Adult with selective mutism, age 27
An adult with selective mutism sees their GP. They can speak at home, with their parents, with their therapist. At the doctor's, they cannot. The doctor might read the silence as defiance, an acute psychiatric issue, or distrust. The QR code handed over at the start of the appointment tells the doctor to communicate in writing rather than pushing for speech.
This case applies to adults with selective mutism diagnosed in childhood or adulthood (often associated with generalized anxiety or ASD), seeing a GP or a specialist.
The moment as it happens
Doctor's office, a new patient. The doctor invites in a 27 year old woman in jeans and a black sweater. She sits down, rests her bag on her lap, and looks at the floor. The doctor opens the empty file: "so, what brings you in today?" Silence. He waits. He tries again: "how long has this been going on?" She doesn't answer. He starts writing in the file "reserved patient, assess mental state".
She takes a small laminated card out of her bag. She places it on the desk. She waits for him to look at it. He sees the QR code on the front, and on the back the note: "I can hear you and understand you, I cannot speak to you. Scan to continue." He scans it. He reads: Lila, 27 years old, selective mutism diagnosed at age 5, associated with generalized anxiety, taking escitalopram 10 mg. Communication during appointments: in writing on her phone (she prepares her answers before the appointment), by yes/no (nodding), by pointing.
He turns his screen toward her and opens a text window. He types "what is the reason for your visit?" She picks up her phone and shows him a pre-written text: "I've had headaches for 3 weeks, not relieved by paracetamol, usually in the morning." The appointment gets underway.
- You write it
- The QR is in place
- The reader scans
- Understood, without explaining again
Where to place the QR code for this case
A small business card sized laminated card in the person's wallet, to hand over at the start of the appointment. The gesture works better than speech: the card explains the situation in three seconds. Front and back format to avoid extra handling: the short message on one side, the QR code on the other.
Duplicate it in a phone card holder (accessible even without the main bag). Duplicate it with regular practitioners (GP, gynecologist, dentist) in the paper file, with the front desk's agreement.
Avoid visible stickers on the bag or clothing: they expose the mutism as a "trait". Avoid disability ID style cards (selective mutism does not automatically qualify for RQTH, Recognition of Disabled Worker Status, in France).
For dental or medical walk-in emergencies, the prepared card can also be kept in a clear sleeve at the front of the handbag, accessible without having to search.
Pre-written text templates
The three templates below are written by the adult themselves. Adult selective mutism is poorly documented and often mistaken for general anxiety: the text needs to state the diagnosis clearly.
For the "Overview" section
"Lila, 27 years old, works in IT. Selective mutism diagnosed at age 5, never went away in adulthood, associated with generalized anxiety. Taking escitalopram 10 mg since 2020. I speak at home, with my parents, with my therapist (Dr X, contact on the back). I cannot speak with people I don't know, especially during medical appointments."
For the "How to help" section
"You can: invite me to type in a window open on your screen, ask me closed questions, let me show you a text I prepared on my phone, print prescriptions so I can read them over calmly, share results with me in writing, allow me a reasonable amount of time to answer."
For the "What to avoid" section
"What to avoid: pushing for forced eye contact, saying 'come on, try to speak' (the mutism is not a choice), offering me an anti-anxiety medication in the office to 'unblock' me (counterproductive), interpreting my silence as defiance or distrust, refusing to switch to writing, calling a psychiatrist for an urgent evaluation."
Conditions related to this case
This case is based on selective mutism in adults (rare and underdiagnosed). It also applies to trauma-related mutism after a shock, mutism associated with high functioning ASD (the person speaks outside of triggering situations), and severe depressive states with verbal shutdown.
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View the casePrepare your profile for this situation, without having to explain it again every school year.
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