What Is Selective Mutism—and How Can Play Therapy Help?

Does your child have a hard time speaking when they feel uncomfortable or overwhelmed? If so, they may be experiencing a childhood anxiety disorder known as selective mutism.

Children (and even some teens or adults) with selective mutism often feel so anxious in certain social settings that speaking becomes extremely difficult or even impossible. This happens despite being perfectly capable of speaking in more comfortable, familiar environments—like at home with family. It’s important to understand that this is not a willful refusal to speak. Rather, it's an involuntary response to overwhelming anxiety.

What Causes Selective Mutism?

Researchers are still uncovering the exact causes of selective mutism, but it is often associated with other conditions such as:

• Autism spectrum disorder (ASD)
• Social anxiety disorder
• Separation anxiety disorder
• Post-traumatic stress disorder (PTSD)

Past trauma, including bullying, abuse, or exposure to violence, may also contribute to its development. Children with speech or language difficulties (such as stuttering) or those with a family history of selective mutism are at a higher risk as well.

In my practice, I’ve worked with many children experiencing selective mutism, and I've seen firsthand how deeply rooted this condition can be in fear and self-protection. Often, it stems from a child’s intense need to feel safe—and their inability to access words when they feel emotionally threatened.

Recognizing the Signs

The hallmark sign of selective mutism is the consistent inability to speak in specific social situations—typically at school, during extracurriculars, or with extended family. But there are often other symptoms too. Your child might:

• Become stiff or frozen in certain situations
• Avoid eye contact
• Use gestures or writing instead of speaking
• Speak in whispers or with a noticeably altered tone
• Give short or delayed responses
• Show signs of physical distress (tense body language, hiding behind adults)
• Withdraw from or act out in social environments

Each child may express their anxiety in different ways. Some may appear shy or introverted, while others might display frustration or even anger due to the stress they’re experiencing.

How Play Therapy Can Help

One of the most effective approaches I’ve found for treating selective mutism—especially in young children—is play therapy.

Play therapy provides a safe, nurturing environment where children can express themselves without the pressure of having to use words. Through imaginative play, storytelling, drawing, and games, kids gradually begin to process their emotions and build trust. As the therapeutic relationship strengthens, many children start to feel safer and more confident—often leading to increased verbal expression.

In sessions, I use carefully selected toys and activities to help children explore their feelings and experiences. We may use puppets to "speak" for them, or roleplay scenarios where they can rehearse social situations in a low-pressure way. Over time, the goal is to help the child internalize a sense of safety and begin using their voice more freely.

For children who are not yet ready to speak in therapy, that's completely okay. Building a relationship without pressuring speech is key. Progress may be slow, but it’s always meaningful.

Supporting Your Child at Home

If your child has selective mutism, it’s crucial to approach them with empathy and patience. Avoid putting pressure on them to speak, and instead, focus on creating a sense of emotional safety. Encouraging small steps and celebrating even nonverbal communication can go a long way.

Collaborating with a therapist trained in childhood anxiety and play therapy can provide your child with the tools and support they need to gradually find their voice.