Abstract

This research focuses on the developmental stages of Selective Mutism (SM) and its impact on people’s lives. Our research also highlights the connection between selective mutism and other anxiety disorders, as well as the development of selective mutism, through exploring genetic, psychological, and environmental factors during various life stages which contribute to SM development. Genetic factors typically come from having a family history of anxiety disorders, including selective mutism, whereas psychological and environmental factors can include an introverted temperament, parenting styles, family and cultural influences, as well as a lack of social exposure in early age. Additionally, the research looks at the significant, and often differentiated, impact selective mutism has on people during key life stages. Notable symptoms of selective mutism include extreme introversion, the inability to speak, impaired self-esteem, fear of making mistakes, social anxiety, and isolation. Furthermore, our research explored selective mutism’s impact on people in social settings, including academic environments and gaining and maintaining employment, as well as the struggles people with selective mutism face. We touch on different treatments for selective mutism, such as Cognitive Behavioural Therapy (CBT) and other therapies. This paper emphasises the importance of early diagnosis and effective treatment in order to prevent worsening of symptoms and encourage remission of the anxiety disorder in all life stages.

Infancy

Selective Mutism (SM) is an early-onset disorder that is often diagnosed when children are first entering school. However, it may begin at much younger ages, and there are several factors that can indicate future development of SM. The typical psychological factors contributing to the development of selective mutism are generally considered to be a child’s natural temperament, the existence of behavioural inhibition, and their familial situation. There are also arguments that a biological component plays a role (Astendig, 1999).

Dow et al. (1995) proposed that biological factors correlate to the later development of selective mutism, stating that “familial history of shyness, SM, or anxiety disorders [is] a precursor to a child developing mutism symptomatology”. Additionally, Stein et al. (2011) states that the CNTNAP2 (rs2710102) gene polymorphism is associated with greater risk of SM manifestation during childhood as well as greater risk of experiencing increased social anxiety during adulthood. The existence of this gene polymorphism that contributes to SM risk, alongside a strong correlation between familial history of anxiety disorders and the development of SM, points to the existence of biological factors as a predisposition, but not necessarily a primary cause. In other words, not only is familial history an indicating factor of selective mutism, a specific gene has also been linked to selective mutism.

In terms of temperament, “most children with SM (85%) are reported to be constitutionally shy, contributing to the symptom of withholding speech” (Steinhausen & Juzi, 1996). Studies have shown a strong correlation between displays of behavioural inhibition (BI) and the development of SM later on in life. In particular, Gensthaler et al. (2016) used the parent-rated Retrospective Infant Behavioural Inhibition questionnaire to show that extreme behavioural inhibition diagnosed in infancy and early childhood may be a risk factor for the manifestation of SM in older age. Children with SM were described as having higher levels of inhibition as infants than children without this diagnosis. As such, BI can be used as a strong indicator of developing SM.

Notably, temperament is not the sole factor determining SM, since many children have shyer dispositions and yet do not have selective mutism. Another factor with a strong correlation to SM is an overdependence on, or anxious attachment to, the parent from a young age. This also tends to have a few major causes. Cunningham et al. (2004) compared parents of children with SM with healthy controls. They found that parents of children with SM expressed more shyness and a higher level of social anxiety, as well as an overall tendency towards avoidant behaviours and social isolation. In addition to this, a parent who is conscious of their child’s temperament may naturally exhibit more protection over their child, which could reinforce a fear of social interaction. This highlights that in addition to a genetic component to the development of selective mutism, there is also a familial component. A developing child has the natural tendency to mimic the actions of their parents, and if a parent is displaying social anxiety and avoidant behaviours around their child, it can result in either the development or escalation of selective mutism.

Moreover, Kristensen (2000) finds that 68% of children with SM were also diagnosed with social phobia, and 32% were also diagnosed with separation anxiety. Separation anxiety naturally results in over-attachment to parents, which often results in a lack of trust towards external environments, compounding the symptoms of selective mutism. By examining the interplay of the conditions mentioned above, we can conclude that many driving factors of SM will exist long before any formal diagnosis is offered.

Childhood

Selective mutism predominantly occurs in children between the ages of 4 and 10 and is more commonly diagnosed in girls than boys. The disorder typically becomes noticeable in early childhood, around ages 2 to 4, but often remains undiagnosed until the child enters a structured social environment, such as a school setting. This is where the pressure to speak becomes more pronounced, and the child’s mutism becomes evident, suggesting that environments play a crucial role in both the manifestation and recognition of the disorder. Keen et al. (2016) conducted a retrospective case-note review and estimated the prevalence of selective mutism to be between 0.47% and 0.76% among children, with varying rates depending on demographic and cultural factors. 

