Disorders usually first diagnosed in
infancy, childhood, or adolescence.
Selective Mutism--

Selective mutism is a social anxiety disorder in which a person who is normally capable of speech
is unable to speak in given situations.

In the Diagnostic and Statistical Manual of Mental Disorders selective mutism is described as a rare
psychological disorder in children. Children (and adults) with the disorder are fully capable of speech
and understanding language, but fail to speak in certain social situations when it is expected of
them. They function normally in other areas of behavior and learning, though appear severely
withdrawn and some are unable to participate in group activities due to their extreme anxiety.
It is like an extreme form of shyness, but the intensity and duration distinguish it. As an example,
a child may be completely silent at school, for years at a time, but speak quite freely or even
excessively at home.

Particularly in young children, selective mutism can sometimes be confused with an autism spectrum
disorder, especially if the child acts particularly withdrawn around his or her diagnostician.
Unfortunately, this can lead to incorrect treatment.

Selective mutism is usually characterised by the following:

* 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

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

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

* 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 Developmental Disorder, Schizophrenia,
or other Psychotic Disorder.

The former name elective mutism indicates a widespread misconception even among psychologists
that selective mute people choose to be silent in certain situations, while the truth is that they are
forced by their extreme anxiety to remain silent; despite their will to speak, they just cannot make
any voice. To reflect the involuntary nature of this disorder, its name had been changed to selective
mutism in 1994. However, mis-conceptions still prevail; for instance, the ABC News erroneously
attributed the cause of selective mutism to trauma and described it as willful in a report dated May
26, 2005.

The incidence of selective mutism is not certain. Due to the poor understanding of the general public
on this condition, many cases are undiagnosed. Based on the number of reported cases, the figure
is commonly estimated to be 1 in 1000. However, in a 2002 study in The Journal of the American
Academy of Child and Adolescent Psychiatry, the figure has increased to 7 in 1000.

No single cause has been established, but there is some evidence that there is a hereditary
component. Typical sufferers have some of the following traits when anxious, some of which are
often perceived as rudeness:

* They find it difficult to maintain eye contact

* Often don't smile and have blank expressions

* They move stiffly and awkwardly

* They find situations where talk is normally expected particularly hard to handle
(answering school registers, saying hello, goodbye, thank-you, etc.)

* They tend to worry about things more than others

* They can be very sensitive to noise and crowds

* Find it difficult to talk about themselves or express their feelings

On the positive side, many sufferers have:

* Above-average intelligence, perception, or are inquisitive

* Sensitivity to others' thoughts and feelings (empathy)

* Very good powers of concentration (focused)

* A good sense of right/wrong/fairness (justice)


Contrary to popular belief, people suffering from selective mutism don't necessarily improve with
age, or just grow out of it. Consequently, treatment at an early age is important. If not addressed,
selective mutism tends to be self-reinforcing; those around such a person may eventually expect him
or her not to speak, and stop attempting to initiate verbal contact, making the prospect of talking
seem even more difficult or foreign. Sometimes in this situation, a change of environment (such as
changing schools) to a place where the condition is not proven make the difference, but in some
cases; with psychological help the sufferer's condition can improve.

Occasionally, treatment in teenage years becomes more difficult, though not necessarily.

Forceful attempts to make the child talk are not productive, usually resulting in higher anxiety levels
and so reinforcing the condition. The behaviour is often viewed externally as willful, or controlling, as
the child usually shuts down all communication and body language in such situations, which is
perceived as rudeness.

The exact treatment depends a lot on the subject, their age and other factors. Typically stimulus
fading is used with younger children.

Some in the psychiatric community believe that anxiety medication may be effective in extremely low
dosages and that higher doses may just make the problem worse. Others in the field believe that
the side-effects of psychiatric medications- in any dose and on any child- are so dangerous as to
negate any temporary benefit, preferring behavioral and psychological interventions.

Stimulus Fading

In this technique the sufferer is brought into a controlled environment with someone who they are at
ease with and can communicate. Gradually another person is introduced into the situation involving a
number of small steps.

These steps are often done in separate stages in which case it is called the sliding-in technique,
where a new person is slid into the talking group. This can take a relatively long time for the first one
or two faded in people.


The subject is allowed to communicate via non-direct means to prepare them mentally for the next
step. This might include email, phone, taped recordings, webchat, until they are in a position to try
more direct communication.

Drug treatments

Some practitioners believe there's evidence indicating that antidepressants such as fluoxetine
(prozac) may be effective in treating children with selective mutism. Though many in the medical
community believe that psychiatric medications decrease the anxiety levels enough to allow
communication to take place in cases of selective mutism, other practitioners and activists (see
articles on Peter Breggin and David Healy (psychiatrist)) stringently decry any use of psychiatric
medications on children and note the lack of medical proof of genetic links to behavioral disorders.

The denunciation of psychotropic intervention on children with behavioral anxiety disorders has
intensified particularly since lawsuits against several drug companies—current to 2005—have
exposed previously unseen internal research documents linking fluoxetine and other SSRI
antidepressants with increased risk of suicide, psychosis and—ironically enough—damage to
areas of the brain which could affect language production and normal social development.
Selective Mutism - Part 1
Selective Mutism - Part 2