By Dr. Elisa Shipon Blum

Many adults look back on their childhood and remember the intense silence that came with Selective Mutism (SM). 

For some, speech gradually returned, and they moved on. But for others, even when the silence faded, lingering struggles remained. Social anxiety. Depression. Trouble making or keeping friends. 

You might wonder:

💭 “If I overcame SM as a kid, why am I still struggling now?”

In a recent Ask Dr. E podcast episode, Dr. Elisa Shipon-Blum, creator of the Social Communication Anxiety Treatment® (S-CAT®) model, addressed this exact question from a listener – an adult male in his 30s who shared:

“I had SM from ages 3-7. I eventually got over it through therapy and medication. As an adult, I’m functional – I have a job and can speak to others. But I’m still very shy, anxious, and depressed. I isolate a lot and have trouble maintaining friendships and relationships.”

🧠 Why Do Lingering Issues Happen?

Dr. E explained that while Selective Mutism is a symptom of underlying factors – such as social anxiety, sensory processing differences, language processing challenges, behavioral inhibition, or even undiagnosed autism spectrum traits – those underlying factors don’t always disappear just because the silence does.

👉 Key reasons lingering struggles continue:

  1. Social Communication Confidence never fully developed.
    • Even if you gained the ability to speak, you may never have practiced or internalized the nuanced skills of back-and-forth conversation, interpreting body language, initiating interactions, or navigating group settings with confidence.
  1. Residual Social Anxiety.
    • Anxiety patterns from childhood can remain in your nervous system, triggered by social expectations, uncertainty, or fear of judgment.
  1. Possible Co-existing Challenges.
    • Dr. E emphasized the importance of assessing for:
      • 🚨 Language processing difficulties (difficulty finding words or organizing thoughts under pressure)
      • 🚨 Reading social cues (understanding humor, sarcasm, indirect requests)
      • 🚨 Executive functioning challenges (planning, organizing conversations, shifting topics)
      • 🚨 Undiagnosed neurodevelopmental differences, like Autism Spectrum Disorder or Social (Pragmatic) Communication Disorder.
  1. Depression and Isolation.
    • Long-term anxiety and lack of fulfilling social relationships can lead to depressive symptoms, which then further reduce motivation to engage with others – creating a reinforcing cycle.

💡 What Can Adults Do?

Dr. E shared that overcoming these struggles requires more than just “exposures” (like forcing yourself into social situations). Instead, it involves building structured social communication skills and working with a therapist to navigate specific challenges.

Here’s what she recommends:

✅ Map Out Social Interactions.

  • Practice action plans before events:
  • Where are you going?
  • Who will be there?
  • What might they ask?
  • What will you say?
  • What can you ask in return?
  • Predicting common questions reduces anxiety and processing demands in the moment.

✅ Build Skills Gradually.

  • Start with low-pressure situations where you already have some confidence (e.g., ordering coffee, small talk with neighbors) before tackling higher-pressure settings like staff meetings or group gatherings.

✅ Assess Underlying Challenges.

  • If you continue to struggle despite therapy or practice, ask your therapist about additional evaluations for language processing, social pragmatic skills, ADHD, or autism-related social communication difficulties.

✅ Focus on Areas of Interest.

  • Friendships often form naturally over shared interests. If you enjoy chess, hiking, music, or gaming, engage in activities and groups centered around these passions to build authentic connections.

✅ Work with a Skilled Therapist.

  • Therapy for adults with SM history should address social confidence, anxiety management, language/processing skills, and relationship maintenance strategies – not just general exposure-based approaches.

💬 Final Thoughts

Dr. E emphasized:

“If you go your whole life without building true social communication confidence, it trails behind you. We need to dive in, tease apart the challenges, and build the skills.”

If you’re an adult who overcame Selective Mutism but still feels socially anxious, shy, or isolated, know that you’re not alone – and it’s never too late to build confidence, deepen relationships, and create the social life you desire.

✅ Next Steps:

If this resonates with you, consider scheduling an evaluation with a therapist who understands SM and social communication anxiety in adults. Tailored strategies can make the difference between silent suffering and thriving connection.