The development of selective mutism is influenced by a complex interplay of genetic, temperamental, environmental, and familial factors, with familial history of anxiety disorders and social influences playing a significant role. Cohan et al. (2006) highlight that the causes of selective mutism are complex and multifaceted, involving a combination of genetic, temperamental, environmental, and familial factors. Many children with selective mutism have a family history of anxiety disorders, indicating a possible genetic predisposition. These children may also display characteristics of social anxiety, extreme shyness, or introversion. The presence of a family history of anxiety disorders suggests a genetic component, which may predispose children to anxiety-related conditions. Environmental factors, such as overprotective parenting or a lack of exposure to social interactions at an early age, can also contribute to the development of selective mutism. The etiological factors of selective mutism emphasise the interaction between innate and environmental influences. However, temperamental traits like shyness or introversion indicate that not all children with these predispositions will develop selective mutism, pointing to the role of environmental factors in its manifestation. For instance, an environment that lacks social exposure or is characterised by overprotection may inadvertently reinforce anxiety and avoidance behaviours, exacerbating the existing shyness and introversion and increasing the likelihood of them developing SM. In the absence of these environmental factors, children who are shy and introverted may be less likely to develop SM. 

Selective mutism significantly impacts children’s social and educational experiences, leading to isolation, misunderstandings, and challenges in developing both social and academic skills. Oerbeck (2018) explored the social implications of selective mutism, finding that it significantly affects children’s ability to participate in social and educational settings. Children with selective mutism may experience social isolation because their inability to speak makes it challenging to form and maintain friendships. This condition can lead to difficulties in classroom participation, group activities, and peer interactions, often resulting in a lack of social skill development. They also noted that children with selective mutism are frequently misunderstood by peers and adults, who may perceive them as disinterested, rude, or oppositional. This misunderstanding can lead to further social withdrawal and heightened anxiety, perpetuating the mutism. Additionally, the lack of verbal communication can negatively affect academic performance, as teachers may not fully recognise the child’s needs or abilities. The child may avoid tasks that require speaking, such as reading aloud, answering questions, or participating in group discussions, further hindering their educational experience. The social and psychological impact of selective mutism reveals a feedback loop where the disorder’s symptoms lead to further social challenges, exacerbating the condition. Misunderstandings by peers and adults reinforce the child’s anxiety and contribute to a negative self-perception, where the child might feel inferior or incapable due to their inability to communicate effectively. This social withdrawal not only limits the development of interpersonal skills but also hinders academic growth, as engagement in the classroom often depends on verbal participation. This cycle highlights the need for educational and social environments to be supportive and understanding of the condition, promoting alternative forms of communication and gradually encouraging verbal interaction.

Family dynamics play a crucial role in the development and persistence of selective mutism, as parental behaviours and familial stress can inadvertently reinforce the child’s anxiety and mutism. Stone and colleagues examined the role of family dynamics in selective mutism and found that parents may unknowingly reinforce the child’s mutism by speaking on their behalf or avoiding social situations that trigger anxiety. Additionally, parental anxiety or overly controlling behaviours can exacerbate the child’s anxiety, contributing to the persistence of the disorder. The study also highlighted that selective mutism can lead to family stress and tension, as parents struggle to understand and support their child’s needs. Siblings may also feel the impact, either by receiving less attention or by being indirectly affected by the emotional climate at home (Stone et al., 2002). The influence of family dynamics on selective mutism underscores the importance of a balanced approach to parenting where anxiety and avoidance are not unintentionally reinforced. Overprotective or anxious parenting styles may mirror or amplify the child’s fears, making it more difficult for them to confront anxiety-provoking situations. Furthermore, the familial stress that can arise from dealing with a child’s selective mutism highlights the broader impact of the disorder, affecting not just the individual but the family unit as a whole. Understanding these dynamics is critical for developing effective family-based interventions that support both the child and the parents in managing anxiety and promoting healthy communication.

