Selective Mutism
Selective mutism is an anxiety-based communication disorder in which those affected do not speak in certain social situations – even though they can speak normally in familiar environments. With the right therapeutic approach, anxiety-free communication can be built up step by step.
What is selective mutism?
Selective mutism is not a choice or defiance – it is an anxiety-driven response of the nervous system. Those affected speak normally at home or with trusted people, but fall silent in social situations such as nursery, school or with strangers.
The condition typically begins in the preschool years and often only becomes apparent when a child starts nursery or school. The earlier it is identified and treated, the better the prognosis.
Signs and characteristics
- Speaking in familiar environments (at home, with close caregivers), silence in social situations
- Physical tension, freezing or withdrawal in anxiety-provoking situations
- Non-verbal communication (nodding, pointing, writing) as a substitute for speaking
- Often co-occurring: social anxiety, separation anxiety or general shyness
- Educational and social limitations due to lack of verbal participation
Causes and development
Selective mutism is not caused by trauma or low intelligence. It arises from an interplay of innate anxiety, temperament and triggering situations – often reinforced by unconscious avoidance in the social environment.
Multilingual children are sometimes misdiagnosed, as language switching can present with similar patterns. A thorough differential diagnosis is therefore important.
Our approach: DortMuT®
Our practice director Paula Kasischke is a certified selective mutism therapist trained in DortMuT® (Dortmund Mutism Therapy). DortMuT® is an evidence-based, behaviourally oriented approach developed specifically for selective mutism.
Therapy works through graduated exposure to anxiety-provoking situations – in small, child-friendly steps. School, nursery and family are actively involved so that progress happens and is consolidated in everyday life.
Therapy process
- 1Comprehensive assessment: speaking across situations, anxiety profile, environment analysis
- 2Parent consultation: understanding triggers, maintenance factors and helpful strategies
- 3Building an anxiety-free therapeutic relationship
- 4Graduated exposure: stepwise expansion of the speaking circle
- 5Transfer to nursery, school and everyday situations
- 6Coordination with teachers and caregivers
Frequently asked questions
Is selective mutism a form of autism?
No. Selective mutism is a distinct anxiety-based communication disorder, not an autism spectrum disorder. Both can occur together, however – careful differential diagnosis is important.
From what age can therapy begin?
The earlier the better. Therapy is possible and beneficial from preschool age. Early intervention prevents avoidance patterns from becoming entrenched and reduces the risk of educational disadvantage.
Does pressure or prompting to speak cause harm?
Yes. Pressure, demands to speak or reward systems without a therapeutic framework are usually counterproductive and increase anxiety. Therapy deliberately uses anxiety-free communication and graduated exposure rather than confrontation.
Who makes the diagnosis and who issues the referral?
The diagnosis is made by child and adolescent psychiatrists or psychologists. A speech therapy prescription can be issued by paediatricians, child and adolescent psychiatrists or school doctors.
Ready for the next step?
Book your first appointment online or get in touch with our practice in Erding.