Selective mutism

Causes

Selective mutism is most common in children under age 5. The cause, or causes are unknown. Most experts believe that children with the condition inherit a tendency to be anxious and inhibited. Most children with selective mutism have some form of extreme social phobia.

Parents often think that the child is refusing to speak, but usually the child is truly unable to speak in certain settings.

Some affected children have a family history of selective mutism, extreme shyness, or anxiety disorders, which may increase their risk for similar problems.

This syndrome is not the same as mutism. In selective mutism, the child can understand and speak, but is unable to speak in certain settings or environments. Children with mutism never speak.

Symptoms

• Ability to speak at home with family
• Fear or anxiety around people they do not know well
• Inability to speak in certain social situations
• Shyness

This pattern must be seen for at least 1 month to be selective mutism. (The first month of school does not count, because shyness is common during this period.)

Exams and Tests

There is no test for selective mutism. Diagnosis is based on the person's history of symptoms.

Teachers and counselors should consider cultural issues, such as recently moving to a new country and speaking another language. Children who are uncomfortable with a new language may not want to use it outside of a familiar setting. This is not selective mutism.

The person's history of mutism should also be considered. People who have been through trauma may show some of the same symptoms seen in selective mutism.

Treatment

Treating selective mutism involves behavior changes. The child's family and school should participate. Certain medications that treat anxiety and social phobia have been used safely and successfully.

Support Groups

For more information and resources, see selective mutism support groups.

Outlook (Prognosis)

Children with this syndrome can have different outcomes. Some may need to continue therapy for shyness and social anxiety into the teenage years, and possibly into adulthood.

Possible Complications

Selective mutism can affect the child's ability to function in school or social settings. Without treatment, symptoms may get worse.

When to Contact a Medical Professional

Call your health care provider if your child has symptoms of selective mutism, and it is affecting school and social activities.

References

Rosenberg Dr, Vandana P, Chiriboga JA. Anxiety disorders. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 23.

Simms MD, Schum RL. Language development and communication disorders. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 32.

Bostic JQ, Prince JB. Child and adolescent psychiatric disorders. In: Stern TA, Rosenbaum JF, Fava M, Biederman J, Rauch SL, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 1st ed. Philadelphia, Pa: Mosby Elsevier; 2008:chap 69.

Update Date: 2/11/2012

Updated by: Linda J. Vorvick, MD, Medical Director and Director of Didactic Curriculum, MEDEX Northwest Division of Physician Assistant Studies, Department of Family Medicine, School of Medicine, University of Washington; and David B. Merrill, MD, Assistant Clinical Professor of Psychiatry, Department of Psychiatry, Columbia University Medical Center, New York, NY. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.