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For people with Down syndrome, family members, caregivers and professionals.

Selective Mutism

September 2010 | Brian Chicoine, MD - Medical Director, Adult Down Syndrome Center

What is selective mutism?

A condition in which a person with normal verbal skills does not speak in particular settings.

Are there typical settings where a person won’t talk?

Often it is a school setting.

Will a person talk in some settings?

Yes, the “selective” piece is that the person won’t talk in some settings but will talk in others.

What are the causes?

It may be a symptom of social phobia – fear in social settings. There does seem to be an anxiety component.

What treatments are available?

Treatments for anxiety are recommended. This would include approaches such as cognitive therapy, counseling, and anti-anxiety medications such as the selective serotonin reuptake inhibitors (such as sertraline, paroxetine, etc.).

There are other treatments such as:

  • Stimulus fading: the person is in a relaxed setting with someone they talk to freely and gradually a new person is introduced to the setting (someone that they have difficulty talking to)

  • Shaping: support, encourage, and reinforce all efforts by the person to communicate (eg. gestures, whispering, etc.) until audible speech is achieved

  • Self-modeling technique: have person watch videotapes of himself or herself performing the desired behavior (e.g. speaking effectively at home) to promote self-confidence and encourage carry over of this behavior into the classroom or setting where mutism occurs

What we see more commonly in people with Down syndrome is a complete lack of talking (in all settings) or whispering (this is not common in our patients but it is more common than selective mutism). This may be related to anxiety, depression, physical illness, and others. It is sometimes associated with obsessional slowness.

More information about anxiety and other mental health conditions can be found in our book Mental Wellness in Adults with Down Syndrome.

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Please note: The information on this site is for educational purposes only and is not intended to serve as a substitute for a medical, psychiatric, mental health, or behavioral evaluation, diagnosis, or treatment plan by a qualified professional. We recommend you review the educational material with your health providers regarding the specifics of your health care needs.