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Selective Mutism Guidance for Schools 2025 Durham EPS

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Selective Mutism Information & Research Association (SMIRA)

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Selective Mutism (SM) is a communication anxiety disorder. This site contains information on and support for parents, people with SM, and professionals.

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Selective Mutism Information & Research Association (SMIRA)

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Selective Mutism (SM) is a communication anxiety disorder. This site contains information on and support for parents, people with SM, and professionals.

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Derby Council 2020 Selective Mutism Guide for Schools

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Leicester Council (2018) SM Resource Pack

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When-the-words-wont-come-out A booklet about SM for teenagers and adults

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Selective Mutism - Key Information Infographic

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Selective Mutism - Key Information Infographic

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Selective Mutism Infographic - Key Information 

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A 15-year-old girl with a condition that makes it hard to talk says she wants to fulfil her dream of performing on stage.
Scarlett, from Flintshire, has selective mutism, a severe anxiety disorder that leaves people unable to speak in certain situations and left her off school for two years.

Along with Lucia, 17, from Swansea, she said a lack of awareness and understanding about the condition could make things worse.

About one in 140 young people are affected, according to NHS estimates.

The NHS says that a child or adult with selective mutism "does not refuse or choose not to speak at certain times, they're literally unable to speak".

"The expectation to talk to certain people triggers a freeze response with feelings of anxiety and panic, and talking is impossible."

Scarlett describes herself as "really chatty" and someone who loves musical theatre, but she can feel overwhelmed with anxiety around other children in school.

"I'm just constantly thinking 'what is that person thinking about me?' And then you're like 'I'm just not going to say anything'," she said.

"I think it's your mind telling you 'no, don't say that'."

At the age of 13, she stopped going to school and did not go back for almost two years.

"Not many people know about it, you can feel quite lonely and isolated most of the time," she said.

Scarlett was diagnosed with selective mutism at the age of eight, although her parents, Steve and Emma, believe she started showing signs as young as five.

"It's been a really long time of struggles and appointments, referrals and just not being settled really, and not being very happy in that time either," said Emma.

The couple described visiting a wide range of professionals, from psychologists to hypnotherapists, with no results.

"I spoke to somebody once that they've been in the profession as a psychologist for 25 years, and they said I probably knew more than they did, so that was a bit of a worry," Emma added.

What is selective mutism?

Selective mutism can start at any age but most often begins in early childhood between the ages of two and four.

The main sign is a marked contrast in the child's ability to engage with different people, a sudden stillness or frozen facial expression when talking to someone outside their comfort zone.

Experts regard selective mutism as a fear or phobia of talking to certain people, the cause is not always clear, but is associated with anxiety.

A child can successfully overcome selective mutism if it is diagnosed at an early age and appropriately managed.

Scarlett's dad Steve said it could be difficult to deal with the lack of understanding from others.

"She is very talkative, outgoing, very social, and she wants to do what every other boy and girl her age is doing: basically, going to the shops, going to the cinema.

"The selective mutism, over the years, has stopped that," he added.

For Lucia from Swansea, selective mutism is also a barrier to her going to school, college or getting a job.

"It's really hard, because it feels like everyone else is moving on with their lives, and I'm just stuck doing nothing," she said.

The 17-year-old said she had whole conversations planned in her head, but her voice completely disappears.

"It is like I just stand with my mouth open, and all I really want to do is just cry, because I'd love to have normal conversations with people, but the words just will not come out," she added.

She has tried numerous therapies but, with limited results, she is worried about her future.

"It's been really hard - because people don't know about it, they don't know how to help," she added.

Anita McKiernan, a specialised speech and language therapist, said there had been poor awareness and understanding of the condition for decades.

She said more research and more specialist therapists meant things had "significantly improved" over the past five years, albeit from a "low base".

Ms McKiernan, an adviser to the Royal College of Speech and Language Therapists in selective mutism, added the condition, while thought of as rare, was relatively common, especially in pre-school children.

