Selective Mutism
What is selective mutism?
Selective mutism
(formally known as elective mutism)
is a disorder that usually occurs during childhood. It is when
the child does not to speak in at least one social setting.
However, the child can speak in other situations. Selective
mutism typically occurs before a child is 5 years old and is
usually first noticed when the child starts school.
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What are some signs or symptoms of selective mutism?
Symptoms are as follows:
- consistent failure to speak in specific social situations
(in which there is an expectation for speaking, such as at
school) despite speaking in other situations.
- not speaking interferes with school or work, or with social
communication.
- lasts at least 1 month (not limited to the first month of
school).
- failure to speak is not due to a lack of knowledge of, or
comfort, with the spoken language required in the social
situation
- not due to a communication disorder (e.g., stuttering). It
does not occur exclusively during the course of a pervasive
developmental disorder (PPD), schizophrenia, or other psychotic
disorder.
Selective mutism is described in the 2000 edition of the
Diagnostic and Statistical Manual of Mental Disorders
(DSM-IV-TR: pp.125-127).
Children with selective mutism may also show:
- anxiety disorder (e.g., social phobia)
- excessive shyness
- fear of social embarrassment
- social isolation and withdrawal
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How is selective mutism diagnosed?
A child with selective mutism should be seen by a
speech-language pathologist (SLP), in addition to a pediatrician
and a psychologist or psychiatrist. These professionals will work
as a team with teachers, family, and the individual.
It is important that a complete background history is
gathered, as well as an educational history review, hearing
screening, oral-motor examination, parent/caregiver interview,
and a speech and language evaluation.
The
educational history review
seeks information on:
- academic reports
- parent/teacher comments
- previous testing (e.g., psychological)
- standardized testing
The
hearing screening
seeks information on:
- hearing ability
- possibility of middle ear infection
The
oral-motor examination
seeks information on:
- coordination of muscles in lips, jaw,and tongue
- strength of muscles in the lips, jaw, and tongue
The
parent/caregiver interview
seeks information on:
- any suspected problems (e.g., schizophrenia, pervasive
developmental disorder);
- environmental factors (e.g., amount of language
stimulation)
- child's amount and location of verbal expression (e.g.,
how he acts on playground with other children and adults)
- child's symptom history (e.g., onset and behavior)
- family history (e.g., psychiatric, personality, and/or
physical problems)
- speech and language development (e.g., how well does the
child express himself and understand others)
The
speech and language evaluation
seeks information on:
- expressive language ability (e.g., parents may have to help
lead a structured story telling or bring home videotape with
child talking if he or she refuses to do so with the SLP)
- language comprehension (e.g., standardized tests and
informal observations)
- verbal and non-verbal communication (e.g., look at pretend
play, drawing)
To contact a speech-language pathologist, visit
ASHA's Find a Professional.
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What treatments are available for individuals with selective
mutism?
The type of intervention offered by an SLP will differ
depending on the needs of the child and his or her family. The
child's treatment may use a combination of strategies, again
depending on individual needs. The SLP may create a behavioral
treatment program, focus on specific speech and language
problems, and/or work in the child's classroom with
teachers.
A behavioral treatment program may include the following:
-
Stimulus fading:
involve the child in a relaxed situation with someone they talk
to freely, and then very gradually introduce a new person into
the room
-
Shaping
: use a structured approach to reinforce all efforts by the
child to communicate, (e.g., gestures, mouthing or whispering)
until audible speech is achieved
-
Self-modeling technique:
have child watch videotapes of himself or herself performing
the desired behavior (e.g., communicating effectively at home)
to facilitate self-confidence and carry over this behavior into
the classroom or setting where mutism occurs
If specific speech and language problems exist, the SLP
will:
- target problems that are making the mute behavior
worse;
- use role-play activities to help the child to gain
confidence speaking to different listeners in a variety of
settings; and
- help those children who do not speak because they feel
their voice "sounds funny".
Work with the child's teachers includes:
- encouraging communication and lessening anxiety about
speaking;
- forming small, cooperative groups that are less
intimidating to the child;
- helping the child communicate with peers in a group by
first using non-verbal methods (e.g., signals or cards) and
gradually adding goals that lead to speech; and
- working with the child, family, and teachers to generalize
learned communication behaviors into other speaking
situations.
To contact a speech-language pathologist, visit
ASHA's Find a Professional.
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What other organizations have information on selective
mutism?
This list is not exhaustive, and inclusion does not imply
endorsement of the organization or the content of the Web site
by ASHA.
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See Also:
Selective Mutism: Causes and Number