Episode 71 features our latest installment of our Ask Dr. E series, where Dr. Elisa Shipon-Blum and Dr. Jenna Blum answer real questions from our Unspoken Words listeners about selective mutism across different ages and settings. 

During this discussion, Dr. E and Dr. Jenna break down the “why” behind common SM challenges — from behavioral dysregulation to family patterns to lack of motivation — and remind us that understanding the whole child, not just the symptom of not speaking, is the foundation of everything that comes next. 

They emphasize that every child is different, and there’s no one-size-fits-all strategy — only deep understanding, compassion, and meeting children where they truly are.

Dysregulation Masquerading as Defiance: Understanding Behavioral Challenges in Verbal Children with SM 

A parent asks about their 4-year-old who talks easily with peers but becomes bossy, mean, and physical when she doesn’t get her way. Dr. Jenna explains: dysregulation, not defiance. When children feel out of control, controlling behavior becomes a coping mechanism. SM is social communication anxiety, and anxiety manifests in maladaptive ways. 

The real work isn’t speech — it’s understanding: Does this child have social reciprocity? Sensory dysregulation? Executive function challenges? What’s her pretend play like at home? Dr. E emphasizes that treating to speak without understanding underlying factors means missing the whole picture. The point isn’t the speech — it’s treating the whole person.

It’s Not Genetic, It’s the Anxiety: Understanding SM in Siblings 

A parent explores whether SM runs in families and how to support a younger sibling when an older one has SM. Dr. E clarifies: SM itself is not hereditary. What runs in families is the genetic predisposition to anxiety — the timid temperament, the social anxiety. The manifestation differs in each child. 

Dr. Jenna adds: 80-90% of families fit within this structure of inherited anxiety. But assess each child separately. Is your 2-year-old innately timid, or mimicking their older sibling? Whether or not a child has SM, SCAT strategies work for any anxious child. Post-Covid, families need exposures, exposures, exposures. 

Don’t wait — facilitate. Even a 2-year-old benefits from playdate experiences that build social comfort.

When School Changes Everything: Distinguishing School Separation Anxiety from SM 

A parent asks about their 7-year-old who is verbal with friends but suddenly struggles to separate from parents and enter school — unlike in kindergarten. Dr. E reminds us: SM doesn’t cause anything. It’s a result of. Something changed. The classroom got louder. The teacher changed. A peer made comments. 

Dr. Jenna emphasizes: Look, listen, and learn. What’s different about this specific classroom? Comfort and communication change from setting to setting. A child might have separation anxiety, social anxiety, or generalized anxiety layered on SM. 

The solution isn’t focusing on speech. It’s creating comfort through buddy systems, teacher partnerships, and parental calm. Meet the child where they’re at, not before they feel safe. Parental anxiety gets transmitted — your modeling matters.

Whispering Isn’t Refusing: Why Acceptance Unlocks Volume 

A child in Stage 3 whispers and “refuses” to use his full voice. Dr. E clarifies: We don’t focus on whispering — it emphasizes anxiety. Whispering is a natural step in the process. It’s okay. What creates a chronic whisper? Pressure. “You need to talk. You need to talk.” When we push, we create avoidance. 

Dr. Jenna shares a strategy: acceptance paired with visuals and choice. When a teen whispers their answer, accept it without fanfare. Over time, volume increases naturally. 

Some children hear their own voice louder in their head, so whispering regulates them in loud environments. Reading and peer interaction naturally increase volume.

No Motivation Isn’t Laziness: It’s a Signal 

A parent asks about their 13-year-old who has been mute since pre-K, refuses accommodations, and shows “no motivation.” Dr. Jenna introduces motivational interviewing and the 0-10 motivation scale. Even a teen at “2” or “3” is motivated — there’s just uncertainty. Meeting them where they’re at, not imposing goals, helps teens articulate what they want. 

Dr. E dives deeper: Lack of motivation signals something else. Are parent and teen disconnected? Has treatment been unrealistic? Is there undiagnosed autism or social communication challenges? Has the child been so misunderstood they’ve learned to shut down? 

The critical mistake: expecting the child to “be brave” without a roadmap. When we meet them where they are, acknowledge what we learned wrong, and help them see what they can do — something shifts. We open a door.

Key Takeaways from Episode 71

  • Dysregulation masquerades as defiance — understanding the underlying “why” is critical
  • SM isn’t genetic, but the anxiety predisposition is — and it manifests differently in each child
  • School separation anxiety is setting-specific — something changed, and that something matters
  • Whispering is progress, not refusal — acceptance unlocks volume naturally
  • Lack of motivation often signals disconnection, unrealistic expectations, or undiagnosed underlying challenges
  • The home environment is the diagnostic North Star — SM symptoms are setting-specific; other challenges persist across all settings
  • Parental modeling of anxiety gets transmitted to children — your calm matters
  • SCAT strategies benefit all anxious and timid children, regardless of SM diagnosis
  • Meeting children where they are — not where we want them to be — shifts everything
  • Every child is different — there’s no one-size-fits-all strategy, only deep understanding and compassion

Final Thoughts

The behaviors may look similar across children. The reasons behind them rarely are. As Dr. E and Dr. Jenna remind us throughout this episode, understanding the “why” behind a child’s shutdown — whether it’s dysregulation, anxiety, disconnection, or something we haven’t discovered yet — isn’t just a clinical exercise. It’s the foundation of everything that comes next. When families finally understand their child through this lens, something profound shifts. There’s nothing wrong with your child. It’s just hard. And hard things, with the right understanding and support, can be navigated.