When Nicole Caplan’s daughter Maebel was four, she was a cheeky child “who would talk to pretty much anyone”. So Caplan was at a loss in 2021 when “slowly, her communication just stopped with quite a few people”.
At first, Caplan didn’t worry when Maebel didn’t want to talk to strangers, but she became concerned when it happened with family too. “She just stopped talking over time to her grandfather – to my dad – and her auntie and uncles and cousins, and pretty much everyone, except me or my mum.”
She described what she was observing to a speech therapist, who suggested a condition Caplan had not heard of: selective mutism.
“Straight away you get images of someone who’s severely impaired, completely mute, and I’m like – that’s not Maebel, she’s so fun and full of life.”
Selective mutism, also known as situational mutism, is a complex childhood anxiety disorder in which a child is unable to speak in certain social settings, such as at school or in front of adults they don’t know well, but can do so where they are comfortable, typically at home.
Jo Brady, a speech pathologist in Melbourne, says half her clients since the pandemic have been children with selective mutism. She says she used to see one or two children a year with the condition, but over the past three years her caseload has risen to 30, with another 10 on the waitlist.
“This is unprecedented for me,” she says.
Brady is unsure whether the caseload reflects an increase in the number of children with selective mutism, or if it is more the result of an increased awareness of anxiety conditions.
Mikaela Fent, a speech pathologist who runs Word of Mouth Therapy in Sydney, says the practice used to see one or two children a year with selective mutism, but since the pandemic has been receiving that number of referrals each month.
“The need for training and upskilling in this area has never been higher,” she says.”
Elizabeth Woodcock, a clinical psychologist and director of the Selective Mutism Clinic in Sydney, says there definitely has been a rise in cases since the pandemic, as with all mental health issues.
Woodcock says there was an 80% increase in referrals to her clinic in 2022 compared with 2019, and that number has risen again this year.
“The experience of lockdowns, with kids missing out on socialisation during the critical period around preschool age, is at least part of the explanation for why there are more cases,” Woodcock says.
Prof Caroline Hunt, the head of the clinical psychology unit at the University of Sydney and the president of the Australian Clinical Psychology Association, says the age group at which children typically develop selective mutism – from around the time a child starts to speak until they enter primary school – has been linked to higher rates of general anxiety since the pandemic.
“If they’re not getting that practice at being able to be going out and thinking, ‘oh, yeah, I can engage with people that are not my immediate family members, and that’s OK, I can do that’ … if they’re missing out on that, there could be a more general anxiety about social interactions too.”
A genuine fear of speaking
Bianca* will never know for sure whether her daughter Hannah* would have developed selective mutism in 2020 had it not been for the pandemic. Hannah did most of her first year of preschool from home and when she went back in person, “it was a matter of us dropping her at the door”, Bianca says.
“We were never allowed through the gate, which I think had a big effect.
“I do feel like if we were able to be a little bit more involved, things could have been a little bit different.”
Bianca says Hannah’s selective mutism while she was in preschool meant she wasn’t able to ask for help. One day Bianca picked her up and her shoes and socks were soaked, but her clothes were dry.
“She had had an accident so early on in the day that her clothes had dried and she had wet feet all day and she couldn’t speak for herself. She couldn’t say, ‘I’ve had an accident, can you change me’.
“It always felt like she would organically just start talking because she’s got such a character and talks so much at home – it didn’t really feel like it would be a long-term thing.” But without any specialist help available in their part of regional Victoria, Bianca says, “we probably actually just did all the wrong things about it”.
“We tried to be stern with her and say things like, ‘you can say thank you’ or ‘just say hello’, which, in hindsight, I feel absolutely terrible about because I didn’t realise how much of a fear of speaking selective mutism is – it’s a genuine fear.”
Bianca says Hannah, now eight, is getting the professional support she needs but “as they get older, it gets harder”.
“Their awareness increases of people’s perception about them, because once they’re known as the kid who doesn’t talk, that becomes part of their identity.”
At school, Hannah is able to speak with her friends, but not teachers. When she needs to communicate with the teachers, she has “speaking buddies” to whom she will whisper and they will answer for her. However, Bianca says her friends are getting sick of speaking for her, and sometimes refuse, while other children tease her when she does speak up.
“It’s heartbreaking as a parent to see your kid at school have no voice, no way to speak for herself.
“She tells me how much she does want to talk, but she just can’t ... When Hannah gets home from school she’s got all this pent-up frustration and energy and emotion because she hasn’t been able to express it at school.”
‘A complete turnaround’
Brady says “situational mutism” is becoming a common way to refer to the condition rather than selective mutism, because “the children don’t select to not speak”.
“It is situational, because there are some situations where they can’t,” she says.
“Whether it’s selective mutism and anxiety, whether it’s not understanding language, whether it’s having a stutter or speech [impediment], no one would ever choose to not be able to verbally communicate and advocate for themselves and join in participation. No one would choose that.”
Brady says treatment for selective mutism involves exposure therapy – “gentle exposure to situations we find challenging, working through a hierarchy designed for that child and providing lots of positive reinforcement”.
Caplan says worrying about what other people think is one of the challenges of helping a child with the condition.
“Sometimes you feel like a really crappy parent because you’ll be out and someone will ask your child a question like, ‘how’s school?’ and they just look blankly at that person. And you’re like, ‘crap, they’re going to think my child’s rude’. And you cover up for your kid and answer for them, which makes the whole situation worse because you are reinforcing that behaviour.”
She travelled to the US to take part in a program that taught techniques that have helped Maebel, along with medication.
Together, they gave Maebel confidence and took the edge off her anxiety, to be able to practise communicating in different environments and realise it wasn’t that scary.
“We just built that up and built that up to a point now where she pretty much can talk to anyone, any time. There are still some situations if there’s a large group, she can get overwhelmed. But in terms of school life, she puts up her hand in class, answers questions in front of everyone. In a cafe she’ll go up and order her own food and drink.
“In just 10 months, she’s done a complete turnaround.”
* Names have been changed