Selective Mutism

What is selective mutism?

Selective mutism (formally known as elective mutism) is a disorder that usually occurs during childhood. It is when the child does not choose to speak in at least one social setting. However, the child can speak in other situations. Selective mutism typically occurs before a child is 5 years old and is usually first noticed when the child starts school.

What are some signs or symptoms of selective mutism?
Symptoms are as follows:

consistent failure to speak in specific social situations (in which there is an expectation for speaking, such as at school) despite speaking in other situations.
not speaking interferes with school or work, or with social communication.
lasts at least 1 month (not limited to the first month of school).
failure to speak is not due to a lack of knowledge of, or comfort, with the spoken language required in the social situation
not due to a communication disorder (e.g., stuttering). It does not occur exclusively during the course of a pervasive developmental disorder (PPD), schizophrenia, or other psychotic disorder.
Selective mutism is described in the 2000 edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR: pp.125-127).

Children with selective mutism may also show:

anxiety disorder (e.g., social phobia)
excessive shyness
fear of social embarrassment
social isolation and withdrawal
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How is selective mutism diagnosed?

A child with selective mutism should be seen by a speech-language pathologist (SLP), in addition to a pediatrician and a psychologist or psychiatrist. These professionals will work as a team with teachers, family, and the individual.

It is important that a complete background history is gathered, as well as an educational history review, hearing screening, oral-motor examination, parent/caregiver interview, and a speech and language evaluation.

The educational history review seeks information on:

academic reports
parent/teacher comments
previous testing (e.g., psychological)
standardized testing

The hearing screening seeks information on:

hearing ability
possibility of middle ear infection

The oral-motor examination seeks information on:

coordination of muscles in lips, jaw,and tongue
strength of muscles in the lips, jaw, and tongue

The parent/caregiver interview seeks information on:

any suspected problems (e.g., schizophrenia, pervasive developmental disorder);
environmental factors (e.g., amount of language stimulation)
child’s amount and location of verbal expression (e.g., how he acts on playground with other children and adults)
child’s symptom history (e.g., onset and behavior)
family history (e.g., psychiatric, personality, and/or physical problems)
speech and language development (e.g., how well does the child express himself and understand others)

The speech and language evaluation seeks information on:

expressive language ability (e.g., parents may have to help lead a structured story telling or bring home videotape with child talking if he or she refuses to do so with the SLP)
language comprehension (e.g., standardized tests and informal observations)
verbal and non-verbal communication (e.g., look at pretend play, drawing)
To contact a speech-language pathologist, visit ASHA’s Find a Professional.

What treatments are available for individuals with selective mutism?

The type of intervention offered by an SLP will differ depending on the needs of the child and his or her family. The child’s treatment may use a combination of strategies, again depending on individual needs. The SLP may create a behavioral treatment program, focus on specific speech and language problems, and/or work in the child’s classroom with teachers.

A behavioral treatment program may include the following:

Stimulus fading: involve the child in a relaxed situation with someone they talk to freely, and then very gradually introduce a new person into the room
Shaping : use a structured approach to reinforce all efforts by the child to communicate, (e.g., gestures, mouthing or whispering) until audible speech is achieved
Self-modeling technique: have child watch videotapes of himself or herself performing the desired behavior (e.g., communicating effectively at home) to facilitate self-confidence and carry over this behavior into the classroom or setting where mutism occurs

If specific speech and language problems exist, the SLP will:

target problems that are making the mute behavior worse;
use role-play activities to help the child to gain confidence speaking to different listeners in a variety of settings; and
help those children who do not speak because they feel their voice “sounds funny”.
Work with the child’s teachers includes:

encouraging communication and lessening anxiety about speaking;
forming small, cooperative groups that are less intimidating to the child;
helping the child communicate with peers in a group by first using non-verbal methods (e.g., signals or cards) and gradually adding goals that lead to speech; and working with the child, family, and teachers to generalize learned communication behaviors into other speaking situations.
To contact a speech-language pathologist, visit ASHA’s Find a Professional.

Other organizations that have information on selective mutism:

K12 Academics
NYU Child Study Center
Selective Mutism Foundation
Selective Mutism and Childhood Anxiety Disorders Group

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