"The entire early years in school workforce also need to be trained in how to identify and effectively manage selective mutism because they're on the front line of picking it up, and the delays tend to occur because staff may be thinking that the child will grow out if it," she said.

The Welsh government said: "Practitioners need to be upskilled to support children and young people with speech, language and communication needs and our Talk with Me delivery plan aims to achieve this.

"We are also developing resources aimed at parents and teaching staff to provide universal and targeted support for children with selective mutism."

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Selective Mutism: 'I struggle to talk but dream of being on stage'

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A lack of awareness of selective mutism is making diagnosis life worse for families living with it.

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When I was performing in pantomimes last year I was in a different changing room to my mum. The other girls were playing games but I could not join in, so I was sat on the sidelines.

Because I cannot talk or join in, I just end up watching.

I can do impressions of people really well, so I can describe all the conversations to my mum when I get home.

I remember what everyone was saying - they think I am not interested but I am.

When I am performing, it is different. I still cannot talk but I feel like I have power.

It is the only time I can look like I can do something, to be part of a show with everyone else. It is not just me on my own.

I like being with people and performing with a big audience. There are a lot of people but they are not expecting me to talk to them, and I know what I have rehearsed and feel confident.

I like the music and I have to wear earplugs, but I like the audience smiling and clapping and having them watch me. I can smile then. I am different.

Earlier this month I held a charity talent show called Uniquely Me. I managed to make a short speech after weeks of practice.

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Selective mutism: 'People think I'm rude but I'm frozen with fear'

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Daisy-Mae, from Essex, has an anxiety condition that causes her to freeze.

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Child therapist raises awareness of selective mutism

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The condition affects one in every 140 children and is often dismissed as shyness or rudeness.

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Selective mutism families left ‘isolated’ due to lack of care

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Joanna Turner, whose daughter, four, has selective mutism, is calling for better care for sufferers.

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‘That’s not Maebel, she’s so fun’: the rising number of children who are afraid to talk

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Cases of selective mutism, a complex anxiety disorder, are growing in Australia, apparently exacerbated by pandemic lockdowns

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A moment that changed me: a teacher’s acceptance of my silence | Phoebe-Jane Boyd

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I stopped talking in the 80s, and my selective mutism marked me out as a strange, silent kid. But one teacher helped me begin to find my voice

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The common condition that leaves children unable to speak for years

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One in 150 children are thought to experience the condition which can leave children unable to speak to people outside their family or immediate social circle for years

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Support for Parents of Children with Selective Mutism

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Led by Lucy Nathanson, our team of specialist therapists supports children with selective mutism, offering tailored therapy and guidance for parents

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How to help a child with SM cope with family gatherings

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How to help a child with SM cope with family gatherings

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Selective Mutism training for schools, settings and services

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Free online training for parents, schools and other professionals

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Free online training for parents, schools and other professionals

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A series of five free online training sessions about selective mutism. The sessions are grouped according to their suitability for supporting selective mutism in the Early Years, Primary School years or Secondary School years (and beyond). The sessions can be accessed at your own pace and as many times as you like.

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Kent Community Health NHS Foundation Trust

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Selective mutism (SM) is used as a term to describe children and young people (CYP) who are able to talk comfortably to some people, such as family members and close friends, but are silent or unable to talk freely when other people are present. There is no guarantee that CYP who have SM will overco…

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Podcast episode exploring the hidden world of selective mutism and empowering strategies to help children find their voices.

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Free online training for parents, schools and other professionals

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Free online training for parents, schools and other professionals

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A series of five free online training sessions about selective mutism. The sessions are grouped according to their suitability for supporting selective mutism in the Early Years, Primary School years or Secondary School years (and beyond). The sessions can be accessed at your own pace and as many times as you like.

# data[].attributes.attachment_link.provider_name
Kent Community Health NHS Foundation Trust

# data[].attributes.attachment_link.description
Selective mutism (SM) is used as a term to describe children and young people (CYP) who are able to talk comfortably to some people, such as family members and close friends, but are silent or unable to talk freely when other people are present. There is no guarantee that CYP who have SM will overco…

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Selective Mutism Awareness in Schools - free webinar

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Selective Mutism Awareness in Schools - free webinar

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A free 30 minute webinar from the St George's NHS Trust, specifically aimed at supporting school staff who are working with students experiencing selective mutism.

