The American Speech-language and Hearing Association has information on a range of speech and language disorders that can have an impact on a person’s communication.

Selective mutism (formerly known as elective mutism) usually happens during childhood. A child with selective mutism does not speak in certain situations, like at school, but speaks at other times, like at home or with friends. Selective mutism often starts before a child is 5 years old. It is usually first noticed when the child starts school.

Signs and symptoms of selective mutism.

• consistent failure to speak in specific social situations (in which there is an expectation for speaking, such as at school) despite speaking in other situations.
• not speaking interferes with school or work, or with social communication.
• lasts at least 1 month (not limited to the first month of school).
• failure to speak is not due to a lack of knowledge of, or comfort, with the spoken language required in the social situation
• not due to a communication disorder (e.g., stuttering). It does not occur exclusively during the course of a pervasive developmental disorder (PPD), schizophrenia, or other psychotic disorder.

Children with selective mutism may also show:

• anxiety disorder (e.g., social phobia)
• excessive shyness
• fear of social embarrassment
• social isolation and withdrawal

How is selective mutism diagnosed?

A child with selective mutism should be seen by a speech-language therapist in addition to a pediatrician and a psychologist or psychiatrist. These professionals will work as a team with teachers, family, and the individual.

It is important that a complete background history is gathered, as well as an educational history review, hearing screening, oral-motor examination, parent/caregiver interview, and a speech and language evaluation. 

The educational history review seeks information on:

• academic reports
• parent/teacher comments
• previous testing (e.g., psychological)
• standardized testing

The hearing screening seeks information on:

• hearing ability
• possibility of middle ear infection

The oral-motor examination seeks information on:

• coordination of muscles in lips, jaw,and tongue
• strength of muscles in the lips, jaw, and tongue

The parent/caregiver interview seeks information on:

• any suspected problems (e.g., schizophrenia, pervasive developmental disorder);
• environmental factors (e.g., amount of language stimulation)
• child’s amount and location of verbal expression (e.g., how he acts on playground with other children and adults)
• child’s symptom history (e.g., onset and behavior)
• family history (e.g., psychiatric, personality, and/or physical problems)
• speech and language development (e.g., how well does the child express himself and understand others)

The speech and language evaluation seeks information on:

• expressive language ability (e.g., parents may have to help lead a structured story telling or bring home videotape with child talking if the child does not speak with the therapist
• language comprehension (e.g., standardized tests and informal observations)
• verbal and non-verbal communication (e.g., look at pretend play, drawing)

For more information and for information on the treatments available please visit ASHA 

Written by Rachel Harrison

Speech and Language Therapist, on behalf of Integrated Treatment Services