Selective Mutism*

Selective mutism was formerly called 'elective mutism.' Its name was changed in 1994 to accurately reflect changes in understanding: selective mutism is not a purposeful refusal to speak, but a failure to speak in specific social settings. These children can be described as a “chatterbox” at home and nonverbal in other environments. 

DSM-V Diagnostic Criteria:
  • Consistent failure to speak in specific social situations in which there is an expectation for speaking (e.g., at school) despite speaking in other situations.
  • The disturbance interferes with educational or occupational achievement or with social communication.
  • The duration of the disturbance is at least 1 month (not limited to the first month of school).
  • The failure to speak is not attributable to a lack of knowledge of, or comfort with, the spoken language required in the social situation.
  • The disturbance is not better explained by a communication disorder (e.g., childhood-onset fluency disorder) and does not occur exclusively during the course of autism spectrum disorder, schizophrenia, or another psychotic disorder. 

Selective Mutism must be differentiated from: communication Disorders (e.g., social communication disorder, childhood-onset fluency disorder, speech sound disorder, language disorder), autism spectrum disorder, schizophrenia, intellectual disability, social anxiety disorder, other psychotic disorders.

Diagnostic Features:
  • Does not initiate speech or reciprocally respond when spoken to by others
  • Lack of speech occurs in social interactions with children or adults
  • Will speak in their home in the presence of immediate family members but often not even in front of close friends or second-degree relatives
  • Disturbance often marked by high social anxiety
  • Often refuse to speak at school, leading to academic or educational impairment, as teachers often find it difficult to assess skills such as reading
  • Lack of speech may interfere with social communication
  • Associated behavioral features may include: excessive shyness, fear of social embarrassment, social isolation and withdrawal, clinging, compulsive traits, negativism, temper tantrums, and mild oppositional behavior

Assessment & Screening Tools

  • Norm-reference parent/caregiver and teacher report measures
  • Competency-based tools such as interviews and observations
  • Hearing screen to rule out hearing loss/dysfunction as a possible contributing factor
  • Selective Mutism Questionnaire
  • School Evaluation for Selective Mutism SM-CDQ-Brief School
  • BASC-2 (Behavior Assessment System for Children) ($)
  • CELF-4 ORS (Clinical Evaluation of Language Fundamentals Observational Rating Scale – administered by a SLP) ($)
  • Peabody Picture Vocabulary Test (receptive language – administered by a SLP) ($)
  • Expressive Test of Narrative Language (expressive language – administered by a SLP) ($)
  • Word Memory Subtest from test for Auditory Processing Disorders (administered by a SLP)

Position Papers & Practice Parameters

  • Position Statement on Selective Mutism Treatment (Selective Mutism Association) (n.d.)

Articles

  • Selective Mutism: A Review of Etiology, Comorbidities, and Treatment (Wong, 2010)
  • Selective Mutism: A primer for parents and educators (Kehle, Bray & Theodore, 2004), National Association of School Psychologists
  • Selective Mutism: A Three-Tiered Approach to Prevention and Intervention (Busse & Downey, 2011)
  • Treatment of Selective Mutism: A 5-year Follow-Up Study (Oerbeck, et al, 2017)
  • The Use of Medication in Selective Mutism: A Systematic Review (Manassis, et al, 2016)

Resources

  • Audio: Use of Medication in the Treatment of SM, Kurtz Lecture on Medications in the Treatment of Selective Mutism by SMCMI
  • Bilingual Issues
  • Educational Planning, IEP, IDEA, and 504 
  • Inspirational Stories And Poems 
  • Learning Disabilities 
  • Medication
  • Parenting
  • Sample Letters for Providers and School 
  • Tools and Resources for School
  • Sensory Issues
  • Shyness 
  • Speech and Language Issues 

Organizations

  • Selective Mutism Foundation
  • Selective Mutism Association
  • Selective Mutism, Anxiety and Related Disorders (SMart) Treatment Center
  • Selective Mutism Group (SMG)

Books

Recommended Reading List for Children, Parents, and Clinicians:
  • Sophie's Story: A Guide to Selective Mutism (Joffe)
  • Can I Tell You About Selective Mutism? A Guide for Friends, Family and Professionals (Johnson & Wintgens)
  • Helping Your Child with their Fear of Speaking (McHolm & Cunningham)
  • Helping Children with Selective Mutism and Their Parents (Kearney)
  • Understanding Katie (Shipon-Blum)-- and its supplement treatment guide
  • Maya, the Brave -- and -- Milo, the Brave (Bos)
*Page contributors: Christie Hance, BS, RN and Charmaine Limpioso, ​BSN, RN, CPN.