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Selective mutism
Selective mutism (SM) is an anxiety disorder in which a person who is otherwise capable of speech becomes unable to speak when exposed to specific situations, specific places, or to specific people, one or multiple of which serve as triggers. Selective mutism usually co-exists with social anxiety disorder. People with selective mutism stay silent even when the consequences of their silence include shame, social ostracism, or punishment.
The DSM-5 describes selective mutism as a persistent difficulty with speaking in specific social settings where speech is expected, such as in school, despite an ability to speak in other situations. The symptoms should not be too temporary and they must affect the person's ability to perform in a certain situation. Consideration should be given to possible other diagnoses.
Children and adults with selective mutism are fully capable of speech and understanding language but may be completely unable to speak in certain situations, even if speech is expected of them. This behaviour may be perceived as shyness for some or rudeness by others. A child with selective mutism may be completely silent at school for years but speak quite freely or even excessively at home. There is a hierarchical variation among people with this disorder: some people participate fully in activities and appear social but do not speak, others will speak only to peers but not to adults, others will speak to adults when asked questions requiring short answers but never to peers, and still others speak to no one and participate in few, if any, activities presented to them. In a severe form known as "progressive mutism", the disorder progresses until the person with this condition no longer speaks to anyone in any situation, even close family members.
Selective mutism is strongly associated with other anxiety disorders, particularly social anxiety disorder. In fact, the majority of children diagnosed with selective mutism also have social anxiety disorder (100% of participants in two studies and 97% in another). Some researchers therefore speculate that selective mutism may be an avoidance strategy used by a subgroup of children with social anxiety disorder to reduce their distress in social situations.
Particularly in young children, selective mutism can sometimes be conflated with an autism spectrum disorder, especially if the child acts particularly withdrawn around their diagnostician, which can lead to incorrect diagnosis and treatment. Although many autistic people are also selectively mute, they often display other behaviors—stimming, repetitive behaviors, social isolation even among family members (not always answering to name, for example)—that set them apart from a child with selective mutism alone. Some autistic people may be selectively mute due to anxiety in unfamiliar social situations. If mutism is entirely due to autism spectrum disorder, it cannot be diagnosed as selective mutism as stated in the last item on the list above.
The former name elective mutism indicates a widespread misconception among psychologists that selectively mute people choose to be silent in certain situations, while the truth is that they often wish to speak but are unable to do so. To reflect the involuntary nature of this disorder, the name was changed to selective mutism in 1994, although this name remains controversial. The name situational mutism was first suggested by Alice Sluckin, and has been used by some activists and autism researchers such as Damian Milton, arguing that the current name still carries the implication that people with the condition are choosing to be mute.
The incidence of selective mutism is not certain. Due to the poor understanding of this condition by the general public, many cases are likely undiagnosed. Based on the number of reported cases, the figure is commonly estimated to be 1 in 1000, 0.1%. However, a 2002 study in The Journal of the American Academy of Child and Adolescent Psychiatry estimated the incidence to be 0.71%.
According to Dr. Elisa Shipon-Blum’s findings, in addition to lack of speech, people with selective mutism often display other common behaviors and characteristics, such as:
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Selective mutism
Selective mutism (SM) is an anxiety disorder in which a person who is otherwise capable of speech becomes unable to speak when exposed to specific situations, specific places, or to specific people, one or multiple of which serve as triggers. Selective mutism usually co-exists with social anxiety disorder. People with selective mutism stay silent even when the consequences of their silence include shame, social ostracism, or punishment.
The DSM-5 describes selective mutism as a persistent difficulty with speaking in specific social settings where speech is expected, such as in school, despite an ability to speak in other situations. The symptoms should not be too temporary and they must affect the person's ability to perform in a certain situation. Consideration should be given to possible other diagnoses.
Children and adults with selective mutism are fully capable of speech and understanding language but may be completely unable to speak in certain situations, even if speech is expected of them. This behaviour may be perceived as shyness for some or rudeness by others. A child with selective mutism may be completely silent at school for years but speak quite freely or even excessively at home. There is a hierarchical variation among people with this disorder: some people participate fully in activities and appear social but do not speak, others will speak only to peers but not to adults, others will speak to adults when asked questions requiring short answers but never to peers, and still others speak to no one and participate in few, if any, activities presented to them. In a severe form known as "progressive mutism", the disorder progresses until the person with this condition no longer speaks to anyone in any situation, even close family members.
Selective mutism is strongly associated with other anxiety disorders, particularly social anxiety disorder. In fact, the majority of children diagnosed with selective mutism also have social anxiety disorder (100% of participants in two studies and 97% in another). Some researchers therefore speculate that selective mutism may be an avoidance strategy used by a subgroup of children with social anxiety disorder to reduce their distress in social situations.
Particularly in young children, selective mutism can sometimes be conflated with an autism spectrum disorder, especially if the child acts particularly withdrawn around their diagnostician, which can lead to incorrect diagnosis and treatment. Although many autistic people are also selectively mute, they often display other behaviors—stimming, repetitive behaviors, social isolation even among family members (not always answering to name, for example)—that set them apart from a child with selective mutism alone. Some autistic people may be selectively mute due to anxiety in unfamiliar social situations. If mutism is entirely due to autism spectrum disorder, it cannot be diagnosed as selective mutism as stated in the last item on the list above.
The former name elective mutism indicates a widespread misconception among psychologists that selectively mute people choose to be silent in certain situations, while the truth is that they often wish to speak but are unable to do so. To reflect the involuntary nature of this disorder, the name was changed to selective mutism in 1994, although this name remains controversial. The name situational mutism was first suggested by Alice Sluckin, and has been used by some activists and autism researchers such as Damian Milton, arguing that the current name still carries the implication that people with the condition are choosing to be mute.
The incidence of selective mutism is not certain. Due to the poor understanding of this condition by the general public, many cases are likely undiagnosed. Based on the number of reported cases, the figure is commonly estimated to be 1 in 1000, 0.1%. However, a 2002 study in The Journal of the American Academy of Child and Adolescent Psychiatry estimated the incidence to be 0.71%.
According to Dr. Elisa Shipon-Blum’s findings, in addition to lack of speech, people with selective mutism often display other common behaviors and characteristics, such as: