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Selective mutism: the child speaks at home and is silent in the garden

Other names: Селективный мутизм, элективный мутизм, избирательный мутизм, ребёнок молчит в садике, ребёнок не разговаривает в школе, молчит с чужими людьми

Selective mutism is a condition in which a child speaks freely in a familiar environment, most often at home with loved ones, but remains consistently silent in certain situations: in kindergarten, school, at the doctor’s, with unfamiliar adults. This is not stubbornness, not whim, or lack of speech: the child wants to speak, but severe anxiety literally blocks the voice. Usually the condition is noticed at three to five years of age or upon entering kindergarten and school. Without help, silence becomes entrenched, interferes with learning and friendships, and over time develops into persistent social anxiety. The good news is that with proper behavioral work and family support, most children begin to speak.

🧾 МКБ-10: F94.0 🏥 Where it is treated: 8 Anxiety disorderNot the stubbornness of a childBehavioral therapy helps
👨‍⚕️ Which doctor
Child psychologist, pediatrician, speech therapist, child psychiatrist if necessary
🔬 Diagnostics
Conversation with parents and teachers, observation, hearing and speech testing, development assessment
💊 Treatment
Behavioral therapy, work with the kindergarten and school, parental support, rarely - medications
📈 Prognosis
Favorable with early help
⚠️ At risk
Anxiety in the family, temperament, moving and changing languages, speech difficulties
⏱ When to see a doctor
Planned

🚨 See a doctor urgently

With these signs do not wait for a scheduled appointment — the condition requires emergency care.

  • Ребёнок перестал говорить и дома, и вне дома
  • Речь пропала внезапно после испуга, травмы головы или болезни
  • Ребёнок не реагирует на обращённую речь и громкие звуки
  • Утрата уже освоенных навыков речи, игры и общения
  • Отказ от еды и питья в саду или школе, длительное удержание мочи из-за страха
  • Синяки, страх перед конкретным взрослым, другие признаки жестокого обращения

What is it and how is it different from shyness?

A shy child in a new environment is silent at first, but after a while he gets used to it and begins to speak. With selective mutism, silence is consistently repeated in the same situations and does not go away on its own, even when the situation is no longer new. A disorder is indicated if a child does not speak where expected for at least a month, and the first month of adaptation to kindergarten or school does not count. At the same time, at home, speech is developed and ordinary, and the understanding of addressed speech is completely preserved.

  • Speech is free at home, silent outside the home
  • Duration of at least a month
  • The first month of adaptation is not taken into account
  • The child understands speech and wants to communicate
  • Silence is not due to ignorance of the language

Causes and risk factors

The underlying cause is anxiety, not reluctance to speak. Many such children are naturally cautious and slowly get used to new things: this is an innate feature of their temperament. A family history of anxiety disorders and social phobia contributes. Additionally, the risk is increased by speech difficulties, due to which the child is embarrassed about his pronunciation, moving and studying in a second language, sudden changes in the team, conflicts and ridicule in the group, as well as overprotection, when adults are constantly responsible for the child. Important: the reason is not poor upbringing or stubbornness.

  • An innate tendency to be anxious and cautious
  • Anxiety disorders in parents
  • Sound pronunciation disorders and speech delay
  • Moving, bilingualism, learning in a non-native language
  • Change of kindergarten, school, team
  • Ridicule and bullying
  • Overprotection and the habit of adults to speak for the child

How does it manifest itself?

The child freezes in anticipation of being addressed, looks away, hides behind the parent, responds with gestures, a nod, a whisper, or writes on paper. The face becomes tense, movements are constrained. In the garden, he may not ask to go to the toilet, not eat or complain of pain, because for this he needs to talk. At home, the same child is noisy, talkative and cheerful, which often confuses parents. Sometimes silence extends only to adults, but speech remains with peers.

  • Silence in the garden, school, at the doctor, in the store
  • Communicate with gestures, nods, whispers
  • Stiffness, frozen posture, avoidance of gaze
  • Refusal to use the toilet or to eat outside the home
  • Free loud speech at home
  • Complaints of abdominal pain and headache before gardening
  • Refusal to go to kindergarten or school

Inspection: who checks what and what?

The first step is the pediatrician: he assesses general development, excludes diseases and refers to specialized specialists. Be sure to have your hearing checked, since hearing loss can look like a refusal to communicate. The speech therapist evaluates sound pronunciation, vocabulary and speech understanding, and for bilingual children, the level of proficiency in each language is separately assessed. A child psychologist collects information from parents and teachers, observes the child in different settings, and sometimes uses home video recordings of speech. Autism spectrum disorders and the consequences of psychotrauma are separately excluded.

  • Pediatric examination and developmental assessment
  • Hearing test
  • Speech therapy examination
  • Assessing proficiency in each language in bilingual children.
  • Observation by a psychologist at home and in a group
  • Information from educators and teachers
  • Rule out autism, developmental delay and psychotrauma

How to help a child

It is not persuasion that works, but a gradual reduction in anxiety. They use a smooth inclusion technique: first, the child speaks with the parent alone in the office, then the teacher quietly joins them, then a peer, and the circle expands in small steps. Every success is celebrated with quiet praise. It is important for parents not to ask again, not to bribe with rewards for words and not to punish for silence, and also not to be responsible for the child. The school and kindergarten should allow non-verbal responses at the first stage. For severe anxiety in older children, a child psychiatrist may add medication support.

