American Speech-Language-Hearing Association
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Selective Mutism

What is selective mutism?

Selective mutism (formerly known as elective mutism) usually happens during childhood. A child with selective mutism does not speak in certain situations, like at school, but speaks at other times, like at home or with friends. Selective mutism often starts before a child is 5 years old. It is usually first noticed when the child starts school.

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

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 the child does not speak with the SLP)
  • language comprehension (e.g., standardized tests and informal observations)
  • verbal and non-verbal communication (e.g., look at pretend play, drawing)

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.

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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What causes selective mutism?

Many times a child with selective mutism has or is experiencing:

  • an anxiety disorder
  • inner self/self-esteem issues
  • a speech, language, or hearing problem

How common is selective mutism?

According to the DSM-IV-TR, selective mutism is an apparently rare disorder that affects fewer than 1% of individuals seen in mental health settings.

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