Selective Mutism

Selective mutism is a psychological disorder in which a child who has already developed language skills stops speaking in particular circumstances. Most frequently the mutism occurs in children under the age of 5 in school or in another social environment and is considered to be an extreme form of social phobia. While it may seem to parents, peers or teachers that the child is simply refusing to speak, the child is actually unable to speak in the anxiety-producing situations. It is also possible that a child will experience selective mutism in the presence of a particular person rather than in a social situation. A specific trauma may precipitate a period of selective mutism.

While no precise cause of the disorder has been identified, research has shown that, as with many other psychiatric disorders, there is a genetic component to this condition. Children with a family history of extreme shyness, selective mutism or other anxiety disorders are at greater risk of developing the condition. Selective mutism is distinguished from mutism by the fact that the latter indicates a physiological impediment to speech, resulting from profound deafness or from abnormalities of the larynx, throat or vocal cords.

Symptoms of Selective Mutism

Children with selective mutism most often suffer from extreme shyness and, while able to speak with family members, may experience:

  • Inability to speak at school or in other social situations
  • Inability to speak to strangers
  • Inability to speak in the presence of a particular person

Diagnosis of Selective Mutism

Selective mutism is diagnosed by a psychological and speech evaluation. Such an evaluation is normally not performed until the problem has been evident for a least a month, not counting the first month of school, since short bouts of mutism are common in childhood, particularly when a child first begins going to school. It is important to take the patient's history and to take into account such factors as trauma or having to learn a new language.

It is not uncommon for patients who suffer from selective mutism to suffer from another psychiatric disturbance as well, such as panic disorder, dissociative disorder, or obsessive compulsive disorder. In order for a diagnosis of selective mutism to be made, however, autism, schizophrenia, and other speech disorders, such as stuttering, must be ruled out.

After eliminating anatomical or medical reasons from the lack of speech, a diagnosis of selective mutism may be made. A mental health care provider, a speech pathologist, and an otolaryngologist may all be involved in the diagnosis.

Treatment of Selective Mutism

Treatment of selective mutism may take various forms. Some type of psychotherapy is usually administered, often including other members of the patient's family (family therapy) or groups sessions with other patients suffering from the same disorder (group therapy). Since selective mutism is a behavioral problem, some behavioral techniques may be used as well. If the problem centers around the school environment, teachers and other students may be involved in offering support. Anti-anxiety medications, as well as antidepressants, may also be administered to help the patient reach a comfort level in the troubling environments.

Prognosis for Patients with Selective Mutism

With psychotherapy, support and possible medication, many children may fully recover from selective mutism. Some, however, may continue to suffer from extreme shyness or social anxiety and require treatment throughout into adulthood. Treatment should always be sought for this disorder because selective mutism, left untreated, may get significantly worse, developing into another serious psychiatric disorder.

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