  • Behavioral therapy with gradual expansion of social circle
  • The work of a psychologist together with parents and teachers
  • Allow nonverbal responses in the first stage
  • Do not force anyone to speak and do not punish them for silence.
  • Do not bribe or praise excessively for every word
  • Give the child time to respond, do not interrupt
  • Classes with a speech therapist for speech difficulties
  • Medication support as decided by a child psychiatrist

Services and prices for this diagnosis

Based on official price lists of Tashkent clinics. The exact cost is determined after examination.

Frequently asked questions: Selective mutism in children

A child who is silent in kindergarten is selective mutism?+
Not necessarily. In the first month of adaptation, silence is normal. They speak of a disorder when a child consistently does not speak in kindergarten or school for more than a month, while at home his speech is developed and free. In such a situation, it is worth showing the child to a psychologist and pediatrician.
Could this be related to bilingualism?+
Yes, children who are learning a second language go through periods of silence. It usually lasts several months and gradually goes away. If a child speaks a language well, but is still silent, and the silence extends not only to the new language, we are talking about selective mutism.
Will selective mutism go away on its own?+
Sometimes it goes away, but more often the silence is reinforced and turns into persistent social anxiety that interferes with studies and friendships. The earlier behavioral work begins, the faster and easier the child begins to speak, so there is no need to wait.
Is this a form of autism?+
No. With selective mutism, the child understands speech well, strives to communicate, and speaks freely and emotionally at home. In autism, communication difficulties occur in all settings, including the home. Examination by specialists helps differentiate between conditions.
How should parents behave?+
Don’t force someone to talk, don’t ask questions in front of strangers, and don’t punish them for silence. Don't answer for your child right away, give him time. Praise calmly for any steps towards communication and be sure to agree with teachers on a common approach.

The information on this page is for reference only and does not replace a doctor consultation. Only a qualified specialist can make a diagnosis and prescribe treatment after an in-person examination.

Where it is treated selective mutism в Ташкенте

Молчание вне дома может быть связано не только с тревогой, но и с нарушением слуха, речевыми расстройствами или особенностями развития, поэтому ребёнка стоит показать специалистам. Clinics Ташкента, где принимают детские специалисты:

st. Mirzaeva 50, Yunusabad 17, Yunusabad district, Tashkent Landmark: opposite the Nazar M...
M Turkiston 🚶 1.5 km
M Yunusobod 🚶 2.0 km
M Shahriston 🚶 2.8 km
🚌 Nearest bus stop 🚶 100 m · buses: 7
Mon–Fri:09:00–18:00
Open now
Mukimiy street 144/1, Chilanzar district, Tashkent Landmarks: Novza metro station (former...
M Novza 🚶 400 m
M Mirzo Ulug'bek 🚶 650 m
M Milliy bog' 🚶 1.3 km
🚌 Nearest bus stop 🚶 170 m · buses: 9Т, 56
Mon–Fri:09:00–18:00
Open now
Branch No. 3: Birlashgan street, opposite the 4-City Clinical Hospital
M Tuzel 🚶 750 m
M Yashnobod 🚶 800 m
M Texnopark 🚶 1.4 km
🚌 Nearest bus stop 🚶 200 m · buses: 22
Пн–Sat:07:00–20:00
Open now
Tashkent, Almazar district, st. Chukursay, 149d
🚌 Nearest bus stop 🚶 950 m · buses: 42
Mon–Fri:09:00–17:00
Open now
Tashkent city, Uchtepa district, block g9a, building 1a
M Olmazor 🚶 1.7 km
M Chilonzor 🚶 1.8 km
M Mirzo Ulug'bek 🚶 2.4 km
🚌 Nearest bus stop 🚶 90 m · buses: 2, 9Т, 23, 56
Пн–Sat:08:30–17:00
Open now
Tashkent, Mirabad district, st. Mehrzhon, 35d
M Toshkent 🚶 850 m
M Oybek 🚶 1.8 km
M Mashinasozlar 🚶 2.0 km
🚌 Nearest bus stop 🚶 240 m · buses: 52, 55
Mon–Fri:09:00–17:00
Open now
Tashkent, Yunusabad district, st. Osiyo, 68d
M Abdulla Qodiriy 🚶 1.2 km
M Minor 🚶 1.3 km
M Yunus Rajabiy 🚶 1.3 km
🚌 Nearest bus stop 🚶 130 m · buses: 2
Mon–Fri:09:00–17:00
Open now
Akhmad, 43-A Yugnakiy, Tashkent
🚌 Nearest bus stop 🚶 130 m · buses: 1, 17, 25
Mon–Fri:08:00–17:00
Open now

ICD-10 code

Official international classification codes — these are used in medical records and statistics.

Other diseases: Psychology

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