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St George’s, Epsom and St Helier Hospital Group

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A one-page information sheet for parents and professionals explaining how Selective Mutism might be understood as a phobia of speaking / the expectation to speak to certain people in certain situations.

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NHS advice and information about Selective Mutism

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NHS advice and information about Selective Mutism

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Selective mutism is an anxiety disorder where a person is unable to speak in certain social situations, such as with classmates at school or to relatives they do not see very often.
It usually starts during childhood and, if left untreated, can persist into adulthood.

A child or adult with selective mutism does not refuse or choose not to speak at certain times, they're literally unable to speak.

The expectation to talk to certain people triggers a freeze response with feelings of anxiety and panic, and talking is impossible.

In time, the person may learn to anticipate the situations that provoke this distressing reaction and do all they can to avoid them.

However, people with selective mutism are able to speak freely to certain people, such as close family and friends, when nobody else is around to trigger the freeze response.

Selective mutism affects about 1 in 140 young children. It's more common in girls and children who have recently migrated from their country of birth.

Signs of selective mutism

Selective mutism can start at any age, but most often starts in early childhood, between age 2 and 4. It's often first noticed when the child starts to interact with people outside their family, such as when they begin nursery or school.

The main warning sign is the marked contrast in the child's ability to engage with different people, characterised by a sudden stillness and frozen facial expression when they're expected to talk to someone who's outside their comfort zone.

They may avoid eye contact and appear:

nervous, uneasy or socially awkward

rude, disinterested or sulky

clingy

shy and withdrawn

stiff, tense or poorly co-ordinated

stubborn or aggressive, having temper tantrums when they get home from school, or getting angry when questioned by parents

More confident children with selective mutism can use gestures to communicate - for example, they may nod for "yes" or shake their head for "no".

But more severely affected children tend to avoid any form of communication - spoken, written or gestured.

Some children may manage to respond with a few words, or they may speak in an altered voice, such as a whisper.

What causes selective mutism

Experts regard selective mutism as a fear ( phobia) of talking to certain people. The cause is not always clear, but it's known to be associated with anxiety.

The child will usually have a tendency to anxiety and have difficulty taking everyday events in their stride.

Find out more about anxiety in children.

Many children become too distressed to speak when separated from their parents and transfer this anxiety to the adults who try to settle them.

If they have a speech and language disorder or hearing problem, it can make speaking even more stressful.

Some children have trouble processing sensory information such as loud noise and jostling from crowds - a condition known as sensory integration dysfunction.

This can make them "shut down" and be unable to speak when overwhelmed in a busy environment. Again, their anxiety can transfer to other people in that environment.

When mutism occurs as a symptom of post-traumatic stress, it follows a very different pattern and the child suddenly stops talking in environments where they previously had no difficulty.

Another misconception is that a child with selective mutism is controlling or manipulative, or has autism. There's no relationship between selective mutism and autism, although a child may have both.

Diagnosing selective mutism

Left untreated, selective mutism can lead to isolation, low self-esteem and social anxiety disorder. It can continue into adolescence and adulthood if not managed.

Diagnosis in children

A child can successfully overcome selective mutism if it's diagnosed at an early age and appropriately managed.

It's important for selective mutism to be recognised early by families and schools so they can work together to reduce a child's anxiety. Staff in early years settings and schools may receive training so they're able to provide appropriate support.

If you suspect your child has selective mutism and help is not available, or there are additional concerns - for example, the child struggles to understand instructions or follow routines - speak to a GP and ask them to refer you to a local specialist service for a formal diagnosis.

You can also contact a speech and language therapy clinic directly. Do not accept the opinion that your child will grow out of it or they are "just shy".

Your GP or local integrated care board (ICB) should be able to give you the telephone number of your nearest NHS speech and language therapy service or another specialist service that can help in your area.

