What is selective mutism?

Selective mutism (SM) is defined as a communication disorder in which a persistent failure to speak in specific social situations exists, even though the person speaks fluently in other, more familiar, situations. Affected children understand language use and, although they have the ability to speak, they demonstrate a persistent inability to speak in some settings over a period of time. This differs from shyness.  Shyness is a socially adaptable personality trait, with developmentally appropriate hesitancies or lack of speaking in new environments (Richard, 2011).

The following five diagnostic criteria are specified in the DSM-IV for selective mutism:

1. There is 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.

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

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

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

5. 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.

Here are some questions to consider when someone expresses concern about a child who is not talking in a particular situation (Kearney & Vecchio, 2007):

1. In what environments does the child not speak (school, day care, restaurants, etc.)?

Children with SM generally have diffi culty speaking in social and public situations, but not in their home environment.

2. Has this behavior been occurring for more than a month?

All children may show periods of shyness when transitioning to a new situation, so a child should be given a time period to adjust to new environments.

3. Does the child speak at home?

Most children with SM speak freely and without difficulty at home.

4. Does this refusal to speak negatively affect the child’s school performance?

If this is truly SM, then the child’s refusal to speak will have negative academic and social ramifications.

5. Are there certain “triggers” that make the child more likely not to speak?

Does the child refuse to speak when a certain teacher is absent or when there have been changes in the family dynamics? These triggers may help establish an intervention plan.

6. Can the child be coached into speaking in public settings?

Children who speak some in public have a better prognosis than children who only speak at home.

7. How does the family compensate for the child’s mutism?

Parents that accommodate and do all tasks for their child (e.g., ordering food at restaurants) may be enabling their child’s avoidance of social speaking.