What are the symptoms? SM may affect a child’s ability to talk with specific members of the immediate family at home as well as teachers or peers at school or in other social situations. Children respond or make their needs known by nodding their heads, pointing or remaining expressionless or motionless until someone correctly guesses what they want. SM may affect a child’s educational performance, but progress at school may not be impeded in those situations where speaking is not required. What are the causes? SM is often not recognised because a child’s behaviour is attributed to shyness or embarrassment. In the past, there was a tendency to perceive SM children as stubborn and oppositional. More recent research, however, indicates that in most cases SM is the result of crippling anxiety. Stressful early experiences, a clash of cultures between home and school, language difficulties, and/or unaccustomed expectations at school, may predispose a child to SM. When under stress, children may become physically rigid and eye-contact increases their discomfort. Children may have the desire to speak but are over-come by ‘stage-fright’ and hence remain silent. In some cases, SM is known to be preceded by delayed milestones and speech and language difficulties (see entry Speech and Language Impairment). A psychological assessment may be useful to exclude the presence of learning difficulties (see entry Learning Disability. The usual onset of SM is around three to five years of age, when a child enters a play-group or nursery school. SM may commence later after a trauma or post operatively, and is then known as ‘traumatic mutism. How is it treated? Treatment is more likely to be successful if started early before the child assumes a ‘non-speaking identity.’ The most effective way of helping can be through a programme in which teachers and parents participate. Such a programme is based on a ‘step-by-step’ approach which aims at reducing the child’s anxiety about speaking through a technique known as ‘stimulus fading.’ This involves moving the child by manageable small steps from a situation where there has been no speech to a situation where there is speech. The child’s cooperation is essential and is gained by making the exercise enjoyable and rewarding. Inheritance patterns and prenatal diagnosis Inheritance patternsAlthough SM may occur in any family, there may be a familiar component in some families. Prenatal diagnosisNot applicable. Is there support? SMIRA (Selective Mutism Information & Research Association) Email: via websiteWebsite: selectivemutism.org.uk The Association is a Registered Charity in England and Wales No. 1022673. It provides information and support to families affected by selective mutism. Group details last updated January 2018.