Mutism Health Article

Definition

Mutism is a rare childhood condition characterized by a consistent failure to speak in situations where talking is expected.

Description

In mutism, the child has the ability to converse normally and does so, for example, in the home, but consistently fails to speak in specific situations such as at school or with strangers. The condition is also called selective mutism, to differentiate it from children who are physically unable to speak. Experts believe that this selective problem is associated with anxiety and fear in social situations such as in school or in the company of adults. It is, therefore, often considered a type of social phobia. This is not a communication disorder because the affected children can converse normally in some situations. It is not a developmental disorder because their ability to talk, when they choose to do so, is appropriate for their age level. This problem has been linked to anxiety, and one of the major ways in which both children and adults attempt to cope with anxiety is by avoiding whatever provokes the anxiety. Affected children are typically shy and are especially so in the presence of strangers and unfamiliar surroundings or situations. However, the behaviors of children with this condition go beyond shyness.

These children understand language and are able to talk normally in settings where they are comfortable, secure and relaxed. Over 90 percent of children with mutism also have social phobia or social anxiety, and some experts view mutism as a symptom of social anxiety. Others view it as a separate, but related, disorder. It is not yet understood why some individuals develop typical symptoms of social anxiety, like reluctance to speak in front of a group of people or feeling embarrassed easily, while others experience the inability to speak that characterizes mutism. What is clear is that children and adolescents with mutism have an actual fear of speaking and of social interactions where there is an expectation to talk. They may also be unable to communicate nonverbally, may be unable to make eye contact, and may stand motionless with fear as they are confronted with specific social settings. This can be quite heart wrenching to watch and is often very debilitating for the child as well as frustrating for parents and teachers.

A child meets the criteria for mutism if the following are true:

• The child does not speak in certain selected places such as school or at particular social events.
• The child speaks normally in at least one environment, usually in the home, but a small percentage of children with mutism are mute at home.
• The child's inability to speak interferes with his or her ability to function in school and/or social settings.
• The mutism has persisted for at least one month.
• The mutism is not caused by a communication disorder (such as stuttering) and does not occur as part of other mental disorders (such as autism).