Selective Mutism

The essential feature of Selective Mutism is the persistent failure to speak in specific social situations (e.g., school, with playmates) where speaking is expected, despite speaking in other situations.

Symptoms include:

• Consistent failure to speak in specific social situations (in which there is an expectation for speaking, e.g., at school) despite speaking in other situations.

• The disturbance interferes with educational or occupational achievement or with social communication.

• The duration of the disturbance is at least 1 month (not limited to the first month of school).

• The failure to speak is not due to a lack of knowledge of, or comfort with, the spoken language required in the social situation.

• The disturbance is not better accounted for by a Communication Disorder (e.g., Stuttering) and does not occur exclusively during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder.

Etiomology

Both environmental and biological causes have been suggested. Frequently inadequacy of the parent–child relationship is cited as a cause of rumination disorder, forcing the child to seek gratification internally; however, no clear evidence to support this theory exists. Predisposing factors for rumination disorder may also include other psychosocial stressors such as lack of stimulation or neglect. Exploration of the relationship between rumination disorder and gastroesophageal reflux may prove fruitful. Genetic factors in the disorder are unknown.

Associated Features

Associated features of Selective Mutism may include excessive shyness, fear of social embarrassment, social isolation and withdrawal, clinging, compulsive traits, negativism, temper tantrums, or controlling or oppositional behavior, particularly at home. There may be severe impairment in social and school functioning.

Teasing or scapegoating by peers is common. Although children with this disorder generally have normal language skills, there may occasionally be an associated Communication Disorder (e.g., Phonological Disorder, Expressive Language Disorder, or Mixed Receptive-Expressive Language Disorder) or a general medical condition that causes abnormalities of articulation.

Mental Retardation, hospitalization, or extreme psychosocial stressors may be associated with the disorder. In addition, in clinical settings, children with Selective Mutism are almost always given an additional diagnosis of an Anxiety Disorder (especially Social Phobia).

Course

Onset of Selective Mutism is usually before age 5 years, but the disturbance may not come to clinical attention until entry into school. The degree of persistence of the disorder is variable. It may persist for only a few months or may continue for several years. In some cases, particularly in those with severe Social Phobia, anxiety symptoms may become chronic.

Diagnostic criteria summarized from:

American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders, fourth edition. Washington, DC: American Psychiatric Association.