Cultural and environmental factors also play a significant role in the development and recognition of selective mutism during childhood. Viana et al. (2009) emphasised that in certain cultures, traits such as shyness and reserved behaviour are often valued, which can delay both recognition and diagnosis of the disorder. For example, what may be considered polite or socially acceptable in one’s culture might mask the underlying anxiety that drives selective mutism. This cultural lens becomes especially relevant during childhood, when social and communication skills are rapidly developing and where early detection of disorders is crucial. Additionally, children from bilingual or immigrant families may face an increased risk of selective mutism due to language barriers and the stress of cultural adjustments. For these children, it becomes difficult to determine whether their reluctance to speak stems from anxiety or from the challenges of learning a new language. This complicates diagnosis, as healthcare providers and educators must carefully distinguish between normal language acquisition issues and symptoms of selective mutism. This requires cultural sensitivity and awareness. Moreover, environmental factors like a lack of social exposure, or a significant life event, such as moving to a new city or school, can trigger or exacerbate symptoms of selective mutism in children. These stressors may increase feelings of anxiety and social withdrawal, particularly during early childhood, when children are especially vulnerable to their surroundings. The interplay between these factors highlights the importance of recognising how cultural and environmental influences can shape the way selective mutism manifests during childhood.

Pre-Pubescent

Puberty begins between the ages of 9 to 11 years old for females and after the age of 11 years old for males (Emmanuel & Bokor, 2022). Selective mutism in older children may be expressed differently than it is in infants or younger children. While older children might still experience a consistent failure to speak in uncomfortable situations, which is a main symptom of SM, they might learn how to make it less obvious in order to avoid attention from other peers and adults. For example, instead of completely freezing when they are spoken to, they might try to avoid the conversation in the first place. Because of this, they are more likely to develop additional symptoms such as externalising behaviours, impaired self-esteem and avoidance, in addition to other symptoms strictly related to anxiety, like marked fear (Vogel et al., 2024). 

Bornstein and Lerner (2024) state that “a person who has lived for twelve years has developed a certain sense of self as well as of self-capacity” (Britannica, 2024). It is then understandable how crucial positive socialisation is in that period of life and how damaging it could be for a child with SM to go through this life stage without proper support. This could result in children creating a “non talking persona” for themselves, resulting in an oppositional behaviour, which used to be considered one of the reasons behind SM (Cunningham et al., 2006; Yeganeh et al., 2003). Dr. Elisa Shipon-Blum (Medical Director of the Selective Mutism Group/Childhood Anxiety Network) affirmed, during the conference: Speaking Out for Our Children (San Diego, 2004) that a child who is still non-verbal in school by the age of eight or nine is unlikely to talk at school until high school, or later (Blau, 2017).

Since children with SM appear to be extremely self-conscious, if SM persists, then it could severely impair their self esteem, which can make treating the disorder more difficult. Indeed older children with SM also display self-conscious tendencies which impair their self-esteem as they are continuously afraid of other people’s judgement. This is an aspect shared among other anxiety disorders, which are reported to be highly comorbid within each other (Sucheta et al., 2006). In particular selective mutism seems to be strictly related to social anxiety, also known as social phobia (SP). Cross-sectional comorbidity rates between SM and SP have been reported to range from 97% to 100% (Black & Uhde, 1995; Dummit et al., 1997). Indeed SM used to be considered a symptom of social phobia (Black & Uhde, 1995).

Since each pre-pubescent peer with SM expresses a unique combination of symptoms, treatments should be planned on an individual basis, considering a multi modal treatment approach and involving the patient’s family and the school staff (Sucheta et al., 2006) in order to avoid the persistence of the disorder during adolescence years.

Adolescence

Although selective mutism is usually discovered in early childhood, it may persist into adolescence. The Selective Mutism Information and Research Association (SMIRA) reveals that older children with selective mutism often have had the condition since childhood. Additionally, 90% of children who have selective mutism also have a social anxiety disorder (Blau, 2017). A 2019 study discovered that selective mutism in children aged 8 to 18 is associated with social anxiety disorder (SAD), as well as a fear of making mistakes, language-related fears, and voice-related fears (Muris & Ollendick, 2021). This same study found that up to 80% of these children living with selective mutism disorder also meet the diagnostic criteria for another anxiety disorder (Muris & Ollendick, 2021). Teenagers with selective mutism are typically aware of other people’s beliefs of them being a silent person (Fisher, 2020). They have been found to hide their social anxiety to seem “normal” (Blau, 2017). Teens can often develop unhealthy ways of dealing with this anxiety disorder, such as refusing to go to school or experiencing test anxiety (Fisher, 2020). Adolescents can often experience low self-esteem that may cause selective mutism to persist into their adulthood. However, adolescents with selective mutism may engage in therapy to work toward overcoming their anxiety and to prevent it persisting into adulthood (Blau, 2017). They can discover good coping mechanisms to overcome selective mutism by working with mental health specialists and learning techniques to express themselves. Through therapy sessions to overcome selective mutism, teens may practise presenting skills or small talk (Fisher, 2020). Cognitive Behavioural Therapy (CBT) can help adolescents recognise the negative thoughts that cause them to worry and replace them with positive thoughts and ideas (Yassin, 2023). Adolescents who don’t participate as much in CBT treatment can also take medications for selective mutism (Fisher, 2020). 

