social anxiety Selective Mutism

Dr. Elisa Shipon-Blum is the Executive Director of - an organization dedicated to providing information about a much misunderstood disorder called selective mutism.  Questions were posed by the editor of and answered by Traci Castles and Dr.Shipon-Blum.

Q. What is Selective Mutism?                                                               

A. It is an adorable 6 year old boy who runs around boisterously in his backyard...but stands expressionless, staring into space within the classroom.  It is the comical 6 year old girl who dances and sings in the entertainment room while her family proudly watches on...but stands motionless and cannot utter a sound when her class rehearses for the school musical.  It is a 9 year old boy cheering loudly and intensely as he watches his favorite hockey team score a goal, but sits alone at a party and sadly turns away when another child approaches him.  It is a sensitive and perceptive little 5 year old girl who tells her parents all the exciting and fun things she wants to do at her birthday party..but has never spoken a word to anyone outside her home.

Q. How do you determine if a child is shy and if the shyness is merely developmental or if the child requires professional help?                    

A. Does your child have these characteristics?  1. Does not speak in certain places such as school or other social events? 2. But can speak normally in other settings such as in their home or in places where they are comfortable and relaxed?   3. Does the child's inability to speak interfere with his/her ability to function in educational or social settings.  4. The mutism has persisted for at least one month?  5. Mutism is not part of another disorder, i.e. autism, aspergers syndrome, schizophrenia.

Q. Do you know the cause of selective mutism?                                                            

A. The cause of Selective Mutism is ANXIETY. Specifically, social phobia. ...approx. 1 in 1000 children are diagnosed with Selective Mutism. Social phobia, also called social anxiety, is a disorder characterized by overwhelming anxiety and excessive self-consciousness in everyday social situations. People with social phobia have a persistent, intense, and chronic fear of being watched and judged by others and of being embarrassed or humiliated by their own actions.

Their fear may be so severe that it interferes with work or school - and other ordinary activities. While many people with social phobia recognize that their fear of being around people may be excessive or unreasonable, they are unable to overcome it. They often worry for days or weeks in advance of a dreaded situation.

Social phobia can be limited to only one type of situation - such as a fear of speaking in formal or informal situations, or eating or drinking in front of others - or, in its most severe form, may be so broad that a person experiences symptoms almost anytime they are around other people. Social phobia can be very debilitating - it may even keep people from going to work or school on some days. Many people with this illness have a hard time making and keeping friends

Physical symptoms often accompany the intense anxiety of social phobia and include blushing, profuse sweating, trembling, and other symptoms of anxiety, including difficulty talking and nausea or other stomach discomfort. These visible symptoms heighten the fear of disapproval and the symptoms themselves can become an additional focus of fear. Fear of symptoms can create a vicious cycle: as people with social phobia worry about experiencing the symptoms, the greater their chances of developing the symptoms.. Social phobia often runs in families and may be accompanied by depression or alcohol dependence.

Q. What causes social phobia?                          

A. Research to define causes of social phobia is ongoing

* Some investigations implicate a small structure in the brain called the amygdala in the symptoms of social phobia. The amygdala is believed to be a central site in the brain that controls fear responses.                                                                * Animal studies are adding to the evidence that suggests social phobia can be inherited. In fact, researchers supported by the National Institute of Mental Health (NIMH) recently identified the site of a gene in mice that affects  fearfulness.                                                            * One line of research is investigating a biochemical basis for the disorder. Scientists are exploring the idea that heightened sensitivity to disapproval may be physiologically or hormonally based.                                                                     * Other researchers are investigating the environment's influence on the development of social phobia. People with social phobia may acquire their fear from observing the behavior and consequences of others, a process called observational learning or social modeling.

Q. Have case studies been done following treated vs. non-treated children to determine the need for intervention?                                        

A. As in other disorders. every child is different and determination of who 'overcomes' SM is variable. Unfortunately, the majority of SM children often do not just overcome SM.  Symptoms of social anxiety often continue throughout childhood, adolescence and into adulthood. Self-esteem is compromised as is proper social development. From the tremendous amounts of SM teens and adults that contact  us we are convinced that 'waiting' is not the answer.  Most of the teens that contact us are still suffering tremendously and have compromised the enjoyment of their youth only to be falsely labeled as 'shy.' 

Adults continuously tell us that 'if only they knew what SM was years ago, then perhaps they could have overcome SM when they were young and had the opportunity to have a happy and fulfilled youth. Taking a chance on whether a child will overcome SM is certainly not worth the risk of the negative repercussions that come along with untreated social anxiety. It is painful and heart wrenching to the individual involved. With intervention, SM children develop coping skills to be able to handle various situations. Isn't it nice to give a child the  wonderful opportunity to overcome SM when they are young, when behavior is not as 'set' and 'ingrained,' then waiting and hoping a child will overcome SM on their own. All one needs to do is to spend time with a Selectively Mute child to see that they are not just shy, they are truly suffering in silence.


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