[1] People with selective mutism stay silent even when the consequences of their silence include shame, social ostracism, or punishment.
A child with selective mutism may be completely silent at school for years but speak quite freely or even excessively at home.
In fact, the majority of children diagnosed with selective mutism also have social anxiety disorder (100% of participants in two studies and 97% in another).
[8][9] Particularly in young children, selective mutism can sometimes be conflated with an autism spectrum disorder, especially if the child acts particularly withdrawn around their diagnostician, which can lead to incorrect diagnosis and treatment.
The former name elective mutism indicates a widespread misconception among psychologists that selectively mute people choose to be silent in certain situations, while the truth is that they often wish to speak but are unable to do so.
[12] Besides lack of speech, other common behaviors and characteristics displayed by selectively mute people, according to Elisa Shipon-Blum's findings, include:[13][14][15][16] On the flip side, there are some positive traits observed in many cases: Selective mutism (SM) is an umbrella term for the condition of otherwise well-developed children or adults who cannot speak or communicate under certain settings.
[citation needed] Most children and adults with selective mutism are hypothesized to have an inherited predisposition to anxiety.
Children between the ages of three and 19 with lifetime selective mutism, social phobia, internalizing behavior, and healthy controls were assessed using the parent-rated Retrospective Infant Behavioral Inhibition (RIBI) questionnaire, consisting of 20 questions that addressed shyness and fear, as well as other subscales.
Corresponding with the researchers’ hypothesis, children diagnosed with long-term selective mutism had a higher behavioral inhibition score as an infant.
About 20–30% of children or adults with selective mutism have speech or language disorders that add stress to situations in which the child is expected to speak.
[20] In fact, children with selective mutism have a lower rate of oppositional behavior than their peers in a school setting.
Without treatment, selective mutism can contribute to chronic depression, further anxiety, and other social and emotional problems.
[citation needed] The exact treatment depends on the person's age, any comorbid mental illnesses, and a number of other factors.
In the United States, under the Individuals with Disabilities Education Act (IDEA), a federal law, those with the disorder qualify for services based upon the fact that they have an impairment that hinders their ability to speak, thus disrupting their lives.
Tactics such as systemic desensitization, modeling, fading, and positive reinforcement enable individuals to develop social engagement skills and begin to progress communicatively in a step-by-step manner.
The two videos of the conversations are then edited together to show the child directly answering the questions posed by the teacher or other adult.
[citation needed] Such videos can also be shown to affected children's classmates to set an expectation in their peers that they can speak.
[30][31][32] The subject communicates indirectly with a person to whom they are afraid to speak through such means as email, instant messaging (text, audio or video), online chat, voice or video recordings, and speaking or whispering to an intermediary in the presence of the target person.
[30][31][32] Some practitioners believe there would be evidence indicating anxiolytics to be helpful in treating children and adults with selective mutism,[34] to decrease anxiety levels and thereby speed the process of therapy.
Use of medication may end after nine to twelve months, once the person has learned skills to cope with anxiety and has become more comfortable in social situations.
[citation needed] Medication is more often used for older children, teenagers, and adults whose anxiety has led to depression and other problems.
[citation needed] Since selective mutism is categorized as an anxiety disorder, using similar medication to treat either makes sense.
In 1877, German physician Adolph Kussmaul described children who were able to speak normally but often refused to as having a disorder he named aphasia voluntaria.
[38] These subtypes are no longer recognized, though "speech phobia" is sometimes used to describe a selectively mute person who appears not to have any symptoms of social anxiety.
While "excessive shyness" and other anxiety-related traits were listed as associated features, predisposing factors included "maternal overprotection", "mental retardation", and trauma.