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Ask the Mental Health Expert Archives 2001-2004

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Selective Mutism

Q. I think my 4-year-old child suffers from selective mutism. When he was a tiny baby people could not get close to him, hold him, or talk to him, or he would start screaming. If I took him places where there were a lot of people but I usually had to leave because he would cry a lot until I got him in the car and then he would stop immediately.

He talks a lot at home to me and some people in our family, however, he won't speak to anyone out in public, except for me and he hardly does even that. At the beginning of the year in public school, he did okay. He played with other children. He spoke to them not a whole lot but he did talk to them and sometimes to his teachers. By Christmas though, he would not go back. He would hide in the closet at school.

Does this sound like selective mutism or is it something else? How can he be tested for what he is suffering from? What kind of doctor should I take him to or what should I do to evaluate him at home?

A. Some of the symptoms you describe in your son certainly could be consistent with Selective Mutism (SM), though other conditions would need to be ruled out. To screen for SM, clinicians usually ask the following questions, which are found on the website for the Selective Mutism Foundation (http://www.selectivemutism.org):

Is it the case that the child:
1. Does not speak in certain places; such as school or other social events?
2. But, can speak normally in other settings; such as in their home or in places where they are comfortable and relaxed?
3. Has an inability to speak that interferes with their ability to function in educational and/or social settings?
4. Shows mutism that has persisted for at least one month?
5. Has mutism that is not part of a communication disorder and does not occur as part of any other mental condition, such as: pervasive developmental disorders (i.e., autism, aspergers syndrome, schizophrenia, etc.).

The best way to determine your son's diagnosis, in my view, is to have him seen by a child psychiatrist with expertise in anxiety disorders. (SM is usually considered part of the social anxiety spectrum of conditions, including social phobic disorder). Neuropsychological testing may be useful in ruling out other disorders that may mimic SM.

A good resource for information is the website noted above. You may also find information--if the diagnosis of SM is confirmed--in the book "Easing School Jitters for the Selectively Mute Child" by Dr. Elisa Shipon-Blum. I hope you get help for your son very soon.

Other Resources:

September 2003

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