Is a rare condition
occurring in childhood. Selective Mutism is characterized by a consistent
failure to speak in specific social situations in which there is an
expectation for speaking. Children with this disorder have the ability
to both speak and understand language, but fail to use this ability.
Most children who experience selective mutism function normally in
other areas of their lives. Selective mutism is not a communications
disorder and is not part of a developmental disorder. Therefore by
definition, the disorder does not include children with conduct disorders,
oppositional defiant behavior, and/or attention-deficit hyperactivity
disorder. The main characteristics are:
Does not speak in certain places; such as school or other social events.
normally in other settings such as in their home or in places where
they are comfortable and relaxed.
inability to speak interferes with their ability to function in educational
and/or social settings.
has persisted for at least one month.
trauma or stressors may be apparent particularly during the time of
A particular mother
profile and mother-child relationship (maternal anxiety, depression,
dependence and a domineering and overprotective approach to the child).
History of developmental
delays and speech and language disabilities.
social cue processing disorder.
shyness, worry, social avoidance,fearful, social withdrawal clinging,
Differential Diagnosis :
Some disorders have similar symptoms. The clinician, therefore, in
his diagnostic attempt, has to differentiate against the following
disorders which need to be ruled out to establish a precise diagnosis.
The problem appears
to be anxiety. This anxiety, which causes avoidance, seems closest
to the definition of social anxiety disorder (social
Shyness in an adjustment disorder.
Pervasive Developmental Disorders
Expressive Language Disorders
At the present
time, it cannot be said with any certainty however, the apparent cause
of selective mutism is due to a psychologically determined refusal
to speak. Some children have histories of speech problems or delay
of onset of speech. Problems within the family or at school appear
to acerbate this disorder. Young children have a higher incidence
of this disorder.
indicated that most children with this disorder are very shy and anxious
when interacting with unfamiliar persons, or in any situation where
they feel that they are the center of attention or are being observed
or evaluated. In fact, it seems likely that in many cases, selective
mutism is no more than an extreme shyness or an early childhood form
of “public speaking anxiety.” Many of the children we
have studied have parents or siblings who have suffered from selective
mutism or from extreme shyness. This observation, suggests that a
vulnerability or tendency to develop the disorder is passed on genetically.
Individual, behavioral, and
family counseling are the best approaches to this type of disorder.
seem to improve over time without any specific treatment. The
process of deciding when and how to treat a child with selective mutism
is a complex one. Multiple factors must be considered, including:
the severity, how much is it interfering with the child’s academic
and social development.
For children who
have been in school for less than 3 to 4 months, treatment may not
be recommended, unless there are other significant problems in addition
to the selective mutism and shyness. In these cases, watching and
waiting is usually the wisest course. For children who have been in
school more than 3 to 4 months, CBT with an experienced therapist
and Psychotherapy [ See
Therapy Section ]:
It appears that
cognitive-behavioral therapy, with the emphasis being on the behavioral
component, depending on the age of the child, is the therapy of choice.
Gentle and consistent
encouragement, support, and reassurance are most likely to be helpful.
Struggles between the child and adults, particularly regarding speaking,
should be avoided as much as possible. Attempts to pressure, demand,
or force the child to speak, to trick the child into speaking, or
to punish or shame the child for not speaking are most often counter-productive.
[ See Psychopharmacology
Section ] :
For more severe
or persistent cases, trial of treatment with a medication called fluoxetine
(Prozac) may be recommended.