Selective Mutism
Selective mutism is a communication disorder primarily affecting children, characterized by a consistent inability to speak in certain social situations, such as at school, while they typically communicate freely at home or in familiar environments. This condition is often seen alongside social anxiety, and it usually manifests in preschool or early primary school-aged children. Although the exact cause of selective mutism is unknown, various factors, including trauma, family dynamics, and learned behaviors, may contribute to its development. Diagnosis is based on observed behaviors rather than definitive tests, requiring a careful assessment to rule out other potential explanations for the child's silence.
Treatment typically involves behavior therapy and psychosocial interventions, with various strategies employed to encourage communication in social settings. In some cases, medication may be prescribed to address underlying anxiety. While many children may eventually outgrow selective mutism, the associated anxieties can persist into adulthood. It's important to recognize that children with selective mutism may still find ways to communicate non-verbally. Overall, a supportive and understanding approach is essential for effectively addressing the challenges of selective mutism.
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Subject Terms
Selective Mutism
Selective mutism is a condition in which a child speaks normally in some situations, such as at home, but refuses to speak in public or social situations, such as school. In some cases, a child who is selectively mute may speak to peers or family members, but not to strange adults in a social situation. Selective mutism is often diagnosed with social phobia and is most common among children of preschool or primary school age, particularly among kindergartners. Behavior therapy and psychosocial interventions are the first-line treatments for selective mutism, although medications to treat anxiety and social phobia may also be prescribed. Many children seem to outgrow the disorder, although the underlying anxieties may remain into adulthood.
Overview
Although a condition similar to selective mutism was first described in the late nineteenth century, selective mutism was first recognized in the fourth edition of the Diagnostic and Statistical Manual (DSM-IV) of the American Psychiatric Organization, published in 1994. According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision, published in 2022, specific diagnostic criteria include the ability to speak normally in home situations, coupled with the persistent avoidance of speaking in particular social situations when speaking is expected (such as in school). In addition, this avoidance must last at least one month, interfere with the individual’s education or social functioning, and cannot be better explained by a communication disorder or solely attributable to autism spectrum disorder, schizophrenia, or another psychotic disorder.
Most children who are diagnosed with selective mutism have one or more other disorders, including, most commonly, social phobia; other common conditions include simple phobia and generalized anxiety disorder. Some children with selective mutism also display oppositional behavior (e.g., stubbornness, irritability, sullenness), and this oppositional behavior may also be displayed differentially between home and public settings. Selective mutism is more common among girls than boys, and its onset may be either gradual or sudden; the mean age of onset is usually in the range of three and a six years old.
The cause of selective mutism is unknown, but several explanations have been offered for it, including reaction to traumatic events; dysfunctional family relationships, conflicts, or phobias; and faulty patterns of learning fostered by negative reinforcement. Some psychologists believe that selective mutism is a type of avoidance behavior: because many children with selective mutism also suffer from social phobia, they may refuse to speak in social situations to avoid triggering a distress response.
There is no definitive test to diagnose a child has having selective mutism or to rule it out, and it is seldom self-reported. Instead, the diagnosis is usually made based on observed behavior, including parent-child interactions, and also requires ruling out other possible explanations for the behavior. Notably, children with selective mutism do not necessarily decline to communicate in social situations; they simply decline to speak. Many will attempt to communicate through gestures, pointing, or facial expressions.
The most common treatment for selective mutism is behavior therapy or family therapy, and multiple interventions appear to be the most effective in addressing the problem. In addition to psychotherapy, in some cases, antidepressant or antianxiety medication may also be prescribed.
Bibliography
Beidel, Deborah C., and Samuel M. Turner. Childhood Anxiety Disorders: A Guide to Research and Treatment. 2nd ed., Routledge, 2005.
Bergman, R. Lindsey. Treatment for Children with Selective Mutism: An Integrative Behavioral Approach. Oxford UP, 2012.
Cline, Tony, and Sylvia Baldwin. Selective Mutism in Children. 2nd ed., Wiley, 2003.
Grills-Taquechel, Amie E., and Thomas H. Ollendick. Phobic and Anxiety Disorders in Children and Adolescents. Hogrefe, 2013.
Johnson, Maggie. Can I Tell You about Selective Mutism? A Guide for Friends, Family and Professionals. Jessica Kingsley Publishers, 2012.
Kearney, Christopher. Helping Children with Selective Mutism and Their Parents: A Guide for School-Based Professionals. Oxford UP, 2010.
Perednick, Ruth. The Selective Mutism Treatment Guide: Manuals for Parents, Teachers, and Therapists: Still Waters Run Deep. Oaklands, 2011.
"Selective Mutism." ASHA, American Speech-Language-Hearing Association, 1997–2025, www.asha.org/Practice-Portal/Clinical-Topics/Selective-Mutism/. Accessed 28 Jan. 2025.
"Selective Mutism." MedlinePlus, National Library of Medicine, NIH, 4 May 2024, medlineplus.gov/ency/article/001546.htm. Accessed 28 Jan. 2025.
Wong, Priscilla. “Selective Mutism: A Review of Etiology, Comorbidities, and Treatment.” Psychiatry, vol. 7, no. 3, 2010, pp. 23–31.