What are the signs and symptoms of SM? Hint: It’s not just shyness. Selective mutism is an anxiety disorder, usually diagnosed in childhood, in which an individual is nonverbal in certain settings and situations, despite being able to communicate when comfortable or at home. If you know a child who displays the following behaviors, you may know a child with SM:

• Speaks freely at home and with family but is nonverbal due to anxiety in public settings or around strangers

• Is paralyzed with fear or shuts down completely when unable to communicate

Additionally, those with SM may also:

• Struggle to make eye contact when uncomfortable

• Present as behaviorally inhibited

• Rely on pointing, nodding, writing, and other forms of nonverbal communication to answer questions

• Speak through a trusted individual—e.g., whispering an answer to a question to a parent or friend at school

Selective mutism often co-occurs with other forms of anxiety, particularly social anxiety. A child is diagnosed with SM when the pattern of being unable to speak is persistent over time and causes significant impairment in daily functioning. An SM diagnosis is likely if it is difficult for a child to effectively participate in school or form friendships with other students their age due to an inability to speak in public.

Individuals with SM do not simply “grow out” of the disorder, and factors like over-accommodation and co-occurring conditions may exacerbate symptoms. Help and treatment is available. Exposure and response prevention, as well as PCIT-SM has proven to be effective in treating selective mutism.