HealthSelective Mutism In Teens And Adults

Selective Mutism In Teens And Adults

When people speak about Selective Mutism (SM), they often refer to children.  That is because SM is an anxiety disorder that is diagnosed in childhood, typically around when a child begins school.  But what happens to SM when a child grows into adolescence, or when a teen matures into adulthood?  Without treatment, SM generally does not “go away” on its own; people often don’t just “grow out of it.”  There are many teens and adults striving to overcome Selective Mutism.

Read this article for a detailed explanation of Selective Mutism – its causes, symptoms, and treatments.

Every day, people of all ages with Selective Mutism struggle with an internal dialogue and conflicting emotions.  They want to talk, but the thought of talking makes them anxious.  Sometimes they go to speak, and nothing comes out.  Candid reactions, teasing from others, or even perceived judgments may further increase their anxiety, making them less likely to be able to speak again on another attempt.  Even in a kindergarten or preschool classroom, it doesn’t take long for other students to identify a student with SM as the child who “doesn’t talk.”

Have you ever said “hello” to someone and they said nothing in return?  Have you ever held the door for someone and they neglected to say “thank you?”  What about the guy at work who never talks to anyone? What if the person you held the door for wanted nothing more than to say “Thank you” with a big smile on their face, but was speechless … because of their anxiety?

The SM Continuum: From Child to Teen to Adult

Many teens and adults with SM struggle with social isolation as a result of their anxiety surrounding speaking to others.  As children, especially in preschool and early elementary years, we are often taught by teachers that all of our peers are our “friends,” regardless of differences.  As children get older, they begin to segregate into social circles, forming closer bonds with those whom they share interests.

These social circles tend to only become more prominent and defined in adolescence and adulthood.  This is often difficult for individuals with SM because they may not be able to tell others what their interests are, or they may be socially isolated by their peers for being “different.”  The fear of speaking, and the realization that others may notice their lack of speaking, often causes the person with SM to withdraw, especially as they get older.

With the misconception that SM only occurs in childhood, it is not uncommon for teens with SM to be mislabeled as “defiant,” or for adults with SM to be labeled as “rude.” Most people expect a teen or an adult to speak when they are spoken to.  When they don’t, it might be seen as an adamant refusal instead of an anxious response.  Not only do some individuals with SM get in trouble for not speaking, they also may be susceptible to being unfairly accused of wrongdoings because of their lack of ability to stand up for themselves, verbally.

For example, a group of students may be rough housing at school and when probed, the other students involved may claim that the student with SM started the rough housing.  When brought into the principal’s office (a high-anxiety situation), the student with SM is unable to speak, even to defend himself, and therefore is assumed to be ‘guilty’ and assumes whatever punishment is given to him.  School suspension might even be a source of immediate relief of the anxiety because this student with SM now has a few days where he does not have to face the anxieties of talking in school.  Instead, he can stay in his comfort zone (home).

Adults with Selective Mutism face additional unique stressors.  How does one get a job if they are too anxious to speak during an interview?  If they get the job, how do they keep it if they are too anxious to talk to customers, coworkers, or their manager?  Unfortunately, many adults with SM are financially dependent on others (such as an elderly parent) for these reasons.

Finding the Right Treatment

There is a lot of hard work involved, but there is hope for overcoming SM.  While early intervention for SM is highly recommended, many adults with SM did not have the option for early intervention.  SM is a rare condition and most mental health providers don’t know what it is, much less how to treat it.  Frequently, people with SM travel for hours, or even to other states, to receive treatment from someone who specializes in the treatment of Selective Mutism.

Selective Mutism treatment requires skills and exercises that are not often addressed in typical anxiety treatment.  This is why it is crucial to seek treatment from a clinician who specializes in the treatment of SM.  Even still, the treatment of adolescents and adults with SM is different than treatment for children with SM.

In the treatment of adults, clinicians who specialize in Selective Mutism have the benefit of working with someone who likely has a fair amount of insight into what they are struggling with.  They tend to have already seen the effects SM has had on their lives in the workplace, at school and in their social, family, and romantic relationships.  Adults with SM also often have a desire to overcome their anxiety around talking.  While treatment methods will vary from clinician-to-clinician, at Pinnacle Counseling and Testing Center, our treatment of adolescents and adults with Selective Mutism always involves a combination of psychoeducation on anxiety, coping-skills building, Cognitive-Behavioral Therapy (CBT), and Graduated Exposure (GE).

The most common reaction to anxiety is to avoid what triggers the anxiety.  In the case of Selective Mutism, this means avoiding situations where speaking is expected.  While this avoidance may reduce one’s anxiety in the moment (e.g., “if I don’t go to that job interview, I won’t feel that high anxiety;” or “if I don’t go to school today, I won’t have to face the anxiety of that oral presentation”), it only makes the anxiety about speaking even stronger and increases the chances of “freezing” the next time there is an expectation or opportunity to speak.

Treatment should involve gradual exposure activities that specifically address areas of challenge that are specific to each individual.  Regarding difficulty speaking during a job interview, exposure activities may include practicing interviewing skills in the office, asking for help in finding items at a grocery store (to become familiar with speaking with and asking questions of an unfamiliar person), sharing personal information about one’s self in the form of a small-group presentation, and then actually participating in a formal interview.

Whether one’s anxiety leads to functional limitations in speaking with family members, co-workers, or people in the community, an individualized treatment plan should be created collaboratively with the individual with SM to help increase speaking in a normal volume in a variety of situations.

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School or Workplace Accommodations

In grade school, college, or the workforce, individuals with Selective Mutism may qualify for school-based or work-based accommodations.  Just like someone with a learning disability, if someone’s academic or vocational work is negatively impacted by their SM diagnosis, they may qualify for special accommodations in order to help them succeed in that environment.

  • In grade school or college, one common accommodation is alternative methods of presentation (e.g., written paper in lieu of a presentation, video recording from home, presenting to teacher/professor one-on-one, or small group presentation).
  • In the workplace, common accommodations include the option for written communication, limited involvement in a role that requires speaking, assistance of a job coach, or involvement of the individual’s clinician in the workplace while conducting graduated exposure activities to increase speaking in the workplace.

In order to obtain formal accommodations, most academic institutions and workplace environments will ask for a report of formal psychological assessment or letter of need from an individual’s clinician.  In grade school, parents can choose to have their child or teen assessed by the school psychologist for accommodations in the form of an IEP or Section 504.  This assessment process through the public school system is free of charge.  Even if a child attends a private school, parents can inquire about an assessment through their public school district office.

Parents can also choose to have their student tested through a private psychologist, preferably one who specializes in Selective Mutism.  Most often, an assessment through a private psychologist will be paid privately or through insurance.  For college and work accommodations, most of the time these assessments need to be conducted by a private psychologist (again, preferably one who specializes in SM) and must be paid for privately by the family or the individual applying, or through their insurance.

While the symptoms of Selective Mutism can feel debilitating at times, the good news is that through hard work, dedication, and the support of a clinician who specializes in the treatment of SM, overcoming Selective Mutism is possible, no matter what age.

President, Pinnacle Counseling and Testing Center at California School of Professional Psychology

Clarissa Gosney, Psy.D., is a licensed clinical psychologist, founder of Pinnacle Counseling and Testing Center. She specializes in helping individuals with Selective Mutism through unique testing services and runs a camp called "Outside Voice" for children and adolescents with the condition. Dr. Gosney employs cognitive-behavioral therapy and exposure therapy to assist clients in overcoming anxiety and traumatic experiences, providing tools for independent, short-term therapy with lasting benefits.


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