Selective Mutism
Naomi Steiner
I. Description of the problem. Selective mutism is an anxiety-related condition and can be seen as the symptomatic expression of social anxiety in an extremely shy child. It is characterized by:
A child’s inability to speak in certain social settings (such as childcare, school) where speaking is expected, despite speaking in other, usually more familiar settings (such as at home). This disturbance affects the child’s daily function.
Onset usually before age 5 years, although it may not come to clinical attention until school entry.
Lasting for at least 1 month (not including the first month of school or child care, during which many children may be shy or reluctant to speak).
A. Epidemiology.
Limited research reports a prevalence of 0.1%-0.7% children in the general population and 1% of children in mental health centers
At least 90% of these children also have social phobia (social anxiety disorder)
Girls outnumber boys 2 to 1
Although selective mutism usually lasts for only a few months, it may persist longer and may even continue for several years.
B. Etiology/contributing factors.
1. Genetic predisposition. There is often a first-degree family history of social phobia (70%) and selective mutism (37%).
2. Speech and language delays are present in 20%–30% (most commonly language and articulation disorders).
3. Bilingualism. Immigrant children who are unfamiliar with or uncomfortable in a new language may refuse to speak to strangers in their new environment; this behavior should not be misdiagnosed as selective mutism. However, a prolonged silent phase should be seen as a potential red flag when selective mutism and language delay are being considered.
4. Contrary to popular belief, no research has associated selective mutism with abuse, neglect, or trauma.
II. Making the diagnosis. Initial screenings are simple, involving some observation and a few questions. The classic sign of selective mutism is that the child talks well within the home but not outside in social settings.
A. Behavioral observations.
Symptoms of withdrawal in unfamiliar situations are, difficulty with eye contact, avoidance of social interaction, stiff body language, blank facial expression, using only gestures to communicate in the office.
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