Diagnosis: Selective Mutism
What does selective mutism look like? What red flags should pediatricians look for? Here’s a quick look on how to diagnose SM in your practice.
A conversation with child psychologist Kristen Eastman, Psy.D
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Selective mutism, or SM, is the inability to talk in select social settings (school, in public) despite normal talking in comfortable settings (at home). It often overlaps with other signs of (usually social) anxiety. Communication varies from setting to setting and person to person. Difficulties are indeed “selective” and thus often misunderstood.
There are three main myths: 1) “It’s rare.” SM isn’t as rare as once thought. This belief has led to missed opportunities for early diagnosis. 2) The child is “choosing” not to talk. SM has been reclassified as an anxiety disorder. It’s not a behavior disorder. The child is not being stubborn. 3) “It’s just shyness.” Shy kids function. Kids with SM freeze up and do not function in select social settings.
Take note if a child cannot readily talk to you/your staff, stops talking to a parent when you enter the exam room, or appears frozen/expressionless and is unresponsive.
Ask the parent the following:
When in doubt, refer for a proper evaluation. Early intervention is critical and will allow for a much better prognosis.