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Selective mutism is a childhood anxiety disorder [1] [2] in which a person who is normally capable of speech is unable to speak in given situations, or to specific people.
In the Diagnostic and Statistical Manual of Mental Disorders selective mutism is described as a rare psychological disorder in children. Children and adults with the disorder are fully capable of speech and understanding language, but can fail to speak in certain social situations when it is expected of them. It is in presentation a reluctance to speak in certain situations. They function normally in other areas of behavior and learning, though appear severely withdrawn and some are unable to participate in group activities. As an example, a child may be completely silent at school, for years at a time, but speak quite freely or even excessively at home.
Particularly in young children, selective mutism can sometimes be confused with an autism spectrum disorder, especially if the child acts particularly withdrawn around his or her diagnostician. Unfortunately, this can lead to incorrect treatment. Individuals with selective mutism can communicate normally when in a situation in which they feel comfortable, as can many individuals on the autism spectrum, especially those with Asperger’s Syndrome. Although children on the autism spectrum may also be selectively mute, they display other behaviors–hand flapping, repetitive behaviors, social isolation even among family members (not always answering to name, for example), sensory integration difficulties, poor eye contact–that set them apart from a child with selective mutism. If a child is simply not speaking in social situations, this is likely not an autism spectrum disorder, but may be selective mutism. Children with selective mutism are not necessarily autistic, but children with autism, which has a large anxiety component, frequently display symptoms of selective mutism. It is critical to have a child with these symptoms evaluated by a developmental pediatrician.
Selective mutism is usually characterized by the following:
The former name elective mutism indicates a widespread misconception even among psychologists that selective mute people choose to be silent in certain situations, while the truth is that they are forced by their extreme anxiety to remain silent; despite their will to speak, they just cannot make any voice. To reflect the involuntary nature of this disorder, its name was changed to selective mutism in 1994.
The incidence of selective mutism is not certain. Due to the poor understanding of this condition by the general public, many cases are likely undiagnosed. Based on the number of reported cases, the figure is commonly estimated to be 1 in 1000. However, in a 2002 study in The Journal of the American Academy of Child and Adolescent Psychiatry, the figure has increased to 7 in 1000.
Most children with selective mutism have an inherited predisposition to anxiety. They often have inhibited temperaments, which is hypothesized to be the result of over-excitability of the area of the brain called the amygdala[3]. This area receives indications of possible threats and sets off the fight-or-flight response.
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