Selective Mutism

The majority of people who exhibit selective mutism appear to have some type of anxiety disorder. A person who has this condition usually has a full understanding of language in most situations. In other cases, though, they appear as if they have a total lack of language where one would expect oral speech, such as in school. This condition may extend over a period of time, at least 1 to 2 months and longer. This occurs in the absence of any specific medical problem that may prevent speech.

Symptoms of selective mutism include:

• refusing to talk in one or more social situations, including school
• a speech disturbance that interferes with achievement in work or school when the condition lasts at least 1 month or more

Selective mutism does NOT appear to be related to:

• lack of familiarity with the spoken language
• degree of comfort with speaking in social situation
• communication disorders, such as stuttering or aphasia
• pervasive developmental delay, schizophrenia, obsessive-compulsive disorder, or other psychotic disorder or attention deficit disorder

The cause of selective mutism is not clear. Possible causes include:

• immigrant family background
• significant early childhood trauma
• injury that affects the mouth
• anxiety
• possible history of speech disorders early in childhood or delayed onset of speech

There is no specific way to prevent selective mutism at this time. Reducing childhood emotional trauma or stress may reduce this and other mental disorders.

Diagnosis of selective mutism is usually by history, physical examination, and ruling out other causes.

Tests may include cranial CT scans, x-rays, dental exams, or examination by specialists. A neurologist or an ear, nose, and throat specialist may rule out other causes of lack of speech. A speech therapist, psychologist, and psychiatrist can assess communication skills and mental state.

Most episodes of selective mutism may only last 2 to 3 months and cause short-term educational or occupational disabilities. Long-term effects may include other behaviors or problems that can have a long-term impact on education and employment.

Selective mutism is not contagious and cannot be spread to others.

Treatment for selective mutism may include cognitive-behavioral therapy. In behavioral treatment or therapy a person can work through situations that may cause selective mutism. Family therapy may also help the family resolve issues that may contribute to selective mutism. Therapy also offers support for those experiencing selective mutism. Medications for anxiety or social phobias may be given.

Some medications may cause drowsiness, sleep disorders, irritability, and stomach upset.

Normal oral speech generally returns in a short time. The person may require further psychological or psychiatric care for any other conditions that are present.

Progress in speech therapy and cognitive-behavioral therapy will assist in monitoring selective mutism. Oral speech progress in a variety of settings will also help in monitoring selective mutism. Any new or worsening symptoms should be reported to the healthcare professional.