Diagnosing selective mutism

Left untreated, selective mutism can lead to isolation, low self-esteem and social anxiety disorder . It can continue into adolescence and adulthood if not tackled.

However, a child can successfully overcome selective mutism if it's diagnosed at an early age andappropriately managed.

It's also possible for adults to overcome selective mutism, although they may continue to experience the psychological and practical effects of years deprived of social interaction or not being able to reach their academic or occupational potential.

It's therefore important for selective mutism to be recognised early by families and schools so they can work together to reduce the child's anxiety. Staff in early years settings and schools may receive training so they're able to provide appropriate support.

If parents suspect their child has selective mutism and help isn't available, or there are additional concerns for example, their child struggles to understand instructions or follow routines they should seek a formal diagnosis from a qualified speech and language therapist.

You can contact a speech and language therapy clinic directly or speak to a health visitor or GP, who can refer you. Don't accept the assurance that you or your child will grow out of it, or you or they are "just shy".

YourGP or local clinical commissioning group (CCG) should be able to give you the telephone number of your nearest NHS speech and language therapy service.

Older children may also need to see a mental health professional or school educational psychologist.

Adults will ideally be seen by a mental health professional with access to support from a speech and language therapist or another knowledgeable professional.

The clinician may initially want to talk to parents without their child present, so they can speak freely about any anxieties they have about their child's development or behaviour.

They'll want tofind out whether there's a history of anxiety disorders in the family, and whether anything is causing distress, such as a disrupted routine or difficulty learning a second language. They'll also look at behavioural characteristics and take a fullmedical history.

A person with selective mutism may not be able to speak during their assessment,but the clinician should be prepared for this and be willing to find another way to communicate.

For example, they may encourage a child with selective mutism to communicate through their parents, or suggest that older children or adults write down their responses or use a computer.

Selective mutism is diagnosed according to specific guidelines. These include observations about the person concerned as outlined below:

• they don't speak in specific situations, such as during school lessons or when they can be overheard in public
• they can speak normally in situations where they feel comfortable, such as when they're alone with parents at home, or in theirempty classroom or bedroom
• their inability to speak to certain people has lasted for at least a month (two months in a new setting)
• their inability to speak interferes with their ability to function in that setting
• theirinability to speak isn't better explained by another behavioural, mental or communication disorder