Question: “There is a child with Selective Mutism in our 5th grade class. She participates fully, laughs, smiles, and seems completely comfortable. She does not look anxious, yet she is still not speaking in class. Can this still be the result of anxiety?”

Answer: “People often assume that to be anxious, you must look anxious. For our children/teens with Selective Mutism, this is not always the case. An individual with Obsessive Compulsive Disorder may wash their hands or clean the house repeatedly. He/she may not look anxious, yet they have OCD and are demonstrating anxiety symptoms. Same with an individual with Trichotillomania. This person may pick their skin and/or pull out their hair but they do not look anxious.

Compare this to individuals with Selective Mutism. This individual developed mutism as a means of avoiding anxious feelings. When a child is young, speaking elicits fear and therefore avoidance prevails. Eventually, you have a child who functions as the 5th grader in your question. She can laugh, smile and communicate with ease non-verbally. However, she is mute. This child is suffering from an anxiety disorder. Her mutism may be learned, ingrained, and a hard habit to break. This individual should be receiving professional help to unlearn her mute behavior and learn coping skills to be able to communicate more productively.”

For some children, they appear very comfortable and mutism is the most noted symptom. This usually means they are able to engage nonverbally with others via astute nonverbal skills (professional mimes!) in most, if not all settings. These children are stuck in the nonverbal stage of communication (Stage 1) and suffer from a subtype of SM called Speech Phobia. Dr. Elisa Shipon-Blum developed the Ritual Sound Approach® (RSA) a proven, step-by-step technique to help these children unlearn their conditioned mutism.

Although mutism is the most noted symptom of SM, the inability to speak merely touches on the surface of our children.  A complete understanding of the child is necessary to develop an appropriate treatment plan for home and in the real world, as well as in school by developing accommodations and interventions, e.g. IEP or 504 Plan.

To effectively overcome Selective Mutism and all anxieties, an individual needs to be involved in a treatment program, such as those rooted in evidenced-based Social Communication Anxiety Treatment® (S-CAT®), like Individualized Intensives and CommuniCamp. Developed by Dr. Elisa Shipon-Blum, this holistic or “whole-person” treatment approach is designed to reduce anxiety, build self-esteem, increase social comfort and communication in all settings. 
As a physician, Dr. Elisa Shipon-Blum (“Dr. E”) views SM as a social communication anxiety where mutism is merely a symptom. The key to an effective treatment plan is understanding factors that contribute to the development and maintenance of SM as well as understanding a child’s baseline stage of social communication on the Social Communication Bridge©. Then, working as a team, the treatment professional, parents, and school staff members help the child build coping skills to combat anxious feelings and to progress across the Social Communication Bridge©.