mutism

Mutism is the inability or marked reduction in the ability to speak. It is not a diagnosis itself but a symptom that can arise from a range of conditions, including neurological injury, developmental or psychiatric disorders, or severe anxiety. Mutism may be temporary or persistent and may affect all speech or only in specific contexts.

Selective mutism is a developmental anxiety disorder in which the person, despite being capable of speech, does not speak in certain social situations (for example, at school) for at least one month. It typically begins in early childhood and is not due to a lack of language ability. Other forms include organic or acquired mutism, which results from brain damage or disease (such as stroke, traumatic brain injury, tumors, or progressive neurodegenerative conditions) or from severe motor or language impairments (for example, apraxia of speech or aphasia) that hinder speech. Mutism can also appear in catatonia, severe depression, or other psychiatric states, and may co-occur with sensory impairments or extreme stress.

Diagnosis and assessment are usually multidisciplinary, involving speech-language pathologists, neurologists, and psychiatrists. For selective mutism, DSM-5 criteria require a persistent failure to speak in specific social settings, despite speaking in other settings, for at least one month, with distress or impairment and onset before age five.

Treatment depends on the underlying cause. Selective mutism is typically addressed with evidence-based psychological therapies (such as cognitive-behavioral therapy with gradual exposure), family involvement, and school accommodations; medications such as SSRIs may be used as adjuncts in some cases. Organic mutism focuses on treating the underlying medical condition, along with speech and language rehabilitation. Prognosis varies by cause; earlier intervention generally improves outcomes.