What is Selective Mutism

Most people have not heard of Selective Mutism thought most people have know children that they have characterised as extremely shy. However there is a line between appropriate shyness and something more. The reason why most people don't recognise this is because children with Selective Mutism are able to speak when their parents are present, which causes most people to get confused and the reason why it is not identified, usually until they reach daycare or school.
Selective Mutism is a diagnosable condition found in the DSM IV Manual which is the manual the Psychologist's and other Professionals use as a guide in diagnosing different psycholigical/psychiatry.

313.23 Selective Mutism (formerly Elective Mutism)

Diagnostic Features

The essential feature of Selective Mutism is the persistent failure to speak in specific social situations (e.g., school, with playmates) where speaking is expected, despite speaking in other situations (Criterion A). The disturbance interferes with educational or occupational achievement or with social communication (Criterion B). The disturbance must last for at least 1 month and is not limited to the first month of school (during which many children may be shy and reluctant to speak) (Criterion C). Selective Mutism should not be diagnosed if the individual’s failure to speak is due solely to a lack of knowledge of, or comfort with, the spoken language required in the social situation (Criterion D). It is also not diagnosed if the disturbance is better accounted for by embarrassment related to having a Communication Disorder (e.g., Stuttering) or if it occurs exclusively during a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder (Criterion E). Instead of communicating by standard verbalization, children with this disorder may communicate by gestures, nodding or shaking the head, or pulling or pushing, or, in some cases, by monosyllabic, short, or monotone utterances, or in an altered voice.

Associated Features and Disorders

Associated features of Selective Mutism may include excessive shyness, fear of social embarrassment, social isolation and withdrawal, clinging, compulsive traits, negativism, temper tantrums, or controlling or oppositional behavior, particularly at home. There may be severe impairment in social and school functioning. Teasing or scapegoating by peers is common. Although children with this disorder generally have normal language skills, there may occasionally be an associated Communication Disorder (e.g., Phonological Disorder, Expressive Language Disorder, or Mixed Receptive-Expressive Language Disorder) or a general medical condition that causes abnormalities of articulation. Mental Retardation, hospitalization, or extreme psychosocial stressors may be associated with the disorder. In addition, in clinical settings, children with Selective Mutism are almost always given an additional diagnosis of an Anxiety Disorder (especially Social Phobia).

Specific Culture and Gender Features

Immigrant children who are unfamiliar with or uncomfortable in the official language of their new host country may refuse to speak to strangers in their new environment. This behavior should not be diagnosed as Selective Mutism. Selective Mutism is slightly more common in females than in males.


Selective Mutism is apparently rare and is found in fewer than 1% of individuals seen in mental health settings.


Onset of Selective Mutism is usually before age 5 years, but the disturbance may not come to clinical attention until entry into school. The degree of persistence of the disorder is variable. It may persist for only a few months or may continue for several years. In some cases, particularly in those with severe Social Phobia, anxiety symptoms may become chronic.

Differential Diagnosis

Selective Mutism should be distinguished from speech disturbances that are better accounted for by a Communication Disorder, such as Phonological Disorder, Expressive Language Disorder, Mixed Receptive-Expressive Language Disorder, or Stuttering. Unlike Selective Mutism, the speech disturbance in these conditions is not restricted to a specific social situation. Children in families who have immigrated to a country where a different language is spoken may refuse to speak the new language because of lack of knowledge of the language. If comprehension of the new language is adequate, but refusal to speak persists, a diagnosis of Selective Mutism may be warranted. Individuals with a Pervasive Developmental Disorder, Schizophrenia or other Psychotic Disorder, or severe Mental Retardation may have problems in social communication and be unable to speak appropriately in social situations. In contrast, Selective Mutism should only be diagnosed in a child who has an established capacity to speak in some social situations (e.g., typically at home). The social anxiety and social avoidance in Social Phobia may be associated with Selective Mutism. In such cases, both diagnoses may be given.

Diagnostic criteria for 313.23 Selective Mutism

A. 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.

B. The disturbance interferes with educational or occupational achievement or with social communication.

C. The duration of the disturbance is at least 1 month (not limited to the first month of school).

D. The failure to speak is not due to a lack of knowledge of, or comfort with, the spoken language required in the social situation.

E. The disturbance is not better accounted for by a Communication Disorder (e.g., Stuttering) and does not occur exclusively during the course of a Pervasive Development Disorder, Schizophrenia, or other Psychotic Disorder.

Reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders. Copyright 2000, American Psychiatric Association.