In the DSM-IV selective mutism is described as a rare psychological disorder in children. Children (and adults) with the disorder are fully capable of speech and understanding language, but fail to speak in certain social situations when it is expected of them. They function normally in other areas of behaviour and learning, though appear severely withdrawn and might be unwilling to participate in group activities. It is like an extreme form of shyness, but the intensity and duration distinguish it. As an example, a child may be completely silent at school, for years at a time, but speak quite freely or even excessively at home.

The disorder is not regarded as a communication disorder, in that most children communicate through facial expressions, gestures, etc. In some cases, selective mutism is a symptom of a pervasive developmental disorder or a psychotic disorder.

In diagnosis, it can be easily confused with autistic spectrum disorder, or Aspergers, especially if the child acts particularly withdrawn around his or her psychologist. Unfortunately, this can lead to incorrect treatment.

Selective mutism is usually characterised by the following:

The person does not speak in specific places such as school or other social events.
The person can speak normally in at least one environment. Normally this is in the home.
The person's inability to speak interferes with his or her ability to function in educational and/or social settings.
The mutism has persisted for at least a month and is not related to change in the environment.
The mutism is not caused by another communication disorder and does not occur as part of other mental disorders.

The former name elective mutism indicates a widespread misconception even among psychologists that selective mute people choose to be silent in certain situations, while the truth is that they are forced by their extreme anxiety to remain silent; despite their will to speak they just cannot make any voice. To reflect the involuntary nature of this disorder, its name has been changed to selective mutism in 1994. However, misconceptions still prevail; for instance, the ABC News erroneously attributed the cause of selective mutism to trauma and described it as willful in a report dated May 26, 2005.

The incidence of selective mutism is not certain. Owing to the poor understanding of the general public on this condition, many cases are undiagnosed. Based on the number of reported cases, the figure is commonly estimated to be 1 in 1000. However, in a 2002 study in The Journal of the American Academy of Child and Adolescent Psychiatry, the figure has increased to 7 in 1000.

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Speech and Language Delay:
From American Family Physician, 6/1/99

What Does This Mean for My Child?

How do I know if my child has speech delay?

If your child doesn't talk as much as most children of the same age, the problem may be speech delay. Your doctor may think your child has speech delay if he or she isn't able to do these things:

* Babble by 12 to 15 months of age

* Understand simple words (like "no," or "stop") by 18 months of age

* Talk in short sentences by three years of age

* Tell a simple story at four to five years of age

What causes speech delay?

These are the most common causes of speech delay:

* Hearing loss

* Slow development

* Mental retardation

Other causes include:

* Bilingualism (two languages are spoken in the child's home)

* Psychosocial deprivation (the child doesn't spend enough time talking with adults)

* Being a twin

* Autism (a kind of brain problem)

* Elective mutism (the child just doesn't want to talk)

* Cerebral palsy (a movement disorder caused by brain damage)

What can my doctor do to find out if speech delay is the problem?

Your doctor can listen to your child's speech and check your child's mental development. Your child should also have a hearing test, just in case your child is having trouble hearing.

What can be done if my child has speech delay?

Your child may not need any treatment. Some children just take more time to start talking. The way your doctor might treat your child depends on the cause of the speech delay. Your doctor will tell you the cause of your child's problem and explain any treatments that might fix the problem or make it better. A speech and language pathologist might be helpful in making treatment plans. This person can also show you how to help your child talk more and speak better.

Other health care workers who may be able to help you and your child include: an audiologist (a hearing doctor), a psychologist (a specialist in behavior problems), an occupational therapist (who might teach your child how to listen or how to lip read) and a social worker (who can help with family problems). Your family doctor will refer you to these health care workers if your child needs their help.

Return to Elective mutism

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