Elective mutism

Synonyms

1

Overview

Elective mutism is the former name for selective mutism. Elective mutism was defined as a refusal to speak in almost all social situations (despite normal ability to do so), while selective mutism is considered to be a failure to speak in specific situations and is strongly associated with social anxiety disorder. In contrast to selective mutism, someone who is electively mute may not speak in any situation, as is usually shown in books and movies. Elective mutism is often attributed to defiance or the effect of trauma.

Symptoms

• Gestures
• Nodding
• Shyness
• Anxiety
• Depression

Causes

Most children with selective mutism have an inherited predisposition to anxiety. They often have inhibited temperaments, which is hypothesized to be the result of over-excitability of the area of the brain called the amygdala. This area receives indications of possible threats and sets off the fight-or-flight response. Some children with selective mutism may have Sensory Integration Dysfunction (SID), which causes the child to have trouble processing some sensory information. This would cause anxiety, which may cause the child to "shut down" and not be able to speak.

Diagnosis

A child with selective mutism should be seen by a speech-language pathologist (SLP), 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.

Treatment

Contrary to popular belief, people suffering from selective mutism do not 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. They then stop attempting to initiate verbal contact with the sufferer, making the prospect of talking seem even more difficult. Sometimes in this situation, a change of environment (such as changing schools) may make a difference. In some cases, with psychological help, the sufferer's condition may improve. Treatment in teenage years may, though not necessarily, become more difficult because the sufferer has become accustomed to being mute.