Breaking the Silence: Understanding and Addressing Mutism in Children

Breaking the Silence: Understanding and Addressing Mutism in Children

It plays with its siblings and parents in familiar surroundings, laughing and raging. However, if a person comes along suddenly, the behaviour changes abruptly: suddenly, the child can’t utter a word; it is silent, looks away, and “knocks out” completely. Do you also know that from your offspring? Your child may have mutism, a communication disorder. Mutism is particularly common in children. The entire linguistic, cognitive, social and emotional development is affected by autistic behaviour. This has consequences for personality development, self-identity and self-confidence. The person affected has difficulties at school, training or work and is sometimes avoided by others. What are the causes and symptoms of mutism?

Definition: What is mutism?

Mutism is a communication disorder that is particularly common in children. Victims remain silent even though they can speak. The term derives from the Latin “mutus” for “dumb” and describes a person’s persistent, fear-induced silence, which increases over time and ultimately can hardly be controlled at will. A defect in the organs of speech or hearing is not the cause.

According to the definition, a distinction is made between “total mutism” – those affected do not speak at all – and the much more common “selective mutism” (also elective mutism), when those affected are only silent to specific people or particular situations.


frequency of mutism

Experts estimate that 6,000 to 10,000 people in Germany suffer from the communication disorder. According to a study from 2001, the number of cases of selective mutism is seven children in 1,000. The phenomenon is about twice as common as autism, with which mutism is often confused.

Causes of Mutism

Diagnosis is not easy, and mutism is often unrecognized, misunderstood, or disregarded as a syndrome to treat. The chances of recovery are good if the communication disorder is recognized early.

Selective mutism is not a disease as such, but one of the possible symptoms of “social anxiety”. Some of the leading causes of selective mutism are:

  • congenital (genetic) shyness or inhibition of the child
  • intrafamilial problems
  • Language development disorders or language problems in the child (the child is silent because it is ashamed of its (imperfect) voice/language)
  • Anxiety disorders, especially “social phobia” (wanting to hide, not wanting to be the centre of attention, fear of unfamiliar people or situations)


mutism in children

Suppose children are entirely silent in certain situations or towards some people. In that case, this does not always have to do with defiance, bad manners or momentary shyness but could be a sign of mutism syndrome.

Parents often misunderstand children with mutism as shy or listless: In the familiar environment of family, siblings and close friends, those affected talk quite commonly and relaxed, but as soon as there is even a suspicion that someone else is listening in or a third party is seeing that the mouth is moved, the mutist falls silent.

Symptoms of autism in children

Parents should be vigilant if their child shows any of the following signs:

  • The child does not speak in certain situations but at home and with familiar people.
  • The child is very expressive and communicative at home and sometimes talks a lot (need to catch up).
  • The child has difficulty initiating interactions independently (e.g. greeting, goodbye, thanks, questions).
  • The pronounced silence is often compensated for at school with good written performance.
  • The child appears to observe and perceive the world around him more carefully than his peers but often has difficulty expressing his feelings.

therapy for mutism

Mutism requires a multifactorial therapy that takes several aspects into account. There are hardly any experts in this field. The therapy is mostly speech, psycho- and family therapy and psychiatric. Additional pharmacological treatment with antidepressants may be indicated in autistic adolescents and adults.

Experts say that the earlier you intervene, the greater your chances of success. Otherwise, the disorder can manifest more severely, persist for years and extend into adulthood. Parents who notice that their child has communication problems should, therefore, not hesitate to go to the practice of an experienced paediatrician.


What can parents do?

If the silence lasts longer than four weeks, a speech therapy examination of the child should be arranged. This requires a remedy prescription for speech therapy, which a paediatrician or ENT doctor issues. Selective mutism falls under language developmental delays; this must be stated on the prescription.

The therapy is paid for by health insurance and is carried out by speech therapists (speech therapists, speech therapists or breathing, speech and voice teachers). Close cooperation between parents, educators/teachers and possibly psychotherapists is recommended.

Tips for parents of mutists

It is not always easy for parents to understand their child’s silence. These tips can help:

  • Don’t take the silence personally!
  • It is recognizing not speaking as an active action that – at some point – has fulfilled its purpose for the child/young person.
  • Those affected cannot consciously avoid the silence, as it has been developed and maintained over the years.
  • Refrain from constantly asking or even urging you to speak. Every request to speak increases the pressure on the child and the fear of the next occasion to speak.
  • Please don’t focus on the child; treat them usually.
  • Don’t exclude the child.
  • The person concerned makes the ultimate decision as to whether and when to break the silence! The task of the parents and the environment is to accompany, to promote skills, to practice patience and to learn to understand.

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