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selective mutism

Alternative Names
elective mutism

Selective mutism is a condition in which a person who is usually fluent in speech won't speak in specific situations. Selective mutism primarily affects children.

What is going on in the body?
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.

What are the signs and symptoms of the condition?
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: What are the causes and risks of the condition?
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
What can be done to prevent the condition?
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.

How is the condition diagnosed?
Diagnosis of selective mutism is usually by physical examination. Tests include cranial CT scans, x-rays, dental examinations, 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 and a psychologist can assess communication skills and mental state.

What are the long-term effects of the condition?
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 behaviours or problems that can have a long-term impact on education and employment.

What are the risks to others?
Selective mutism is not contagious and cannot be spread to others.

What are the treatments for the condition?
Treatment for selective mutism may include cognitive-behavioural therapy. In behavioural 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.

What are the side effects of the treatments?
Some medications may cause drowsiness, sleep disorders, irritability, and stomach upset.

What happens after treatment for the condition?
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.

How is the condition monitored?
Progress in speech therapy and cognitive-behavioural 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 doctor.

Author: Ann Reyes, Ph.D.
Reviewer: HealthAnswers Australia Medical Review Panel
Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia
Last Updated: 1/10/2001
Potential conflict of interest information for reviewers available on request

This website and article is not a substitute for independent professional advice. Nothing contained in this website is intended to be used as medical advice and it is not intended to be used to diagnose, treat, cure or prevent any disease, nor should it be used for therapeutic purposes or as a substitute for your own health professional's advice.  All Health and any associated parties do not accept any liability for any injury, loss or damage incurred by use of or reliance on the information.


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