Symptoms of selective mutism usually begin to appear during the toddler years as shyness and a sporadic reluctance to speak despite being able and quite happy to do so. It may be noticed in the nursery school or other preschool activity setting but these are of relatively short duration and the fact that a child is not talking may not be noticed. It is often not until the child is in school all day that the problem becomes apparent.

There are a number of non-verbal indications of a child's being selectively mute. These include blushing, avoiding eye contact and fidgeting or becoming rigid. Communication is achieved by gesturing and pointing and any activity which requires speaking is avoided, as is any physical activity where there is any possibility of being expected to speak and activities which require the need to ask for permission or assistance. This avoidance, particularly in young children, can lead to wetting and soiling accidents outside the home which can be misunderstood and assumed to be due to developmental delay. Other misinterpretations that often occur are defiant, manipulative or oppositional behaviours when the child, in fact, is only avoiding what to him/her is a fearful situation.

Very often, a "best friend" voluntarily becomes the selectively mute child's spokesperson, so that it may appear that this child just has the more dominant personality of the two rather than it being immediately apparent that the other child is not talking. Sometimes, it is another child who realises that "a boy/girl in my class doesn't talk" before the teacher or parents even know that there is anything wrong.

The fear of speaking may manifest itself in reactions such as tantrums, irritability and not being able to sleep. It can result in extreme timidity and withdrawal when moves to approach or touch are made. There are sometimes indications that obsessive compulsive disorder is also present. Attempts by the child to control the anxiety lead to unfavourable perceptions of him/her, by both adults and other children, as someone who is expressionless, stares, refuses to make eye contact and, since he/she doesn't ask other children to play with him/her, is unsociable.

Ironically quietness and good behaviour in the classroom, at the library, dance class or swimming pool are also signs of selective mutism. The fact that the quiet, well-behaved child does not speak, eat or go to the washroom can be easily overlooked in an over-crowded classroom or the relatively short time spans of the other activities.

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