Selective mutism has been found to negatively affect adolescents in social and academic environments. In schools, teenagers with selective mutism might not have the same opportunities as their peers because they can’t interact with other people as easily. It can be difficult for these students to do basic tasks, such as asking a question aloud in a class or checking books out at a school library (Blau, 2017). Teens with selective mutism often experience a lot of fear of social situations and being in public around other people, which could be related to the high level of comorbidity between selective mutism and social anxiety. This fear makes it hard for adolescents with selective mutism to do daily activities in their lives (Yassin, 2023). Because it’s hard for older children with selective mutism to communicate with other children in school environments, they can be at risk of social isolation (Muris & Ollendick, 2021). People with selective mutism can also have other disorders including depression, panic disorders, and obsessive-compulsive disorder (Wong, 2010). This can put teens at risk of depression and suicidal thoughts (Blau, 2017). Due to these difficulties, many schools offer tracks such as the 504 plan or Individualised Education Plan (IEP) which can offer students accommodations (Fisher, 2020), such as access to school counselling, flexible attendance policies, and more time to complete school work. 

Adulthood

Although much less discussed, selective mutism can persist or even develop during adulthood and acts as a significant anxiety disorder that impairs communication within everyday life. Similarly to how the condition presents in childhood, selective mutism causes the affected adult to be unable to talk in certain social situations, despite being perfectly capable of doing so in others. This can severely hinder a person’s sociability and make it harder to remain employed, affecting one’s quality of life tremendously. 

Unfortunately, little research into selective mutism in adults has been completed, as the primary focus of work into the disorder tends to focus on those aged 5 and below. This is partly due to the condition first being labelled as a childhood disorder when it was discovered by Adolf Kussmaul (1877), initially referred to as aphasia voluntaria. Eventually, the name was changed to selective mutism under the new pretence that the behaviour was not voluntary and was instead due to high levels of physiological anxiety. Despite all of the further research done on the topic, we still know quite little about how and why it affects adults, largely due to it being far more likely to develop in children under the age of 3 (Standart & Couter 2003; Sharp et al. 2007). 

One piece of research that focuses on selective mutism in adults was an article covering how adults’ mental health is affected by selective mutism by Walker and Tobbell (2015). This qualitative analysis of four digital interviews from those aged 20+ who struggle with selective mutism aims to better understand how living with the condition as an adult can damage and affect one’s psyche. They performed a data analysis across these interviews and found recurring themes of isolation, dissociation, and the idea of a “waste or loss of life”. The study highlights how those affected by selective mutism often become isolated from society and lose their sense of identity, and these problems can then feed into their anxiety disorder, making the condition more prevalent. Despite the very small sample size, this research demonstrates the need for more support and understanding of how adults are affected by selective mutism and what can be done to alleviate the symptoms.

As mentioned, if the condition is not addressed thoroughly in childhood, it will not resolve itself and will likely continue to affect an individual into their adult life. However, the anxiety disorder rarely develops during adulthood with no history of prior symptoms. This can be caused by a connection to other anxiety disorders such as SAD (Social Anxiety Disorder), heightened sensitivity to the environment (which can lead to overstimulation and further anxiety), a fear of negative judgement from others (in the case of selective mutism, this is usually related to being afraid of peers finding the sufferer’s voice unintelligent), a lack of confidence, a strict upbringing which caused anxiety when talking to their parents, any underlying trauma that resurfaces in their adult years, and also certain genetic factors.

Furthermore, it is much harder to cure the symptoms of selective mutism as an adult, but there are ways to cope with the disorder. For example, by better understanding and remembering specific triggers for going mute, the sufferer can avoid these situations and live a normal life. Common triggers involve unfamiliar people or places, or large crowds and noises if they are easily overstimulated. These triggers can then be shared with close friends and family to better support loved ones affected by selective mutism. The condition can also be regulated by cognitive behavioural therapy in adults. CBT tries to take a gentle approach to try and help those with selective mutism overcome their fears in certain situations. It teaches practical skills to help reduce anxiety in situations in which sufferers would usually be unable to communicate, such as breathing techniques. It also aims to boost confidence in adults with SM, so that they may cope better and have fewer instances of going mute. A more specific treatment would be speech therapy, in which those with SM are gradually exposed to social situations and practise trying to talk to gradually build their confidence when expressing themselves while anxious. Research supports that this kind of treatment is effective in targeting SM (Bopp et al., 2004). However, the disorder becomes very difficult to cure completely at this stage of life, and will often continue to persist into an individual’s later years.

