Selective Mutism

Selective Mutism

Selective Mutism is the name given to a mental disorder found mostly in children, which is characterized by the child's failure to speak in certain situations and settings for greater than one month. These children have the ability to speak and understand spoken language, yet they are unable to speak in many social settings. Most speak at home or to certain individuals in the home, but are unable to speak in school. Most do, however, function normally in other ways and learn age-appropriate skills. Some children experience Selective Mutism for short periods of time, while others experience it for years. It can be a persistent disorder, even into adulthood. Literature suggests that it occurs in less than one percent of children, however, due to unreported, undiagnosed and misdiagnosed cases, the true rate of occurrence of Selective Mutism is unknown. While the exact cause also remains unknown, there does appear to be a relationship between severe anxiety, shyness and Selective Mutism.

This disorder was first reported in 1877 by a German physician, who described a child that developed mutism in certain situations. He termed this condition "Asphasia Voluntaria", meaning voluntary inability to speak. Many years later, an English physician described several children with similar symptoms, and named the disorder "Elective Mutism". More recently, the name has been changed to Selective Mutism, as the term "elective' may give the connotation that one actually chooses not to speak.

Initial symptoms of Selective Mutism usually occur between the ages of 1 and 3 years old, typically at the times when a child is asked to interact socially in preschool and other settings. The symptoms include shyness, a fear of people, and a reluctance to speak in some situations. Additional behaviors frequently associated with this condition include lack of eye contact, immobility, lack of facial expressions, and nervous fidgeting. These behaviors appear to be an attempt to control anxiety. While the cause of Selective Mutism remains unknown, recent research suggests that there may be a genetic component. Many family members of children with this disorder report that they have or had in the past experiences with extreme shyness, anxiety disorders, and even Selective Mutism.

It is critical in the diagnosis of Selective Mutism to confirm that the child has the ability to speak normally and comprehend the spoken language. This differs dramatically from Autism, where Autistic children have limited language ability. Other groups that should be excluded from this diagnosis include immigrants who speak a different language, and those that stop speaking temporarily due to a traumatic event.

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