Muteness is a rare condition that can be either temporary or permanent, depending upon the underlying cause. Someone who is mute may have been born that way, or their symptoms may arise after a severe injury, illness, or traumatic event. Not all cases of muteness are permanent, but many are misunderstood. 

In this article, Ability Central will answer the most frequently asked questions about mutism. The questions include the following:

• What is muteness?
• What are the types of mutism?
• What causes muteness?
• What is selective mutism?
• How is muteness related to agoraphobia?
• What diagnoses are linked with mutism?
• What are the day-to-day communication challenges of living with mutism?

What is muteness?

Muteness refers to the inability, limited ability, or unwillingness to speak. While some forms of mutism are permanent, mutism is usually a temporary condition resulting from another physical or psychological medical issue. Someone who is mute may regain their ability to speak after treatment for underlying issues like social anxiety or brain injury.

What are the types of mutism?

There are four primary types of mutism.

• Selective mutism (SM) is the most common form of muteness. People with selective mutism have the ability to speak but feel like they can’t, usually because of shyness or social anxiety. 
• Organic mutism is caused by brain injury. Someone with organic mutism cannot speak at all, even if they want to.
• Cerebellar mutism is caused by the removal of a brain tumor. Like organic mutism, someone with cerebellar mutism can’t speak at all.
• Aphasia makes it difficult for people to speak because of a stroke, brain tumor, or head injury. Someone with aphasia may speak in short, incomplete sentences, have difficulty finding words, or not speak at all.

What causes muteness?

Mutism can be caused by a variety of factors, including:

• Physical injury or trauma to the throat, larynx (voice box), or vocal cords.
• Vocal cord paralysis, nodules, polyps, or cancer.
• Neurological disorders or injuries, such as strokes, brain tumors, or degenerative diseases like amyotrophic lateral sclerosis (ALS).
• Psychological trauma, which can cause selective mutism.
• Developmental conditions that affect speech, like apraxia of speech or developmental apraxia.
• Infections and inflammation of the throat (typically temporary).
• Neurological developmental disorders, like autism spectrum disorder (ASD), which can cause speech delays or challenges.
• Neuromuscular disorders that affect the muscles and nerves involved in speech production, such as the chronic autoimmune disorder myasthenia gravis.

What is selective mutism (SM)?

Selective mutism (SM) is an anxiety disorder that affects one in about 140 children and about 1% of people across all age groups. 

Someone with selective mutism has a consistent inability to speak in specific social situations but may have no trouble speaking in others. For example, a child with selective mutism may have excellent conversations with her parents at home but find herself unable to speak up in the classroom. 

Other symptoms associated with selective mutism include:

• Difficulty making eye contact
• Withdrawal or isolation from others
• Clinging behaviors or separation anxiety with loved ones
• Temper tantrums, either from panic or from frustration at not being understood

Although it is often confused for simple childhood shyness, selective mutism is an anxiety disorder that can overlap with other conditions and impact self-esteem, sociability, and communication in later life.

According to the American Speech-Language-Hearing Association (ASHA), early intervention is key to treating selective mutism. This rare condition typically appears in children between the ages of 3 and 6. In extremely rare cases, adults can also develop selective mutism, often in response to severe trauma or as a symptom of post-traumatic stress disorder (PTSD). 

With appropriate treatment, such as talk therapy to address trauma or severe anxiety, kids and adults with selective mutism can gradually regain their ability to communicate.

To learn more about symptoms of mutism in adults, see How to Recognize the Early Signs of Muteness.

How is muteness related to agoraphobia?

Agoraphobia is an anxiety disorder that causes an overwhelming fear of certain places or situations. Someone with agoraphobia may panic in situations where they feel like they can’t escape or get help, like in a large crowd or an unfamiliar town.

Because of this fear, someone with agoraphobia might avoid anything that takes them outside of their house or involves social interaction, especially with strangers. A person with agoraphobia does not have to be in one of these situations to feel severe anxiety symptoms. Simply knowing one must face strangers soon can lead to extreme fear, like overwhelming anxiety or panic attacks before a doctor’s appointment.

Selective mutism and agoraphobia can be connected—in fact, the severe fear people with selective mutism experience in certain social situations can cause them to develop agoraphobia later in life. 

Both are anxiety disorders: where selective mutism causes difficulty speaking in certain social situations, agoraphobia makes the fear of those situations far more severe. To that end, the symptoms of one disorder can intensify the symptoms of the other, leading to a long-lasting cycle of communication difficulties. 

What diagnoses are linked with mutism?

Other diagnoses linked to mutism include:

• Autism spectrum disorders (ASD)
• Apraxia
• Social anxiety disorder
• Communication disorders, including expressive language disorder and phonological disorder
• Neurological conditions, including cerebral palsy
• Traumatic brain injury (TBI)
• Stroke
• Deafness
• Psychiatric disorders, including schizophrenia or severe depression
• Obsessive-compulsive behavior (OCD)
• Asperger's disorder

What are the day-to-day communication challenges of living with mutism?

It is important to note that even if someone is mute, that does not mean they cannot communicate. A person who is mute may communicate through sign language, by writing, or by typing. 

Certain accessible mobile devices can also help a person with mutism communicate. Features like text-to-speech software and digital notepads can make communication easier in social situations.

To discover devices ideal for muteness, see Ability Central’s resource library.

Where can I get more information about muteness?

Ability Central maintains a searchable database of nonprofits that specialize in communication disorders like muteness. Use our Service Locator tool to find a provider or organization near you. These organizations can help people who are mute with things like diagnosis, treatment, and social support.

Ability Central offers a series of articles to further your knowledge about muteness. See:

• How to Recognize the Early Signs of Muteness
• Long-term Care Strategies for Muteness
• What Should I Do After a Muteness Diagnosis?