Social Anxiety and Selective Mutism

Although a consensus has yet to be solidified in the research regarding the precise relationship between selective mutism and social anxiety, it is highly common for children and adolescents with selective mutism to also receive a social phobia diagnosis. Fortunately, regardless of whether a child meets criteria for both diagnoses or one, evidence-based treatment for these disorders is relatively similar and rooted in cognitive-behavioral principles. This article explores the interplay between social anxiety and selective mutism and differentiates shyness and typical expressions of anxiety from psychopathology.

Children who do not speak in social settings, especially when prompted, are often perceived as defiant. However, this pattern of behavior is best understood through anxiety pathways and negative reinforcement. When a child is faced with an anxiety-provoking situation, they are likely to avoid or elicit “help” from caregivers. For instance, when a child with selective mutism is asked their name by a waiter, they may not speak and look towards their caregivers to provide a response for them. While a caregiver’s desire to reduce their child’s anxiety is well-intentioned, speaking for the child often has the impact of reinforcing the child’s fear.

Therefore, both (a) validating a child’s internal experience of anxiety while also (b) encouraging a child to approach their fears and engage in social interaction is crucial. Individuals with anxiety disorders often perceive danger to be heightened despite a lack of real threat in the environment. With social phobia in particular, children often fear embarrassment. As such, it is important for children to be able to put their expectations to the test and have the potential to experience new learning. For example, a child may fear starting a conversation with a peer due to thinking this peer may respond negatively. However, by adopting a nonverbal position, they miss the opportunity to test this theory. Similarly, children who consistently avoid speaking in certain settings and with certain people miss the opportunity to practice bravery and autonomy.

Everyone has experienced worry about social interactions, and individuals vary in their interest in and comfortability regarding social interaction. Anxiety is considered pathological when it impacts a child’s ability to function in day-to-day life (e.g., leads to problems focusing at school, establishing social relationships, etc.) and is significantly distressing. Furthermore, selective mutism and shyness are not synonymous. A child who is shy may be slow to warm up and approach environments with caution. On the other hand, children with selective mutism may be engaged in new environments, but in a perpetually nonverbal manner. Hence, while a child who is shy will likely eventually speak in the environment, a child with selective mutism may never speak in the environment without intervention. Additionally, it is not uncommon for children with selective mutism to present as nonverbal in public settings but highly talkative at home. Therefore, while a child who is shy may be slow to warm up in almost all novel situations, a child with selective mutism may present quite differently depending on the environment and who is in that environment.

Navigating the nuances of treatment for selective mutism can be difficult for caregivers. Thriving Minds offers assessment, weekly therapy and intensive therapy services for children and adolescents with selective mutism. Call us to schedule a 15 minute consultation.