Your child may also need to see a mental health professional or school educational psychologist.

The clinician may initially want to talk to you without your child present, so you can speak freely about any anxieties you have about your child's development or behaviour.

They'll want to find out whether there's a history of anxiety disorders in the family, and whether anything is causing distress, such as a disrupted routine or difficulty learning a second language. They'll also look at behavioural characteristics and take a full medical history.

A person with selective mutism may not be able to speak during their assessment, but the clinician should be prepared for this and be willing to find another way to communicate.

For example, they may encourage a child with selective mutism to communicate through their parents, or suggest that older children or adults write down their responses or use a computer. They may watch the child playing or watch a video of them speaking in a comfortable environment.

Diagnosis in adults

It's possible for adults to overcome selective mutism, although they may continue to experience the psychological and practical effects of spending years without social interaction or not being able to reach their academic or occupational potential.

Adults will ideally be seen by a mental health professional with access to support from a speech and language therapist or another knowledgeable professional.

Diagnosis guidelines

Selective mutism is diagnosed according to specific guidelines. These include observations about the person concerned as outlined:

they do not speak in specific situations, such as during school lessons or when they can be overheard in public

they can speak normally in situations where they feel comfortable, such as when they're alone with parents at home, or in their empty classroom or bedroom

their inability to speak to certain people has lasted for at least 1 month (2 months in a new setting)

their inability to speak interferes with their ability to function in that setting

their inability to speak is not better explained by another behavioural, mental or communication disorder

Associated difficulties

A child with selective mutism will often have other fears and social anxieties, and they may also have additional speech and language difficulties.

They're often wary of doing anything that draws attention to them because they think that by doing so, people will expect them to talk.

For example, a child may not do their best in class after seeing other children being asked to read out good work, or they may be afraid to change their routine in case this provokes comments or questions. Many have a general fear of making mistakes.

Accidents and urinary infections may result from being unable to ask to use the toilet and holding on for hours at a time. School-aged children may avoid eating and drinking throughout the day so they do not need to excuse themselves.

Children may have difficulty with homework assignments or certain topics because they're unable to ask questions in class.

Teenagers may not develop independence because they're afraid to leave the house unaccompanied. And adults may lack qualifications because they're unable to participate in college life or subsequent interviews.

Treating selective mutism

With appropriate handling and treatment, most children are able to overcome selective mutism. But the older they are when the condition is diagnosed, the longer it will take.

The effectiveness of treatment will depend on:

how long the person has had selective mutism

whether or not they have additional communication or learning difficulties or anxieties

the co-operation of everyone involved with their education and family life

Treatment does not focus on the speaking itself, but reducing the anxiety associated with speaking.

This starts by removing pressure on the person to speak. They should then gradually progress from relaxing in their school, nursery or social setting, to saying single words and sentences to one person, before eventually being able to speak freely to all people in all settings.

The need for individual treatment can be avoided if family and staff in early years settings work together to reduce the child's anxiety by creating a positive environment for them.

This means:

not letting the child know you're anxious

reassuring them that they'll be able to speak when they're ready

concentrating on having fun

praising all efforts the child makes to join in and interact with others, such as passing and taking toys, nodding and pointing

not showing surprise when the child speaks, but responding warmly as you would to any other child

As well as these environmental changes, older children may need individual support to overcome their anxiety.

Cognitive behavioural therapy

Cognitive behavioural therapy (CBT) helps a person focus on how they think about themselves, the world and other people, and how their perception of these things affects their thoughts and feelings. CBT also challenges fears and preconceptions through graded exposure.

Behavioural therapy

Behavioural therapy concentrates on helping combat current difficulties using a gradual step-by-step approach to help conquer fears.

Techniques

There are several techniques based on CBT and behavioural therapy that are useful in treating selective mutism. These can be used at the same time by individuals, family members and school or college staff, possibly under the guidance of a speech and language therapist or psychologist.

Graded exposure

In graded exposure, situations causing the least anxiety are tackled first. With realistic targets and repeated exposure, the anxiety associated with these situations decreases to a manageable level.

