Mutism: Symptoms, Causes, Treatment

Mutism is the state of being unable to or unwilling to speak to an extent that interferes with daily life. This article discusses the symptoms and causes of mutism, its risk factors, how it’s diagnosed, and when to get help.

Symptoms of Mutism

The most common symptoms of selective mutism include:

• Social anxiety or shyness outside of the home
• Silence that interferes with work or school
• Mutism that can’t be explained by trouble with language skills

Other symptoms of mutism include:

• Mutism lasting for at least a month
• History of experiencing trauma
• Sudden silence after previously speaking regularly
• In organic or cerebellar mutism, inability to speak despite wanting to

With aphasia, mutism can be accompanied by difficulty reading, telling time, understanding numbers, and writing.

Causes of Mutism

Common causes of selective mutism include:

• Social anxiety or extreme shyness
• Social phobias
• Autism (Selective mutism may be mistakenly diagnosed as autism.)
• Trauma
• Anxiety about a new language when from a foreign country

Other types of mutism, such as organic mutism, have physical causes or result from health issues, including:

• Brain injury from accidents or drug use
• Brain tumors or surgery near the cerebellum (as in cerebellar mutism)
• Stroke
• Psychosis

What Medications Can Cause Mutism?

Some medications and drugs can cause catatonia, which is a condition that includes mutism and an inability to move parts of the body. These medications include:

• Antipsychotic medications like fluphenazine, Haldol (haloperidol), and Risperdal (risperidone)
• Disulfiram, a drug used for alcohol use disorder (AUD)
• Recreational drugs such as synthetic cannabinoids (K2 or spice)

How to Treat Mutism

For children with selective mutism, treatment options can include:

• Establishing consistent expectations and routines
• Providing praise for social successes and promoting positive social perspectives
• Using alternative communication methods, such as pictures or words, including through art therapy
• Collaborating with a specialist to practice sounds gradually leading to letters, words, and conversation

Other treatments for selective mutism might include:

• Cognitive behavioral therapy (CBT): Psychotherapy that targets the ideas and thoughts behind behaviors
• Mindfulness: Letting emotions pass through the body without judgment or action
• Exposure therapy: Gradual exposure to feared situations
• Relaxation exercises: Deep breathing, meditating, etc.
• Shaping: Practicing talking in stress-free situations, like reading out loud or during a board game, before graduating to full conversation

Treatment for organic or cerebellar mutism can include:

• Speech and language therapy
• Physical therapy
• Medication

For catatonia, which can be experienced by people with psychosis and can involve mutism, treatment options are medication and, at times, electric shock therapy.

Complications and Risk Factors Associated With Mutism

With children, it’s advised to treat mutism as early as possible so it doesn’t result in social and developmental delays. Mutism that is not addressed could lead to:

• Speech development delays
• Difficulty developing and maintaining social skills
• Problems or delays with school or work
• Trouble building relationships and feeling a sense of belonging
• Debilitating social anxiety
• Phobias

Factors that can increase the likelihood of living with mutism include:

• Anxiety disorder and social phobia
• Obsessive-compulsive disorder
• A parent or family member who has social anxiety combined with selective mutism
• Social environment, like a family that doesn’t encourage social contact
• A shy temperament
• A language barrier from moving to a new country

For other types of mutism, contributing factors include:

• Brain injury from a stroke or a tumor
• Recreational drug use
• Psychosis
• Medications that increase the risk of mutism

Are There Tests to Diagnose the Cause of Mutism?

Diagnosing selective mutism is usually a team effort between caretakers, school workers, healthcare providers, and possibly social workers. The process most likely entails:

• Observations of environment and behavior from specialists, teachers, and parents
• Speech development and cognitive tests to rule out issues with development
• If a child speaks a foreign language, evaluating whether they feel more comfortable in their native language and if they have fears about misunderstanding a language

Other ways to diagnose selective mutism include:

• A detailed family history of mental health concerns
• Autism screening
• A hearing test to rule out hearing troubles

For adults, a healthcare provider might ask about the following when diagnosing selective mutism:

• Being silent in social situations outside of the home
• Paralyzing anxiety
• Using nonverbal communication when spoken to
• Asking others to speak for them
• Interruptions in daily well-being because of mutism

Organic muteness can be a symptom of conditions like psychosis, a brain tumor, or stroke. Diagnosis can include screening for the suspected condition with brain scans and observing other symptoms.

When to See a Healthcare Provider

With children, mutism could interfere with developing social skills at a crucial time, while for adults, mutism can interfere with overall well-being. A healthcare provider’s help is encouraged if mutism:

• Is caused by intense anxiety or social phobia
• Interferes with school or work
• Creates difficulty connecting

Organic or cerebellar mutism usually require the assistance of speech and physical therapists to help the person return to communicating verbally.

If mutism occurs along with symptoms of psychosis, like hallucinations, decline in self-care, and intense emotional fluctuations, getting treatment as early as possible is highly advised.

If you would like to address mutism with the help of a professional but cost is an issue, consider sliding scale therapists or online help. The Substance Abuse and Mental Health Administration (SAMHSA) also has an online clinic finder that could help you get started with finding free or low-cost federally funded mental health care.