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People with selective mutism are not "selecting" to be speechless, as if being oppositional.

Selective mutism is driven by anxiety in certain situations, thus, "situational" mutism may be more accurate.

Though the person is speechless, with some creativity, communication can still occur.

Over the years, in the juvenile court clinic, my colleagues and I have had several cases where a child referred for evaluation speaks only to select people. It is sometimes noted that the child has been diagnosed with selective mutism, though seems to interact with many people just fine. The referring source, usually a probation officer or attorney, might be wondering whether the child has become truly unable to speak, or if they are just being oppositional. It seems "selective" mutism may be a confusing term.

Selective mutism, for those unfamiliar, is when someone becomes speechless around certain people or social situations despite having normal speaking ability. It tends to develop early on and historically was only applied to children. In the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, published in 2013 (DSM-5), it was noted that adults can also suffer from the affliction.

Oppositional or anxious?

The condition first appeared in the medical literature in 1877—aphrasia voluntaria or “voluntary absence of speech.” It was changed to elective mutism in the 1930s (Drieson and colleagues, 2020). It wasn’t until the DSM-3 (1980) that it became an official diagnosis. At that time, it was still referred to as elective mutism because of the continued belief that there was an elective, or voluntary, nature to the child becoming mute. This implied the failure to speak was oppositional and thus a “behavioral” issue.

Before the DSM-3, however, some clinicians in the 1960s, most notably Alice Sluckin, felt the condition was not a function of contrariness, but rather one of anxiety (Kocovska, 2020). This would indicate it is more a failure to speak due to anxiety around certain people or situations. Kocovska (2020) also noted that some practitioners at the time began applying the term selective mutism to the condition, though it was unclear why.

Following the DSM-3 and after more research, the American Psychiatric Association (APA) recognized that speechlessness was a function of anxiety, and changed elective mutism to selective mutism for the DSM-4. The rationale for the alteration, according to Drieson and colleagues: “This type of mutism is found in specific contexts rather than being (necessarily) self-chosen (2020).” This, of course, could be what was implied when the term was first used in the 1960s.

Is selective mutism an accurate description?

The change to selective mutism has not been without its critics, as “selective” can still imply there is a voluntary nature to the speechlessness. While it is still called selective mutism in the DSM-5, in recent years, situational mutism has become an increasingly popular, acceptable term. Advocates feel this more clearly indicates the person's speechlessness results from certain situations, and they are not simply “selecting” not to speak (for example, Goodwin, 2025). Interestingly, Sluckin, in the 1960s, was ahead of her time as she suggested situational mutism was a fitting description.

This is not to say that some people, whether out of opposition or otherwise, are indeed electing not to speak. In fact, selective-situational mutism is considered a rare condition, with a prevalence of no more than 2 percent (for example, Koskela and colleagues, 2023; Rodrigues-Pereira and colleagues, 2023). The low prevalence, however, does not mean one should jump to conclusions that the child is just being oppositional.

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Navigating first encounters with speechless individuals

It can be frustrating to sit across from someone who seemingly is unwilling to speak, especially if they are seen speaking with others, and get irritated with the person. If they are someone who truly struggles with situational mutism, any show of authoritarianism to try to get them to speak is likely going to heighten their anxiety and keep them muted.

By now, you’re probably wondering how best to navigate interacting with a speechless child. If possible, consult with the parent or guardian, if present, about the child’s lack of talking. Is it characteristic of them in certain situations? If so, that can assuage any frustration by making it not so personal and lead to a more constructive interaction.

If situational mutism is characteristic, is there anything helpful in getting them to talk once they become speechless? Perhaps the child can speak to the parent, who can then relay the information. It also does not have to be verbal. In my encounters with situationally mute children, I have found that they readily complete questionnaires and can at least shake or nod their heads to basic questions. Some may provide written answers to questions asked.

Don't jump to conclusions

Since speechlessness is the chief symptom of selective-situational mutism, mental health professionals encountering a speechless child might quickly conclude a selective/situational mutism diagnosis. However, as Emil Kraepelin, the father of modern diagnostic classification said, "A single symptom, however characteristic it may be, never justifies a diagnosis by itself.” (Spitzer and colleagues, 2002, page 487).

Jumping to a conclusion of selective mutism could lead to inappropriate treatment. We can rule out other reasons why a child may not be talking in certain situations or around certain people. The first is social anxiety, which some consider selective mutism a form of (for example, Poole and colleagues, 2020). People with social pragmatic disorder and autism can show similar symptoms, along with immigrants, especially children, who have not yet mastered the new language. Interested readers can review these differential diagnoses and how they differ from selective-situational mutism in detail in the DSM-5 TR (2022).

A referral for psychological testing can be helpful to rule out other conditions and for treatment planning.

For those interested in learning more about selective-situational mutism, a comprehensive resource with clinical descriptions and screening tools can be found in the work of Oerback and colleagues. (2019).

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.).

Driessen, J., Blom, J.D., Muris, P., Blashfield, R.K., & Molendijk, M,L. (2020). Anxiety in children with selective mutism: A meta-analysis. Child Psychiatry and Human Development, 51(2), 330-341. doi: 10.1007/s10578-019-00933-1. PMID: 31650460; PMCID: PMC7067754

Goodwin, J. (2025, May 5). All about situational mutism: A guide for allies. https://reframingautism.org.au/all-about-situational-mutism-a-guide-for-allies. Reframing Autism. https://reframingautism.org.au/all-about-situational-mutism-a-guide-for…

Kocovska, E. (2020, January 15). From ‘aphasia voluntaria’ to ‘selective mutism’. Gillberg Neuropsychiatry Centre Blog. https://www.gu.se/en/gnc/from-aphasia-voluntaria-to-selective-mutism

Koskela, M., Ståhlberg, T., Yunus, W.M.A.W.M., & Sourander, A. (2023). Long-term outcomes of selective mutism: A systematic literature review. BMC Psychiatry, 23(779). https://doi.org/10.1186/s12888-023-05279-6

Muris, P. & Ollendick, T.H. (2021). Selective mutism and its relations to social anxiety disorder and autism spectrum disorder. Clinical Child and Family Psychology Review, 24 (2), 294–325. https://doi.org/10.1007/s10567-020-00342-0

Poole, K.L., Cunningham, C.E., McHolm, A.E., & Schmidt, L.A. (2021). Distinguishing selective mutism and social anxiety in children: A multi-method study. European Child and Adolescent Psychiatry, 30 (7), 1059–1069. https://doi.org/10.1007/s00787-020-01588-3

Rodrigues Pereira, C., Ensink, J.B.M., Güldner†, M.G., Lindauer, R.J.L., DeJonge, M.V., & Utens, E.M.W.J. (2023). Diagnosing selective mutism: A critical review of measures for clinical practice and research. European Child and Adolescent Psychiatry, 32, 1821–1839. https://doi.org/10.1007/s00787-021-01907-2

Spitzer, R. L., Gibbon, M., Skodol, A. E., Williams, J. B. W., & First, M. B. (Eds.). (2002). DSM-IV-TR casebook: A learning companion to the diagnostic and statistical manual of mental disorders (4th ed., text rev.). American Psychiatric Publishing, Inc.

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