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Selective mutism

Definition

Selective mutism is a condition in which a child who can speak stops speaking, usually in school or social settings.

Causes, incidence, and risk factors

Selective mutism is most common in children under age 5. The cause, or causes are unknown. Most experts believe that children with the condition inherit a tendency to be anxious and inhibited. Most children with selective mutism have some form of extreme social phobia .

Parents often think that the child is refusing to speak, but usually the child is truly unable to speak in certain settings.

Some affected children have a family history of selective mutism, extreme shyness, or anxiety disorders, which may increase their risk for similar problems.

This syndrome is not the same as mutism. In selective mutism, the child can understand and speak, but is unable to speak in certain settings or environments. Children with mutism never speak.

Symptoms

  • Ability to speak at home with family
  • Fear or anxiety around people they do not know well
  • Inability to speak in certain social situations
  • Shyness

This pattern must be seen for at least 1 month to be selective mutism. (The first month of school does not count, because shyness is common during this period.)

Signs and tests

There is no test for selective mutism. Diagnosis is based on the person's history of symptoms.

Teachers and counselors should consider cultural issues, such as recently moving to a new country and speaking another language. Children who are uncomfortable with a new language may not want to use it outside of a familiar setting. This is not selective mutism.

The person's history of mutism should also be considered. People who have been through trauma may show some of the same symptoms seen in selective mutism.

Treatment

Treating selective mutism involves behavior changes. The child's family and school should participate. Certain medications that treat anxiety and social phobia have been used safely and successfully.

Support Groups

For more information and resources, see selective mutism support groups .

Expectations (prognosis)

Children with this syndrome can have different outcomes. Some may need to continue therapy for shyness and social anxiety into the teenage years, and possibly into adulthood.

Complications

Selective mutism can affect the child's ability to function in school or social settings. Without treatment, symptoms may get worse.

Calling your health care provider

Call your health care provider if your child has symptoms of selective mutism, and it is affecting school and social activities.

Prevention

References

Rosenberg Dr, Vandana P, Chiriboga JA. Anxiety disorders. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. . 19th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 23.

Simms MD, Schum RL. Language development and communication disorders. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. . 19th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 32.

Bostic JQ, Prince JB. Child and adolescent psychiatric disorders. In: Stern TA, Rosenbaum JF, Fava M, Biederman J, Rauch SL, eds. . 1st ed. Philadelphia, Pa: Mosby Elsevier; 2008:chap 69.

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    Encyclopedia content is provided as information only and not intended to replace the advice and instruction from your personal physician.