Mutisme

Mutisme, or mutism in clinical terms, is a condition characterized by a persistent inability to speak in certain social situations despite normal speech in other contexts. The term is most often used to describe selective mutism in children, where a child who is capable of speech remains silent in specific settings (for example, at school or in public) while speaking freely at home or with familiar people.

Causes and types of mutism vary. It can reflect anxiety disorders, especially social anxiety, but may also accompany developmental or language disorders, autism spectrum conditions, hearing impairment, or neurological illnesses. Selective mutism is the most common form in young children; total mutism, in which speech is absent across most or all situations, is rarer and typically associated with more complex medical issues.

Clinical features typically include a consistent failure to speak in designated social settings for at least about one month, despite the ability to speak in other contexts. Onset is usually in early childhood, often before school age. Mutism may be accompanied by signs of anxiety, social withdrawal, and discomfort in speaking to strangers or authority figures.

Diagnosis involves clinical assessment, hearing evaluation, and language/developmental testing. It requires ruling out other conditions that can cause speech avoidance, such as speech or language disorders, autism spectrum disorders, or severe communication barriers. DSM-5 criteria for selective mutism emphasize a persistent pattern affecting educational or social functioning, not attributable to language lack or other medical conditions.

Treatment is typically multidisciplinary and evidence-based. Core approaches include cognitive-behavioral therapy with exposure techniques, involving parents, teachers, and therapists; gradual reintroduction to speaking in feared settings; and accommodations in school. Pharmacotherapy, such as selective serotonin reuptake inhibitors, may be considered for severe or comorbid anxiety disorders. Early intervention generally improves prognosis, though outcomes vary with severity and associated conditions.