Selective Mutism

Selective mutism is a childhood anxiety disorder that starts before the age of 5 years. It is characterized by inability for children to communicate in certain social situations. With selective mutism children have a hard time initiating conversations or responding when spoken to in social situations.

Children with selective mutism are able to talk in settings they feel safe and comfortable in such as with family and friends. Therefore, it might come to clinical attention once a child starts school and interacts with people outside of the family. 

What causes selective mutism

Since it’s a relatively rare condition, causes or risk factors of selective mutism are not known. There are few factors or triggers that make it more likely to develop.

  • Genetics: Family history of any anxiety disorder including selective mutism, phobias and speech-language problems.
  • Speech-language problems: Speech-language difficulties or minor learning disabilities and shyness might add to the child’s anxiety in situations where they are expected to speak.
  • Environmental factors: Poor familial relationships and overly controlling or overprotective parents 

There is a common misconception that selective mutism in children is often a result of trauma or abuse. However, children who become mute after abuse or trauma are mute in all situations and not specific social settings as is the case with selective mutism.

Lastly people believe that children with selective mutism are just shy or will grow out of it. In fact, these children are willing to speak but are unable to talk or communicate what they want to say due to extreme anxiety.

Signs of Selective Mutism

According to DSM-V the diagnostic criteria for Selective Mutism is as follows:

  • Consistent failure to speak in specific social situations in which there is an expectation for speaking, e.g., at school despite speaking in other situations.
  • The disturbance interferes with educational or occupational achievement or with social communication.
  • The duration of the disturbance is at least 1 month (not limited to the first month of school).
  • The failure to speak is not attributable to a lack of knowledge of, or comfort with, the spoken language required in the social situation.
  • The disturbance is not better accounted for by a Communication Disorder (e.g.,childhood-onset fluency disorder) and does not occur exclusively during the course of autism spectrum disorder, schizophrenia, or another psychotic disorder.


Selective mutism is most receptive to treatment when it is started early. The success of treatment will depend on the age of the child, presence of co-existing speech-language or learning difficulties and the cooperation of the parents and teachers. The treatment for selective mutism may include psychotherapy or medication and aims at reducing the anxiety associated with speaking. 

Therapy: Mental-health therapy and speech-language therapy is commonly used to treat selective mutism. In order to reduce the anxiety in social settings behavioural interventions such as Cognitive Behavioural Therapy (CBT) is most widely used by therapists.

Medication: It is only used in chronic cases or when therapy fails to achieve desired results. Anxiety medication is prescribed by doctors after consultation with the parents.

What can you do at home?

  • Don’t let your child know when you are anxious
  • Create a positive environment for them to encourage speech
  • Reassure them that they’ll overcome the conditions when they’re ready
  • Praise their effort when they interact with others verbally or nonverbally (nodding or pointing)
  • Don’t act surprised when your child makes progress but respond normally as you would to any other child

If you are child’s suffering from selective mutism and you want to learn more about how you can help them please do get in touch with our skilled speech-language pathologists.

Attention-deficit/hyperactivity disorder (ADHD)

Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder. It is characterized by inability to pay attention, impulsive behavior and hyper-activity. People with ADHD may seem restless, may have trouble concentrating on a task and may act on impulse.

ADHD usually starts in childhood and often persists into adulthood. Most cases are diagnosed during the age of 6 to 12 years old. The symptoms of ADHD usually improve with age. People with ADHD may also experience other problems, such as anxiety disorders and ASD.


Causes and risk factors of ADHD are largely unknown. However, research indicates that genes play a major role and ADHD tends to run in families. Experts believe that ADHD is mostly hereditary i.e. children with family members similarly affected are at greater risk than other children. 

Other factors suggested as potentially having a role in ADHD include: 

  • Stress during pregnancy 
  • Alcohol consumption or smoking during pregnancy
  • Premature birth
  • A brain injury or a brain disorder (especially damage to frontal lobe)
  • Poor  nutrition 
  • Exposure to toxins, such as lead may affect a child’s brain development.

A common misconception is that excessive screen time, too much sugar consumption, poverty, chaos at home or poor parenting may cause ADHD. However, these factors may worsen symptoms of ADHD but are not known to cause ADHD. 


There are three different types of ADHD. A person can be predominantly inattentive, predominantly hyperactive-impulsive or both. 

Predominantly Inattentive Presentation: 

  • Have a short attention span
  • Easily distracted
  • Have trouble organizing or finishing a task
  • Make careless mistakes
  • Usually lose things
  • Don’t follow instructions
  • Forgetful about routine activities
  • Doesn’t like to do things that require sitting still
  • Tends to daydream

Predominantly Hyperactive-Impulsive Presentation:

  • Have trouble sitting still
  • May run, jump or climb constantly (especially in smaller children)
  • Interrupts others
  • More accident prone
  • Have trouble waiting their turn
  • Talks excessively or speak at inappropriate times
  • The individual seems restless
  • Grab things from people

Symptoms of the above two types of ADHD might be equally present in the person as well.


There is no absolute cure for ADHD however with therapy and medications presentation of symptoms can be reduced and functioning can improve. 

  • Medication: Medication is usually prescribed by a doctor after consultation with the parents. It can help control hyperactive and impulsive behaviour and also improve attention span. 
  • Mental-health therapy: Mental-health therapy is a common treatment for ADHD. Therapy helps people manage their emotions in a better manner and also improves self-esteem.

Parent coaching and education programmes aim to teach parents and caretakers about behaviour management and increases their ability to help their children while improving their relationship.

How can I help my child?

  • Learn all you can about ADHD. 
  • Ask questions from your child’s health care provider in order to understand the problems your child has
  • Discuss your child’s progress with the therapist
  • If your child is prescribed adhd medicine, administer them safely
  • Discuss your child’s situation at their school and with family members and work with your child’s school
  • Learn which parenting approaches are best for a child with ADHD.
  • Talk openly and supportively about the condition with your child. 
  • Focus on your child’s strengths 
  • Be an example of calm, focused behavior.

A few lifestyle changes can also help your child manage symptoms:

  • Eat a healthy and balanced diet.
  • Get some exercise daily.
  • Limit screen time and time spent on electronic devices.
  • Keep a clear schedule and fixed routines.