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most children meeting diagnostic criteria for social phobia (DSM-IV) or
social anxiety disorder of childhood (ICD-10). Indeed, some argue that
selective mutism should be seen simply as a symptom of a social anxiety
disorder rather than as a distinct diagnostic syndrome.
2 Language problems. By definition, the child must be able to chat fairly
normally in some situations, but there is often a history of somewhat
delayed speech milestones, or continuing minor problems with artic-
ulation. This has implications for assessment. Since selectively mute
children are unlikely to talk to the assessor, it is important to assess the
child’s articulation and language level in some other way, for example,
by listening to an audio recording of the child chatting at home, or
asking to see written work. Despite this limitation, a formal assessment
of language level by a psychologist or speech and language therapist can
sometimes be very helpful. It is possible to screen for receptive language
problems by using a picture vocabulary test – this assessor reads out
words and asks the child to point to the picture that best illustrates each
word.
3 Intelligence. This obviously needs to be assessed using tests that do not
require the child to speak, for example, using the visuospatial subtests
from wide-ranging intelligence tests. The average non-verbal IQ in
selective mutism was 85 in one study, but ranged from above 100 to
under 70. Selective mutism can occur in children with mild or severe
intellectual disability.
4 Relationships. Most children have been noted to be markedly shy from
the preschool years onwards, and are withdrawn both with children and
adults.
5 Personality. An unshakeable determination not to speak in some settings
is often accompanied by other evidence of a strong will. Some children
are sulky with strangers and aggressive at home; other children are
shy with strangers and submissive at home; and yet other children are
sensitive and easily distressed both at home and elsewhere. Mixtures of
these personality styles are common.
6 Family factors. There is often a history of social anxiety or selec-
tive mutism in a parent or sibling. Maternal over-protectiveness is
commonly described, as is an association with marital discord (but
not marital breakdown), parental mental illness (anxiety and de-
pression), and parental personality problems (marked aggression or
shyness).
7 Traumatic experiences. Although studies of selective mutism have gener-
ally emphasised personality factors rather than specific traumas, there
is some evidence that selectively mute children are more likely than
classroom controls, or children with developmental speech or language
problems, to have suffered definite or probable abuse, usually sexual
abuse. The role of abuse and other traumatic experiences has yet to be
confirmed.