Selective mutism is categorized as an anxiety disorder by the American Psychological Association (APA). A child with selective mutism is often unable to speak in front of others or communicate effectively in social settings, and they will generally only speak comfortably when they are in a familiar place, such as at home.
Psychologists diagnose selective mutism when the child enters school for the first time, and the problem of not speaking in a particular setting must persist for at least one month to make an accurate diagnosis. Selective mutism is relatively rare, with a prevalence of 18 in 10,000 children. In a specific study, psychologists Brown and Lloyd found a prevalence of 0.03% in their sample of five-and six-year-old students. Selective mutism usually occurs in children aged 3-6 years old, but severe selective mutism can also have long-term effects, decreasing a child's potential for self-esteem, socialization, and academic success.
Studies have also indicated that separation anxiety disorder is a subtype of selective mutism. Separation anxiety disorder commonly presents as a deep fear of separation from parents or other family members. A study of a seven-year-old Mexican immigrant who was diagnosed with selective mutism found results consistent with this subtype.
Jose had intense separation anxiety, demonstrated by clinging to his mother and showing symptoms of anxiety when taken away from her. Jose's treatment process was dedicated to bringing more cohesion to the family, since family conflict was found to be one of the main stressors of his condition.
The families that have children with selective mutism are often characterized by the over-involvement of one parent and withdrawal of the other. Researchers examined 442 Selective Mutism Comprehensive Diagnostic Questionnaires to investigate subtypes of selective mutism that would differentiate the diagnostic criteria and treatment process for a child’s unique condition. One of the subtypes found was the sensory/pathology subtype, which was present in most races and a large amount of bilingual children. In addition, it had the most children with separation anxiety problems. In another study, 72 of 100 children with selective mutism had a history of separation anxiety during the infancy stage. These three studies demonstrate that separation anxiety disorder is a subtype of selective mutism and sometimes has different effects than the overall condition of selective mutism.
Adolescence is a crucial developmental stage. This time is when issues of identity and self-esteem become some of the most important challenges a teenager must overcome. Assaults on an adolescent's sense of self may be particularly harmful, especially since the adolescent's self-identity is still growing. For example, the development of adolescent brain-triggers can cause sensitivity to peer reactions, which may explain the high prevalence of mental health issues during adolescence. Teenagers have less sophisticated coping strategies to deal with stressors and the school environment than adults, which may be a biological cause for high rates of depression and anxiety. Family economic stress can also have a negative impact on adolescents in the developmental stage; for example, it can impair marital and parent-child relationships, which may cause worse outcomes in an adolescent's mental health.
Selective mutism is a disorder that not many people know about, and this needs to change. If we want to help the intellectual and social growth of young children as well as the development of adolescent maturity, we need to recognize how this disorder (and other anxiety disorders) impair success. Once we begin to address these issues, we can create a more accepting and open-minded society that provides support for children at all levels of development.
Author: Joyce Zhou
Editor: Simona Hausleitner
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub.
Kopp, S., & Gillberg, C. (1997). Selective Mutism: A Population-based Study: A Research Note. Journal of Child Psychology and Psychiatry, 38(2), 257–262. https://doi.org/10.1111/j.1469-7610.1997.tb01859.x
Brown, J.B., & Lloyd, H. (1975). A controlled study of children not speaking at school.
Association of Workers with Maladjusted Children, 3, 49–63.
Mulligan, Christy A. (2012). Selective Mutism: Identification of Subtypes and Influence on Treatment. PCOM Psychology Dissertations. Paper 210.
Kim, S. Y., Schwartz, S. J., Perreira, K. M., & Juang, L. P. (2018). Culture's Influence on Stressors, Parental Socialization, and Developmental Processes in the Mental Health of Children of Immigrants. Annual review of clinical psychology, 14, 343–370. https://doi.org/10.1146/annurev-clinpsy-050817-084925
Muris, P., Hendriks, E., & Bot, S. (2016). Children of Few Words: Relations Among Selective Mutism, Behavioral Inhibition, and (Social) Anxiety Symptoms in 3- to 6-Year-Olds. Child psychiatry and human development, 47(1), 94–101.