Speech Disorders

Selective Mutism

Selective mutism is a complex anxiety disorder that affects pragmatic language. Despite the term “selective,” individuals with selective mutism do not elect where to speak but are more comfortable speaking…

What Is Selective Mutism?

Selective mutism is a complex anxiety disorder that affects pragmatic language. Despite the term “selective,” individuals with selective mutism do not elect where to speak but are more comfortable speaking in select situations. According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (American Psychiatric Association, 2022, p. 222), selective mutism is an anxiety disorder, and the diagnostic criteria for selective mutism are as follows:

  • The child shows 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 lack of verbal communication interferes with educational or occupational achievement or with social communication
  • The duration of the mutism is at least 1 month (not limited to the first month of school)
  • The failure to speak is not attributable to a lack of knowledge of, or comfort with, the spoken language required in the social situation

The mutism is not better explained by a communication disorder (e.g., childhood-onset fluency disorder) or exclusively due to the presence of autism spectrum disorder, schizophrenia, or another psychotic disorder. The onset of selective mutism typically occurs between 3 and 6 years of age, with diagnosis often occurring when the child enters school (Sharp et al., 2007). Different characteristics of the three primary factors (i.e., person, place, activity) can trigger a child’s mutism and influence the child’s ability to socially engage and communicate (Schwenck et al., 2022).

Some examples are as follows:

  • The child is generally able to speak to familiar people who they are comfortable with in familiar settings
  • With the same familiar person, the child may be verbal in one setting but mute in another setting
  • Within the same setting, the child may be verbal with some people but mute with others or maybe mute during specific anxiety-producing activities (e.g., reading out loud, music class)
  • Performance is most difficult when there is an expectation for speaking (mostly at school)

Patterns of selective mutism can vary greatly and can interfere with academic, educational, and/or social performance. Speech Therapists are integral members of an interprofessional team and often collaborate with school-based teams (e.g., teachers, guidance counselors, school staff) and behavioral health professionals (e.g., school or clinical psychologist, psychiatrist, school social worker). Collaboration between the Speech Therapist and assigned team members is particularly important for appropriate assessment and treatment because selective mutism is an anxiety-based disorder that can significantly impact the ability to access speech and language skills.

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