Selective Mutism vs. Social Anxiety Disorder: What Are the Differences?

Selective mutism and social anxiety disorder share similar symptoms but are distinct conditions. However, researchers believe that the conditions are interrelated and they often occur together at the same time.

Around 9.1% of adolescents experience social anxiety disorder at some point before the age of 18. Selective mutism is less common, affecting around 1% of children. Studies suggest that nearly 40% of children with selective mutism also have social anxiety disorder.

Learn more about the differences between selective mutism and social anxiety disorder. Talk to your child's doctor if you think your child might have one or both conditions.

Symptoms

Selective mutism and social anxiety disorder are both characterized by anxiety in social situations. Kids with social anxiety feel anxious in response to social or performance situations. This anxiety leads to significant distress, interferes with a child's ability to function, and often contributes to avoidance behaviors.

Social mutism causes children to stop speaking in specific social situations. While they speak in other settings, such as at home or around people they are familiar with, they will often become completely nonverbal in others. Symptoms of the condition affect a child's social life, ability to maintain friendships, and educational achievement. 

Causes

The exact causes of selective mutism and social anxiety disorder are not completely understood. Various factors—including genetics, environmental variables, and social influences—are believed to play a role.

Selective Mutism

Selective mutism appears to have some genetic influences. According to the National Organization for Rare Diseases (NORD), some children may have a genetic vulnerability that interacts with environmental factors to increase the risk of developing the condition.

Children with the condition tend to have family members who also have anxiety disorders. Temperament factors and family influences may increase a child's risk. For example, a child with a shy, inhibited temperament who grows up around adults who model anxious behaviors might be more likely to develop selective mutism.

Social Anxiety Disorder

Like selective mutism, social anxiety disorder is believed to stem from a mix of genetic, environmental, and social variables. Some evidence shows that social anxiety tends to run in families. Certain temperaments, which are associated with genetic influences, are linked to a higher risk for social anxiety. 

Children with social anxiety tend to have shy temperaments marked by higher levels of behavioral inhibition. Children with this temperament tend to be more fearful and resistant when encountering unfamiliar situations.

Structural differences in the brain may also play a part. For example, an overactive amygdala, the part of the brain associated with fear, may cause people to interpret social situations as threatening and fear-inducing.

Diagnosis

In order to make a diagnosis, a healthcare practitioner will ask questions about a child's symptoms. They will want to know more about the type of symptoms a child experiences, when they have them, and how severe they are. In addition to observing a child's behavior, they may also talk to other people who interact with the child, such as teachers and other family members.

While the two conditions share similarities, there are symptom patterns that can help distinguish between the two. Kids with social anxiety disorder are more likely to have physical symptoms, such as frequent headaches and stomach aches. 

Children with selective mutism are more likely to exhibit other speech difficulties, including problems understanding speech and speech delays. Symptoms of the condition usually begin earlier and occur in specific settings.

Treatment

Treatments for selective mutism and social anxiety disorder are very similar. Cognitive-behavioral therapy (CBT) is often the first-line approach. CBT addresses the underlying thoughts that contribute to anxiety and avoidance behavior. 

Specific forms of CBT that can be helpful in treating selective mutism or social anxiety include desensitization and exposure therapy. People are gradually exposed to what they fear. With prolonged and repeated exposure, they eventually become desensitized and their fear decreases.

Prevention

Because selective mutism and social anxiety disorder are caused by multiple factors, including genetics and brain differences, there is no way to eliminate all risks. While you can't prevent your child from experiencing social anxiety, there are things you can do to help them cope and prevent anxiety from getting worse:

• Parents should avoid trying to shield their children from anxiety-provoking social situations. Instead, provide opportunities to practice social skills safely and in a controlled way. 
• Encourage your child to participate in social activities and model positive behaviors.
• Give your child extra time and practice to prepare for social situations.
• Teach your child techniques that can help them manage their anxiety, such as deep breathing and grounding techniques.
• Work on progressively increasing your child's social experiences. Start slow, and keep going as they gradually become more accustomed to social activities.

Most importantly, seek help if you think your child needs extra assistance. Treating social anxiety early on can prevent symptoms from getting worse, which may help reduce the risk of selective mutism.

Summary

Selective mutism and social anxiety disorder are separate conditions, but they share similar symptoms and may share a connection. Some experts believe that selective mutism may represent a more severe form of social anxiety disorder.

Despite these connections, there are important differences. Social anxiety disorder tends to be less specific and occurs in various situations. Selective mutism is characterized by symptoms that often only appear in certain settings, such as at school or around strangers. Both conditions can create significant disruptions in a child’s life, but effective treatments can help kids overcome feelings of anxiety.

A Word From Verywell

Selective mutism and social anxiety disorder share common features and appear to be related, but are separate conditions. If your child is struggling to engage socially and experiences significant anxiety in social situations, talk to their doctor for further evaluation. With diagnosis and treatment, both are highly treatable conditions. By working with a therapist and supporting your child, you can help them manage their anxiety and build social confidence.