Geriatric

Since it is most commonly found within the early stages of life, selective mutism is often overlooked in adults entering the latter years of their life. In this section, we will focus on those over the age of 65 or past retirement age. While it is uncommon for major symptoms of selective mutism to not have met the diagnostic requirements prior to 65 years of age, there are some cases in which this has come to be, as well as other effects of the condition showing themselves in other facets of life. 

Upon diagnosis with selective mutism at an early age, it is common to see the symptoms and effects of the condition ease as time goes on, unless, as previously mentioned, SM is left untreated when discovered. However, if and when a person stays selectively mute into adulthood, this can have long term effects that move beyond being unable to speak in certain social situations. One of the many symptoms of selective mutism is social isolation, especially when moving into adulthood when many have the option to choose to remain home. In a study by Johns Hopkins University, it has been found that social isolation greatly increases the chances of developing dementia and other cognitive diseases (Crocker, 2023). If this is the case, avoiding social outings altogether because of selective mutism may increase the risk of  developing a degenerative disease. When present in the elderly, conditions like dementia greatly impact the quality of life of a person, and can even lead to death. Hence why catching selective mutism at an early stage is important, in order to reduce negative impacts of the disorder persisting into adulthood.

From a socioeconomic perspective, selective mutism can take a major toll on the late life stability that older adults may seek. Left untreated, selective mutism may lead to agoraphobia, the fear of leaving home or going to crowded places. This in turn can lead to a plethora of issues for a person both physically and socially, including in attempts to find employment. While not impossible to find work while being selectively mute or agoraphobic, options are limited and many come without health benefits or a consistent wage. In the long term, lower wages and lower quality health care is a major issue when it comes to the well-being of the elderly, and their retirement comfortability. Moreover, if someone is afraid to leave their house entirely they may overlook other health issues related to ageing in fear of going to the hospital, potentially leading to a very serious outcome. 

While moving into late stage life with selective mutism is unlikely, and treatment for the condition should be received early on, the effects of being selectively mute in the elderly are still prominent. When looking at its effects, we cannot just focus on the lack of speech as other symptoms can be just as (if not more) catastrophic, so while selective mutism may lessen as time goes on, the mental strain and potential cognitive issues associated with its symptoms may never lessen. Because of its effects throughout the lifespan, it is becoming more and more important to understand SM’s causes, and what we can do to prevent it.

Other Components

Selective mutism is hard to attribute purely to experience or purely to genetics, as both play a part. Selective mutism often has some sort of lifestyle and behavioural origin, but a patient could also have a genetic predisposition that causes them to be more susceptible to developing selective mutism. Unfortunately, due to often developing from experiences (e.g., neglect), it is often hard to diagnose in children, so it’s actually reported much less than it occurs (Rozenek, 2020). For example, there are symptoms other than an inability to speak, but those are rarely diagnosed because very little research is done on them (Vogel, 2024). Similarly, reports show that selective mutism is more common in females than it is in males. Realistically, this is most likely not because it occurs more frequently in females, but instead because it is more likely to be reported in females, whereas some males may also be afflicted with selective mutism but are unaware or unwilling to be formally diagnosed (ASHA, 2022).

Selective mutism could also be difficult to diagnose as it is often experienced in tandem with other diagnoses, including social anxiety disorder and autism spectrum disorder (ASD). Other speech impairments may also affect selective mutism and though anxiety is a prominent feature of selective mutism, other aspects of the disorder may imply greater similarity to ASD (Muris 2021). Specifically, the learning and social impairments that may occur due to communicative difficulties is characteristic of both selective mutism and ASD (Astendig, 1999). Typically, however, selective mutism is classified as an anxiety-based disorder, marking the inability to speak as a physical manifestation of the anxiety. Patients also tend to be diagnosed with some other kind of anxiety disorder at the same time as having selective mutism, specifically social anxiety disorder or generalised anxiety disorder. For example, a Norwegian study conducted with 54 children diagnosed with selective mutism showed that 46.3% of patients also met diagnostic criteria for other anxiety disorders (Rozenek, 2020). Thus, selective mutism is often treated as a byproduct of other anxiety disorders and patients undergo typical anxiety treatment to reduce the symptoms. When the treatment is focused on the speech difficulties within selective mutism, patients will often work with speech-language pathologists and therapists to address the mutism specifically (ASHA, 2022). As selective mutism is a behavioural manifestation and not a manifestation of a neurotransmitter deficit or excess, medication is typically not an option (Vogel, 2024).

