Hesselman coined the term “selective mutism” in 1983 to describe the disorder previously called “aphasia voluntaria, elective mutism, speech phobia, psychological mutism, and hearing mute” among fourteen other historic terms (Dow, Freeman, Garcia, Leonard, & Miller, 2004; Kearney, 2010). The American Psychiatric Association, or APA, characterizes selective mutism by a “persistent failure to speak in specific social situations where speech is expected, despite speaking in other situations.” Selective mutism shifted in recent years from being viewed as a response to trauma sustained early in life to a manifestation of an anxiety disorder (Dow et al, 2004). This paper briefly covers all aspects of selective mutism from signs and symptoms to diagnosis and treatment.
Selective mutism is a rare condition and some discrepancies exist pertaining to its incidence. Beidel and Turner (2005) state that the incidence falls between .18-.76 percent, while Kearney (2010) states that the incidence falls between .20-2.0 percent. No known cause currently exists. Researchers identified common similarities between children with selective mutism. The most prevalent similarities are gender (1.5 females have selective mutism compared to every one male), having a language or anxiety disorder, having a social phobia, and a family history of selective mutism or social phobia. Dow, Freeman, Garcia, Leonard, and Miller (2004) state that out of patients with selective mutism, “70 percent had a first degree relative with a social phobia or avoidant disorder and 37 percent had a first degree relative with selective mutism” (p. 286).
The APA classifies selective mutism under DSM-IV. A child’s behavior must meet these criteria for diagnosis of selective mutism:
A consistent failure to speak in social situations where speech is expected, despite speaking in other situations; the disturbance interferes with educational or occupational achievement or with social communication; the duration of the disturbance lasts at least one month and persists after the first month of school; the child’s failure to speak is not due to a lack of knowledge of, or comfort with, the spoken language required in the social situation; and the disturbance is not better accounted for by a communication disorder and does not occur exclusively during the course of a persuasive developmental disorder, schizophrenia, or other psychotic disorder. (Beidel & Turner, 2005, p. 229)
Many children with selective mutism speak normally, and often, while around or in familiar people and situations. Situations recognized as familiar and comfortable vary for each child. Generally, children feel most comfortable in their home. One child might whisper to a teacher at school while another child might only speak to one friend in the school setting. While children with selective mutism might have several close friends, the environment in which they are determines whether the child will interact with them....