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Selective mutism

Definition

Selective mutism is a condition in which a child who can speak well stops speaking, usually in school or social settings.

Causes, incidence, and risk factors

The cause of selective mutism is unknown. Most experts believe that children with the condition inherit a tendency to be anxious and inhibited. Most children with this condition 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 condition is most common in children under age 5.

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

Symptoms

  • Ability to speak at home with family
  • Failure to speak in certain social situations
  • Fear of people
  • Shyness

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

Signs and tests

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 necessarily selective mutism.

Treatment

Current treatment involves behavior changes, family participation, and the child's school. 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.

Expectations (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.

Complications

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

Calling your health care provider

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

References

Stafford B, Boris NW, Dalton R. Anxiety disorders. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 24.

Simms MD, Schum RL. Language development and communication disorders. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 32.2.

Victor AM, Bernstein GA. Anxiety disorders and posttraumatic stress disorder update. Psychiatr Clin North Am. 2009;32:57-69.


Review Date: 2/28/2010
Reviewed By: Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine; and Michelle Benger Merrill, MD, Instructor in Clinical Psychiatry, Department of Psychiatry, Columbia University Medical Center, New York, NY. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
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