Selective mutism is a disorder that forms a bridge between different approaches to psychology. It’s cognitive by definition, but potentially either psychodynamic or biological in origin. Hence, it requires study from different perspectives in order to gain a comprehensive understanding of the disorder to offer better treatment or proper diagnoses to patients. It’s also important to note that most of the research done on selective mutism is on children and adolescents. Thus, it would be important to study the development and effects of selective mutism in other age groups as well, given that there already is less of an understanding of the disorder overall, let alone in those groups where it is less common (Olivine, 2024). The classification of selective mutism as an anxiety disorder in the DSM-V is already questioned, due to these other components and factors regarding the disorder and its treatment.

It is difficult to describe an exhaustive set of the causes or demographics for selective mutism, as there are many factors that affect its development in children. However, studies have shown higher cases of selective mutism in children with higher levels of anxiety. In a study with 30 children, half monolingual and half bilingual, aged 3-5 years old, higher levels of anxiety were reported in the children with insufficient language reception skills, according to the paper written by Anja Starke. Additionally, the study found that while solely being bilingual was not a causal factor in  the development of selective mutism in the children, being bilingual and having higher levels of anxiety resulted in significantly more cases of the development of selective mutism. This indicates that selective mutism is not simply the result of difficulties with language. Having both an anxious mind and knowing a second language can increase risks of developing selective mutism. For example, children may not be able to speak their second language because they do not feel comfortable, whereas in some severe cases they can’t speak their second language in general, but can speak their first language without difficulty. According to “The Guide to Selective Mutism in Children” by the Child Mind Institute, clinicians are cautious treating and diagnosing selective mutism in children due to fear of misattributing symptoms to the condition, when it could simply be the results of the “silent period” of learning (2024). The “silent period” is the period of time in the learning process where children are able to understand and absorb the language they are learning, but can’t speak it or form their own sentences. Psychologists have to keep this in mind when diagnosing their patients, so that they don’t think their patient has selective mutism when, in reality, the patient just isn’t able to form their own phrases yet. 

Another aspect of life that can influence a child’s risk of developing selective mutism is family background and culture. Familial background, such as immigration status, can affect a child’s risk of developing selective mutism. One study shows that when comparing data of children affected by the disorder, immigrant children are three times as likely as native children to develop selective mutism, with a prevalence of 0.5% in native children, compared to 2.2% in immigrant children (Hu, 2022). This may be due to immigration trauma in tandem with the anxiety and stress that is linked with significant changes in one’s life, especially in children. As for the effects of culture on selective mutism, the cultural expectations and roles one has to play can affect children so severely that it causes the development of selective mutism. One of the most prominent countries when it comes to selective mutism at the moment is China (Hu, 2022). China has a large population of children that are left in the care of extended family or other relatives, and families in China have higher numbers of only children. Exploring these two factors, scientists were able to illustrate that having avoidant or absentee parents can significantly increase their child’s risks of developing SM (Hu, 2022). This was because the care and affection provided by parents and siblings play important roles in the lives of young children and their development. Hence, the absence of those familial figures could cause increased anxiety, decreased security and comfort, as well as heightened risks of selective mutism. This is a specific example as to how researchers were able to study and observe social and cultural differences between nations and correlate those observations with selective mutism, as well as provide reasonable evidence as to why their claims about the cultural effects on selective mutism are valid.

Conclusion

Selective mutism (SM) is classified as an anxiety disorder with an exceptional early onset, since its symptoms could be identified during infancy. But as our findings highlight, SM can persist or even develop later in life, impairing the lives of the people affected by it and potentially leading to the development of other anxiety disorders if left untreated.

The causes behind the development of SM are still unclear, though suggestions have been made. Thus, as of now, early diagnoses and proper treatment are essential in order to prevent the worsening of the symptoms and encourage the outgrowth of the disorder.

