What are the other Names for this Condition? (Also known as/Synonyms)

• SM (Selective Mutism)

What is Selective Mutism? (Definition/Background Information)

• Selective Mutism is a childhood anxiety disorder characterized by an inability to speak effectively in certain social settings, such as in a school or classroom. Once the affected individual is in a comfortable and relaxed environment, they are able to speak and communicate normally
• Selective Mutism falls into the category of anxiety disorders, which are a cluster of disorders characterized by significant feelings of nervousness and fear, causing physical symptoms of increased heart rate, quivering, and shakiness
• Affected individuals may display symptoms of Selective Mutism as early as infancy. This disorder develops due to a combination of biological and environmental factors. Most affected individuals primarily inherit symptoms of anxiety from their family members; however, being in an overprotected environment can also increase the risk for developing Selective Mutism
• The treatment of Selective Mutism may be through a combination of physical and psychiatric methods, to reduce one’s anxiety levels and encourage communication in unfamiliar and uncomfortable settings
• The affected individuals are able to overcome this disorder quite successfully with regular treatment. The length of treatment may vary based on the severity of each individual case

Who gets Selective Mutism? (Age and Sex Distribution)

• Selective Mutism affects about 6 in 1,000 children (0.6% incidence rate)
• Children with Selective Mutism may develop symptoms of the disorder between the ages of 2-4 years; however, most children are not typically diagnosed until they are about 5-8 years old, when they enter a formal school setting
• Although both genders may be affected, it is more prevalent in females
• This disorder may be observed in individuals of all racial and ethnic groups

What are the Risk Factors for Selective Mutism? (Predisposing Factors)

The following risk factors may be observed for Selective Mutism:

• Personal history of anxiety disorders
• Family history of anxiety disorders
• Social inhibition: Conscious or unconscious avoidance of social interaction
• Overprotective environment 

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Selective Mutism? (Etiology)

• Selective Mutism is primarily caused by biological factors, such as a family history of the condition
• However, some environmental factors may also lead to the development of this disorder, such as being brought up in an overprotective environment at home

What are the Signs and Symptoms of Selective Mutism?

The signs and symptoms of Selective Mutism may vary based on the severity of the disorder among affected individuals, and may include the following:

• Social anxiety symptoms: Extreme discomfort in social situations
• Physical health problems
  • Stomach ache
  • Nausea
  • Joint pains
  • Headaches
  • Chest pain
  • Shortness of breath
  • Diarrhea 
• Frozen, blank, and expressionless face in unfamiliar settings
• Delays in development (motor, communication, or social skills)
• Sensory integration dysfunction: Difficulties with processing information in a crowded environment
• Emotional behavior

How is Selective Mutism Diagnosed?

A diagnosis of Selective Mutism can include the following methods:

• Complete physical examination
• Comprehensive personal and family medical history evaluation
• Assessment of symptoms based on the criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)
  • An inability to speak in at least one social situation, despite speaking normally in other settings
  • A negative impact on academic or occupational achievement in society 
  • The condition is present for a minimum of 1 month (not counting the first month of school, which can be attributed to being shy)
  • The lack of communication is not due to a lack of knowledge
  • The condition is not due to a communicative disorder, and does not occur exclusively during a developmental or psychotic disorder
• Differential diagnosis to rule-out other disorders that may be present with similar signs and symptoms

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Selective Mutism?

The following complications may develop as a result of Selective Mutism:

• Inability to function in social settings
• Poor self-esteem
• Underachievement in academic and occupational life
• Social isolation
• Development of depression and other anxiety disorders
• Substance use and abuse 
• Suicidal thoughts and behaviors

How is Selective Mutism Treated?

The treatment for Selective Mutism focuses on reducing anxiety and encourages communication in social settings based on the severity of the symptoms present. The affected individuals may be treated using a combination of the following methods:

• Behavioral therapy, which is the primary method of treatment that may include:
  • Stimulus fading to help individuals get comfortable in new situations by slowly changing the setting (such as increasing the number of people present in therapy)
  • Shaping reinforcement to reward individuals for reaching target behaviours (mouthing words, whispering, etc.)
  • Contingency management to reward positive behavior until the affected individual can communicate in all settings
  • Self-modeling technique to increase confidence in communication and apply it to unfamiliar settings
• Medication to aid with underlying anxiety and associated depression
• Speech-language therapy to aid with speech and language difficulties

How can Selective Mutism be Prevented?

• Currently, there are no methods or guidelines available for the prevention of Selective Mutism
• Seeking professional help when there is a family history of anxiety disorders may aid in the diagnosis of Selective Mutism in the early stages and prevent progression of the disorder

What is the Prognosis of Selective Mutism? (Outcomes/Resolutions)

• The prognosis of Selective Mutism is typically good
• Affected individuals who follow a consistent treatment plan and having the help and support of family members and close friends are able to successfully overcome this disorder
• However, the length of treatment may vary based on the severity of each individual case

Additions and Relevant Useful Information for Selective Mutism:

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is a handbook of mental disorders, prepared and published by the American Psychiatric Association (APA) that serves as a diagnostic guide for physicians around the world.