Older children and adults are encouraged to work out how much anxiety different situations cause, such as answering the phone or asking a stranger the time.

Stimulus fading

In stimulus fading, the person with selective mutism communicates at ease with someone, such as their parent, when nobody else is present.

Another person is gradually introduced into the situation and, once they're included in talking, the parent withdraws. The new person can introduce more people in the same way.

Shaping

Shaping involves using any technique that enables the person to gradually produce a response that's closer to the desired behaviour.

For example, starting with non-verbal communication, gradually moving to making eye contact, saying short words and then longer sentences and, finally, 2-way conversation.

Positive and negative reinforcement

Positive and negative reinforcement involves responding favourably to all forms of communication and not inadvertently encouraging avoidance and silence.

If the child is under pressure to talk, they'll experience great relief when the moment passes, which will strengthen their belief that talking is a negative experience.

Desensitisation

Desensitisation is a technique that involves reducing the person's sensitivity to other people hearing their voice by sharing voice or video recordings.

For example, email or instant messaging could progress to an exchange of voice recordings or voicemail messages, then more direct communication, such as telephone or Skype conversations.

You could also record your child at home and encourage them to watch or listen to themselves speaking.

Medicine

Medicine is only really appropriate for older children, teenagers and adults whose anxiety has led to depression and other problems.

Medicine should never be prescribed as an alternative to environmental changes and behavioural approaches. Though some health professionals recommend using a combination of medicine and behavioural therapies in adults with selective mutism.

However, antidepressants may be used alongside a treatment programme to decrease anxiety levels, particularly if previous attempts to engage the individual in treatment have failed.

Advice for parents

Do not pressurise or bribe your child to encourage them to speak.

Let your child know you understand they're scared to speak and have difficulty speaking at times. Tell them they can take small steps when they feel ready and reassure them that talking will get easier.

Do not praise your child publicly for speaking because this can cause embarrassment. Wait until you're alone with them and consider a special treat for their achievement.

Reassure your child that non-verbal communication, such as smiling and waving, is fine until they feel better about talking.

Do not avoid parties or family visits, but consider what environmental changes are necessary to make the situation more comfortable for your child.

Ask friends and relatives to give your child time to warm up at his or her own pace and focus on fun activities rather than getting them to talk.

As well as verbal reassurance, give them love, support and patience.

Getting help and support

Teenagers and adults with selective mutism can find information and support at iSpeak and the Facebook group SM SpaceCafe.

The Selective Mutism Information and Research Association (SMiRA) is another good resource for people affected by selective mutism. There's also a SMiRA Facebook page.

The Royal College of Speech and Language Therapists and the Association of Speech and Language Therapists in Independent Practice can help you find professionals in your area with experience in treating selective mutism.

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Find out about selective mutism, an anxiety disorder that prevents people from speaking in certain social situations.

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This is a recording of an initial Selective Mutism training session delivered by Newcastle Educational Psychology Service. It is for use by those schools, settings and services who have already received training and who may wish to cascade it to colleagues.

This document is password protected, so please contact the Educational Psychologist who delivered your training session for access details.

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Selective Mutism Training Webinar access details

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Confident Talking – The Stages of One-to-One Interaction
This guide outlines nine stages of how children with selective mutism may communicate during one-to-one interactions – from Stage 0: Absent to Stage 8: Conversation. It helps parents and professionals recognise the different ways a child might engage, even when they are not speaking. Children may move back and forth between stages depending on how safe or anxious they feel. Understanding these patterns allows adults to respond in ways that support the child without adding pressure.

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Confident talking - stages of one-to-one interaction

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High- and Low-Profile Presentations of Selective Mutism

This infographic helps professionals understand how selective mutism can present in more or less obvious ways. High-profile cases are easier to identify, with children showing clear signs of communication anxiety such as freezing or complete silence. In contrast, low-profile presentations may involve minimal but functional speech, making the child’s difficulties harder to detect and more likely to be misunderstood or overlooked.