Ability Central. (2024). What keeps someone from talking? information you should know about muteness. https://abilitycentral.org/article/what-keeps-someone-talking-information-you-should-know-about-muteness?gad_source=1&gclid=Cj0KCQjwrKu2BhDkARIsAD7GBoto7OTaM2w4VLWG6SxdKRlnZU87dMw6V7OYAu4oWl6cnjvtFnGllWQaAqbAEALw_wcB.

​American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Publishing.

ASHA (2022). Selective mutism – ASHA. https://www.asha.org/Practice-Portal/Clinical-Topics/Selective-Mutism/.   

Astendig, K. (1999). Is selective mutism an anxiety disorder? Rethinking its DSM-IV classification.” Journal of Anxiety Disorders, Pergamon. 

Black, B., & Uhde, T. W. (1995). Psychiatric characteristics of children with selective mutism: a pilot study. Journal of the American Academy of Child & Adolescent Psychiatry, 34(7), 847–856. https://doi.org/10.1097/00004583-199507000-00007.

Blau, R. (2017). Info: Older children & teens. SMIRA. https://www.selectivemutism.org.uk/info-older-children-teens.  

Bopp, K. D., Brown, K. E., & Mirenda, P. (2004). Speech-language pathologists’ roles in the delivery of positive behaviour support for individuals with developmental disabilities. American Journal of Speech-Language Pathology, 13(1), 5–19. 

Chavira, D.A., Shipon-Blum, E., Hitchcock, C., Cohan, S., Stein, M.B. (2007). Selective mutism and social anxiety disorder: All in the family? Journal of the American Academy of Child & Adolescent Psychiatry; 46(11): 1464–1472.

Cohan, S. L., Chavira, D. A., & Stein, M. B. (2006). Practitioner review: Psychosocial interventions for children with selective mutism: A critical evaluation of the literature from 1990–2005. Journal of Child Psychology and Psychiatry.

Connolly, S. D., & Bernstein, G. A. (2007). Practice Parameter for the Assessment and Treatment of Children and Adolescents With Anxiety Disorders. Journal of the American Academy of Child & Adolescent Psychiatry, 46(2), 267–283. https://doi.org/10.1097/01.chi.0000246070.23695.06.

Crocker, K. (2023). New studies suggest social isolation is a risk factor for dementia in older adults, point to ways to reduce risk. Johns Hopkins Medicine. https://www.hopkinsmedicine.org/news/newsroom/news-releases/2023/01/new-studies-suggest-social-isolation-is-a-risk-factor-for-dementia-in-older-adults-point-to-ways-to-reduce-risk.  

Cummings, L. (2022). Selective mutism in immigrant children – uni scholarworks. Selective mutism in immigrant children. 

Cunningham, C.E., McHolm, A., Boyle, M.H., Patel, S. (2004). Behavioural and emotional adjustment, family functioning, academic performance, and social relationships in children with selective mutism. Journal of Child Psychology & Psychiatry; 45(8): 1363–1372.

Dow, S., Sonies, B., Scheib, D., Moss, S., Leonard, H. (1995). Practical guidelines for the assessment and treatment of selective mutism. Journal of the American Academy of Child and Adolescent Psychiatry, 34, pp. 836-846.

Dummit, E. S., Klein, R. G., Tancer, N. K., Asche, B., Martin, J., & Fairbanks, J. A. (1997). Systematic Assessment of 50 Children With Selective Mutism. Journal of the American Academy of Child & Adolescent Psychiatry, 36(5), 653–660. https://doi.org/10.1097/00004583-199705000-00016.

Emmanuel, M., & Bokor, B. R. (2020). Tanner Stages. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK470280/.

Essau, C. A. (2003). Comorbidity of anxiety disorders in adolescents. Depression and Anxiety, 18(1), 1–6. https://doi.org/10.1002/da.10107.

Fisher, J. (2020). Selective mutism in adolescence. Kurtz Psychology. https://www.kurtzpsychology.com/selective-mutism-in-adolescence/.  

Gensthaler, A., Khalaf, S., Ligges, M., Kaess, M., Freitag, C.M., Schwenck, C. (2016). Selective mutism and temperament: The silence and behavioural inhibition to the unfamiliar. European Child & Adolescent Psychiatry; 25(10): 1113–1120.

Hu, X., Reitman, J., & Pan, S. W. (2022). Selective mutism in China: A nationwide survey and Case-control study. medRxiv. 

Kagan, J. , Bornstein, Marc H. and Lerner,  Richard M. (2024). human behaviour. Encyclopedia Britannica. https://www.britannica.com/topic/human-behavior.

