Free explainer2 min read
Selective mutism
Understand the model, recognise it in a stem, separate the look-alikes, then apply it.
Start with the mental model
Selective mutismA complete absence of speech despite the physical ability to speak.Read more → matters because the child can speak perfectly normally in one setting, usually at home, yet consistently fails to speak in another, usually school, and that setting-specific pattern is the clue that it is anxiety-based, not a language problem. It is diagnosed as a consistent failure to speak in specific social situations where speech is expected, despite speaking normally in other situations. For example, imagine a girl who chats freely with her family at home but has not spoken a single word at school in over a year, despite understanding everything asked of her. In practice, that intact ability to speak elsewhere is exactly what rules out a primary language or speech disorder.
01Core model
The mutismA complete absence of speech despite the physical ability to speak.Read more → must persist for at least one month, not counting the first month of school, which can cause normal shyness, and cause significant impairment in education or social communication. It is closely linked to social anxiety, and many children with selective mutism also meet criteria for social anxiety disorder. The child understands language normally and speaks fluently in comfortable settings, which is what separates it from a language disorder, where speech difficulty would appear everywhere. Say the same girl's vocabulary and grammar are tested informally at home, where her language skills prove entirely age-appropriate. In practice, that normal language ability at home confirms the problem is situational anxiety, not a language impairment.
02Recognise it in an SBA
• Which duration rule does ICD-11 apply before selective mutismA complete absence of speech despite the physical ability to speak.Read more → can be diagnosed in a child starting school?
• Which disorder most often coexists with selective mutism in children?
• A teacher plans to insist that a child with selective mutism answers aloud in class before being allowed to leave. What is the likely effect?