Selective Mutism Discussion

Selective Mutism Discussion

Selective Mutism Discussion

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Selective mutism denotes children who remain silent except when alone or with a small group of intimates. The disorder typically begins during preschool years (ages 2–4), after normal speech has developed. Such a child, who speaks appropriately at home among family members but becomes relatively silent when among strangers, may not attract clinical attention until formal schooling begins. Although often shy, most such children have normal intelligence and hearing. When they do speak, they tend to use normal articulation, sentence structure, and vocabulary. The condition often improves spontaneously within weeks or months, though no one knows how to identify such a patient in advance of improvement.

Selective mutism is uncommon, with a prevalence of under 1 in 1,000; it appears to affect girls and boys about equally. Family history is often positive for social anxiety disorder and relatives with selective mutism. Comorbid conditions include other anxiety disorders (especially separation anxiety disorder and social anxiety disorder). They do not tend to have externalizing disorders, such as oppositional defiant or conduct disorder.

Essential Features of Selective Mutism

Despite speaking normally at other times, the patient regularly doesn’t speak in certain situations where speech is expected, such as in class.

The Fine Print

The first month of a child’s first year in school is often fraught with anxiety; exclude behaviors that occur during this time.

The D’s: • Duration (1+ months) • Distress or disability (social or work/academic impairment) • Differential diagnosis (unfamiliarity with the language to be used, a communication disorder such as stuttering, psychotic disorders, autism spectrum disorder, social anxiety disorder)