Keen, D.V., Fonseca, S., & Wintgens, A. (2016). Selective mutism: A retrospective case-note review of 100 referrals. Child and Adolescent Mental Health. 

Kristensen H. (2000). Selective mutism and comorbidity with developmental disorder/delay, anxiety disorder, and elimination disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 39(2): 249–256.

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. SpringerLink, Springer US. 

Oerbeck, B., Stein, M.B., Wentzel-Larsen, T., Langsrud, Ø., & Kristensen, H. (2018). A randomised controlled trial of a parent–child intervention for young children with selective mutism. Journal of the American Academy of Child & Adolescent Psychiatry. 

Olivine, A. (2024). Selective mutism in adults: Trauma link and coping. Verywell Health. https://www.verywellhealth.com/selective-mutism-in-adults-8631321.  

Robb-Dover, Kristina (2020). How to manage job-related agoraphobia problems. FHE Health. https://fherehab.com/learning/job-agoraphobia#:~:text=These%20kinds%20of%20roles%20include,Remote%20IT%20support. 

Rozenek, E.B., Orlof, W., Nowicka, Z.M., Wilczyńska, K., Waszkiewicz, N. (2020). Selective mutism – an overview of the condition and etiology: is the absence of speech just the tip of the iceberg?” PubMed, U.S. National Library of Medicine. 

Portsmouth City Council (2023). Selective mutism – Guidance for 11-16 year olds.https://www.portsmouth.gov.uk/services/health-and-care/health/mental-health/mental-health-support-for-young-people-semh/mental-health-support-guidance-for-11-16-year-olds/selective-mutism-guidance-for-11-16-year-olds/#:~:text=It%20can%20persist%20into%20adulthood,any%20child%20or%20young%20person.  

Sharp, W.G., Sherman, C., & Gross, A.M. (2007). Selective mutism and anxiety: A review of the current conceptualization of the disorder. Journal of Anxiety Disorders, 21(4), 568–579. 

Slobodin, O., Shorer, M., Friedman-Zeltzer, G., & Fennig, S. (2023). Selective mutism in immigrant families: An ecocultural perspective. Transcultural Psychiatry, 61(1), 15–29.

Standart, S., & Couteur, A. L. (2003). The quiet child: A literature review of selective mutism. Child and Adolescent Mental Health, 8(4), 154–160.

Starke, A. (2018). Effects of anxiety, language skills, and cultural adaptation on the development of selective mutism. Journal of Communication Disorders.    

Stein, M.B., Yang, B-Z, Chavira, D.A., Hitchcock, C.A., Sung, S.C., Shipon-Blum, E., Gelernter, J. (2011). A common genetic variant in the neurexin superfamily member CNTNAP2 is associated with increased risk for selective mutism and social anxiety-related traits. Biological Psychiatry, 69(9): 825–831.

Steinhausen, H., Juzi, C. (1996). Elective mutism: An analysis of 100 cases. Journal of the American Academy of Child and Adolescent Psychiatry, 35, 606-614.

Stone, W. L., Ruble, L. A., Coonrod, E. E., & Hepburn, S. L. (2002). Brief report: Psychosocial characteristics of children with selective mutism and developmentally matched peers: A research note. Journal of Autism and Developmental Disorders. 

Strong, R. (2022). Can adults have selective mutism?. Healthline. https://www.healthline.com/health/anxiety/adult-selective-mutism#causes-in-adults.  

Sussex Publishers. (2021). Selective mutism. Psychology Today. https://psychologytoday.com/us/conditions/selective-mutism#:~:text=Selectively%20mute%20teens%20may%20also,or%20is%20in%20a%20daze.  

Vogel, F., Röse, C., & Schwenck, C. (2024). Symptoms of selective mutism beyond failure to speak in children and adolescents. European Child & Adolescent Psychiatry. 

Walker, A. S., & Tobbell, J. (2015). Lost voices and unlived lives: Exploring adults’ experiences of selective mutism using interpretative phenomenological analysis. Qualitative Research in Psychology, 12(4), 453–471. 

Wang, R., & Monga, S. (2023). Practical tips for paediatricians: helping kids find their voices in selective mutism. Paediatrics & Child Health, 29(1), 7–9. 

Wong, P.  (2010). Selective mutism: A review of aetiology, comorbidities, and treatment. Psychiatry 7(3): 23-31.

Yassin, F. (2023). Understanding selective mutism in teens. thewaveclinic.com. https://thewaveclinic.com/blog/understanding-selective-mutism-in-teens/.