severe anxiety disorder in which a person cannot speak in a specific social situation”.

We can take the example of a person who is not able to speak if he comes in front of the whole class or to relatives they are not much familiar with.

It often starts during childhood years and it can go for long years if not treated properly.

In the case of selective mutism, a child does not have control over him not speaking at a specific situation as he does not refuse to speak.

The situation in which the child has to talk to certain people often accompanies a freeze response along with feelings of panic just like a case of really bad stage fright where the person stops talking completely.

Once the person starts anticipating the situation he just starts avoiding the situation altogether.

These people tend to speak with other people they are comfortable with like their close friends and family members.

Selective mutism affects almost 1 in 140 young children and it is found more common in girls than in boys.

It is also found more common in children who are trying to learn a second language like children who have migrated to another country from their home country.   

  • How to know if a person is suffering from selective mutism in adults?

If you are worried about your child or any other person around you is suffering from selective mutism and you want to know for sure if that is the case then you should look for the following signs in them.

These signs are for adults as well as children who are almost 2 to 4 years old because it is often noticeable when a child starts interacting with people other than the family members like when they do while going to school or a preschool.

You would definitely see a visible and significant difference in a person or child’s ability to talk to certain people.

They will give frozen facial expressions when they are about to talk to someone whom they are not familiar with.

They avoid eye contact and often appear to be. 

  • Clingy
  • Nervous
  • Uncomfortable
  • Socially awkward
  • Rude
  • Stiff
  • Shy
  • Withdrawn
  • Poorly coordinated
  • Disinterested
  • Tense
  • Sulky
  • Aggressive
  • Temper Tantrums 
  •  Angry
  • Stubborn

Some people with a higher level of confidence often use gestures and signals to communicate as they may nod or shake their heads when they are trying to say yes or no respectively.

However, others with low confidence often avoid communication and do not use any kind of gestures and just go completely quiet.

Yet other people, as well as children, may use an alternate form of communication like whispering or saying a few words.

  • Causes of selective mutism in adults

There are a few theories that have been doing rounds about the causes of selective mutism but nothing can be said for sure.

Some of the causes of selective mutism are given below.

  • Phobia as a cause of selective mutism in adults

 Phobia is considered as one of the main causes of selective mutism and the answer to what causes selective mutism in adults.

Selective mutism is often associated with anxiety even if the cause is not always clear.

The person will have a tendency towards anxiety and mostly have difficulty while doing everyday chores and work.

People often feel anxious in certain situations and that’s why they go completely quiet and mute while talking to certain people.

If the person is also suffering from some kind of speech or communication problem, it will only make things worse and make the speaking even more problematic and stressful.

Other people have trouble processing loud noises or jostling from crowds because they have a problem in processing sensory information.

That’s why they just shut down and do not speak when the environment around them becomes overwhelming.

Their anxiety gets transferred to the people around them. 

  • Post Traumatic Stress Disorder cause of selective mutism in adults

Selective mutism can also occur as a symptom of post-traumatic stress and it does not follow the usual pattern of selective mutism.

In this case, people often go quiet in the environment and people who are already familiar.

In that case, they did not have difficulty talking in those environments or to those people before the traumatic event happened.

It occurs rarely but it has occurred and it is reported as one of the causes of selective mutism.

This first occurs only as a speech withdrawal and if the problem is not addressed then the person can develop full-fledged selective mutism.

Moreover, the person can develop even more anxiety about general communication as a result of post-traumatic stress. 

Some people have also listed that autism can be a potential cause of selective mutism or a child can be autistic if he has selective mutism.

Parents have often seen children as manipulative and controlling when they actually have selective mutism.

A child can develop both but there is no relationship or causal link in autism and selective mutism. 

Selective Mutism in adults (A Comprehensive Guide)
  • How to diagnose selective mutism in adults?

Selective mutism in adults can cause severe problems if it has not gotten proper attention and it can lead to a person making him isolated, suffering from low self-esteem, and even social anxiety.

It can also cause problems in occupations and relationships.

It is of utmost importance that the person is properly diagnosed and treated with the same caution as any other mental disorder.

The diagnostic guidelines for the diagnosis of selective mutism in both children and adults are given below. 

  • Diagnosis of selective mutism in children

Children become successful adults if selective mutism is treated in the early stages.

School staff and parents need to come together to save children from selective mutism.

You need to go to a speech and language therapist in order to get your child diagnosed appropriately for selective mutism.

You can talk to the therapist about every need as well as the anxiety from which the child is suffering.

The therapist will look at behavioral and family issues as well even if the child doesn’t speak to the parents he should be encouraged or the parents should tell everything. 

  • Diagnosis of selective mutism in adults

Adults can overcome selective mutism but they may keep experiencing psychological and practical effects of years they have spent without any social interaction or not being able to achieve academically or occupationally what they wanted to achieve. 

Adults can be seen by a mental health professional who can get support from a speech and language therapist or another knowledgeable mental health professional.

  • Treatment of selective mutism in adults

If a child suffers from selective mutism, he or she can be treated if they are diagnosed on time and with appropriate guidelines.

Handling appropriately is very important, once they are diagnosed, a mental health professional needs to work on the treatment guidelines and how to deal with a selective mutism patient.

For an effective treatment, the mental health professional needs to know about the length of selective mutism as well as any additional difficulties associated with it.

Moreover, support and cooperation with school staff and other members is also of utmost importance.

There are the following treatment options available for children and adults suffering from selective mutism.

The most effective types of treatment are cognitive behavioral therapy (CBT) and behavioral therapy.

  • Cognitive Behavioral Therapy (CBT) for  selective mutism in adults

As the name represents, this therapy focuses on a person’s cognition and how they think of themselves.

CBT also helps the person face the challenges and fears by using graded exposure.

It is probably the best therapy for adults and it can also be used for older children and not for younger ones.

For instance, CBT may include talking about anxiety and understanding how it affects their body and behavior and learning a range of coping strategies for anxiety or other anxiety management techniques.

Selective Mutism in adults (A Comprehensive Guide)
  • Behavioral therapy for selective mutism in adults

The name shows that this therapy is used to reinforce the desired behavior and replace inappropriate behavior with an appropriate one.

It does not deal with thoughts or past and it provides a step by step approach to help the person overcome his fears.

Different techniques of behavior therapy used for selective mutism are as follows

  1. Stimulus fading
  2. Positive and negative reinforcement
  3. Desensitization
  4. Shaping
  5. Graded exposure

Other treatment options for selective mutism can be medicines and mostly applied to children and not adults.

However, they are in no way alternative to the therapies mentioned above.

Selective Mutism in adults (A Comprehensive Guide)
  • FAQ about What is selective mutism in adults

What could members of the social support group do for a person to overcome selective mutism?

Do not pressurize the sufferer and just encourage them to speak.

Let them know that you understand their predicament and really there to help.

However, don’t praise them for speaking in public either.

Verbal assurance, love, support, and patience are necessary.

What triggers selective mutism?

Causes are still unknown but they are mostly related to anxiety.

Can selective mutism be cured?

If it is treated right, the prognosis could be promising considering other factors like social support and lack of other complications are well

  • References
  1. NHS.uk: “Selective Mutism”
  2. Gosney, C. J. (2020, March) Selective Mutism: More than just childhood anxiety. Retrieved from anxiety.org

Selective Mutism in adults (A Comprehensive Guide)

Juanita Agboola

Juanita Agboola is the editor in chief of HFNE and an expert in mental health online. She has been writing about online behavior, mental health and psychology issues since 2012. All Guides are reviewed by our editorial team which constitutes various clinical psychologists, PhD and PsyD colleagues.