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Selective mutism - medical information

Selective mutism is a psychiatric disorder in which a person who is normally capable of speech is unable to speak in given situations or to specific people.

Selective mutism usually co-exists with shyness or social anxiety. In fact, almost all children diagnosed with selective mutism also have social anxiety disorder.

Definitions

  • Consistent failure to speak in specific social situations despite speaking in other situations.
  • The condition interferes with educational achievement and with social communication.
  • The duration is at least one 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 lack of speech 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.

Causes of selective mutism

  • We are not always sure what causes some children to develop selective mutism although it is thought to occur as the result of anxiety.
  • Most children with selective mutism are believed to have an inherited predisposition to anxiety.
  • Given the very high overlap between social anxiety disorder and selective mutism it is quite possible that social anxiety disorder causes selective mutism. 
  • Children with selective mutism are not more likely than other children to have a history of early trauma or stressful life events.
  • Children who have suffered from trauma however are known to suddenly stop speaking.

Treatments for selective mutism

  • Contrary to popular belief, people suffering from selective mutism do not necessarily improve with age.
  • Consequently, treatment at an early age is important. If not addressed, selective mutism tends to be self-reinforcing.
  • Those around a child with SM may eventually expect him or her not to speak and therefore stop attempting to initiate verbal contact.
  • Alternatively, they may pressure the child to talk, making them have even higher anxiety levels in situations where speech is expected.
  •  Treatment does not focus on the speaking itself, but focuses on reducing the anxiety the child has for speaking to and being overheard by people outside their immediate circle of family and friends.
  • The most effective forms of treatment are behavioural therapy and cognitive behavioural therapy.