Mutism or Autism?
The Selective Mutism Foundation, Inc. is a national non-profit organization founded in 1991. This summary is intended to be informational and to assist with identifying undiagnosed and misdiagnosed students struggling with Selective Mutism, a misunderstood and socially crippling disorder.
Selective Mutism is a Social Anxiety Disorder most commonly found in children and often mistaken and misdiagnosed as Autism. On the surface some of the characteristics may appear to mimic Autistic behaviors. However, Selective Mutism is currently described as a Social Anxiety Disorder and is included in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in the anxiety disorders section, diagnostic code 313.23.
Selective Mutism is characterized by a persistent failure to speak in select settings, usually most evident in school. Typically, these children speak normally to their parents at home and possibly a few select others with whom they feel comfortable with. Other characteristics may include no or minimal eye contact or interaction, remaining expressionless, or motionless and/or pointing or nodding their head in lieu of responding or speaking up. Shyness and embarrassment of their voice being heard plays a significant role in the associated behaviors. Some will non-verbally participate in activities while others will stand off to the side, alone, in a playground- frozen with embarrassment and fear.
It is crucial to understand that Selectively Mute children do speak normally, respond, and interact normally in settings where they are comfortable and that they have no related learning difficulties. It is also imperative to understand that the failure to speak is not a refusal to speak and that the associated behaviors are not willful or related to stubbornness, abuse, speech/language deficits, or emotional problems. In fact, some are able to speak on the phone because the face-to-face eye contact is removed.
Prior to making a diagnosis of Autism or Autism Spectrum, teachers, school staff, therapists, and other professionals should ask family members if the child speaks at home or anywhere else. This is important for ensuring the proper educational setting; IEP or 504 Plan development and for therapeutic treatment interventions for the student. Some parents/family members that have not heard of Selective Mutism assume that their child is Autistic, while others provide videos of the child speaking to teachers and therapists as proof that they can verbalize normally. Assuming that the child is Autistic can lead to inappropriate interventions that can cause the Mutism to become embedded and more difficult to treat.
As the pioneers of Selective Mutism, we devised Behavioral Interventions and school-based accommodations that are used to assist these individuals with speaking up and overcoming social anxiety.
Many adults who report having had Selective Mutism as children describe themselves as having residuals of the disorder. Many are able to speak up but struggle with doing so and have symptoms of social anxiety and low self-esteem. It is important to keep in mind that the vast majority of adults who struggled with Selective Mutism did not receive formal treatment because there was no research, understanding of, or attention given to the disorder until the Selective Mutism Foundation, Inc. was developed.
More research is needed to understand exactly what causes Selective Mutism and how to successfully treat it. The disorder appears to be inherited or linked to family members who have an array of anxiety disorders and/or panic attacks. Due to the ongoing undiagnosed and misdiagnosed cases, it is not possible to determine how many individuals have Selective Mutism.
Written by Sue Newman-Mercado 3/2015
Co-founder, Selective Mutism Foundation, Inc.