Editing Selective mutism (section)

==Signs and symptoms==
{{More citations needed section|date=August 2010}}The [[DSM-5]] describes selective mutism as a persistent difficulty with speaking in specific social settings where speech is expected, such as in school, despite an ability to speak in other situations. The symptoms should not be too temporary and they must affect the person's ability to perform in a certain situation. Consideration should be given to possible other diagnoses.<ref>American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (Fifth ed.). Arlington, VA: American Psychiatric Publishing. p. 195. {{ISBN|978-0-89042-555-8}}.</ref>

Children and adults with selective mutism are fully capable of speech and understanding language but may be completely unable to speak in certain situations, even if speech is expected of them.<ref>{{cite book|last=Adelman|first=L.|year=2007|title=Don't Call me Shy|publisher=LangMarc Publishing|isbn=978-1880292327|url-access=registration|url=https://archive.org/details/dontcallmeshypre0000adel}}</ref> This behaviour may be perceived as shyness for some or rudeness by others. A child with selective mutism may be completely silent at school for years but speak quite freely or even excessively at home. There is a hierarchical variation among people with this disorder: some people participate fully in activities and appear social but do not speak, others will speak only to peers but not to adults, others will speak to adults when asked questions requiring short answers but never to peers, and still others speak to no one and participate in few, if any, activities presented to them. In a severe form known as "progressive mutism", the disorder progresses until the person with this condition no longer speaks to anyone in any situation, even close family members.

Selective mutism is strongly associated with other anxiety disorders, particularly [[social anxiety disorder]]. In fact, the majority of children diagnosed with selective mutism also have social anxiety disorder (100% of participants in two studies and 97% in another).<ref name="pmid9136500">{{cite journal |last1=Dummit |first1=E. Steven |last2=Klein |first2=Rachel G. |last3=Tancer |first3=Nancy K. |last4=Asche |first4=Barbara |last5=Martin |first5=Jacqueline |last6=Fairbanks |first6=Janet A. |title=Systematic Assessment of 50 Children With Selective Mutism |journal=Journal of the American Academy of Child & Adolescent Psychiatry |date=May 1997 |volume=36 |issue=5 |pages=653–660 |doi=10.1097/00004583-199705000-00016 |pmid=9136500 |doi-access=free }}</ref><ref name="doi10.1007/s10862-005-3263-1">{{Cite journal | last1 = Vecchio | first1 = J. L. | last2 = Kearney | first2 = C. A. | doi = 10.1007/s10862-005-3263-1 | title = Selective Mutism in Children: Comparison to Youths with and Without Anxiety Disorders | journal = Journal of Psychopathology and Behavioral Assessment | volume = 27 | pages = 31–37 | year = 2005 | s2cid = 144770110 }}</ref><ref name="pmid7649954">{{Cite journal | last1 = Black | first1 = B. | last2 = Uhde | first2 = T. W. | doi = 10.1097/00004583-199507000-00007 | title = Psychiatric Characteristics of Children with Selective Mutism: A Pilot Study | journal = Journal of the American Academy of Child & Adolescent Psychiatry | volume = 34 | issue = 7 | pages = 847–856 | year = 1995 | pmid = 7649954 }}</ref> Some researchers therefore speculate that selective mutism may be an avoidance strategy used by a subgroup of children with social anxiety disorder to reduce their distress in social situations.<ref>{{Cite journal | last1 = Yeganeh | first1 = R. | last2 = Beidel | first2 = D. C. | last3 = Turner | first3 = S. M. | doi = 10.1002/da.20139 | title = Selective mutism: More than social anxiety? | journal = Depression and Anxiety | volume = 23 | issue = 3 | pages = 117–123 | year = 2006 | pmid = 16421889 | s2cid = 39403140 | doi-access = free }}</ref><ref>{{Cite journal | last1 = Sharp | first1 = W. G. | last2 = Sherman | first2 = C. | last3 = Gross | first3 = A. M. | doi = 10.1016/j.janxdis.2006.07.002 | title = Selective mutism and anxiety: A review of the current conceptualization of the disorder | journal = Journal of Anxiety Disorders | volume = 21 | issue = 4 | pages = 568–579 | year = 2007 | pmid = 16949249 | citeseerx = 10.1.1.560.5956 }}</ref>

Particularly in young children, selective mutism can sometimes be conflated with an [[Autism spectrum|autism spectrum disorder]], especially if the child acts particularly withdrawn around their diagnostician, which can lead to incorrect diagnosis and treatment. Although many autistic people are also selectively mute, they often display other behaviors—[[stimming]], repetitive behaviors, social isolation even among family members (not always answering to name, for example)—that set them apart from a child with selective mutism alone. Some autistic people may be selectively mute due to anxiety in unfamiliar social situations. If mutism is entirely due to autism spectrum disorder, it cannot be diagnosed as selective mutism as stated in the last item on the list above.

The former name ''[[elective mutism]]'' indicates a widespread misconception among psychologists that selectively mute people choose to be silent in certain situations, while the truth is that they often wish to speak but are unable to do so. To reflect the involuntary nature of this disorder, the name was changed to ''selective mutism'' in 1994, although some people are calling for a name change to "situational mutism" because the current name can promote the belief that it is a behavior the individual selects rather than it occurring in certain situations.{{cn|date=April 2025}} <!-- Don't tell us that this interpretation is not without controversy if the work you are citing is from or takes its material from something written before 1994. As just stated, the understanding of selective mutism changed in the early '90s. Works before that reflect an outdated mode of thinking. If you find a study performed since 1994 that came to the conclusion that selective mutism is not caused by anxiety, we would love to discuss it here. -->

The [[incidence (epidemiology)|incidence]] of selective mutism is not certain. Due to the poor understanding of this condition by the general public, many cases are likely undiagnosed. Based on the number of reported cases, the figure is commonly estimated to be 1 in 1000, 0.1%.<ref>{{cite journal | last1 = Chvira | first1 = Denise A. | last2 = Shipon-Blum | first2 = Elisa | last3 = Hitchcock | first3 = Carla | last4 = Cohan | first4 = Sharon | last5 = Stein | first5 = Murray B. | year = 2007 | title = Selective Mutism and Social Anxiety Disorder: All in the Family? | pmid = 18049296 | journal = Journal of the American Academy of Child & Adolescent Psychiatry | volume = 46 | issue = 11| pages = 1464–472 | doi = 10.1097/chi.0b013e318149366a }}</ref> However, a 2002 study in ''The Journal of the American Academy of Child and Adolescent Psychiatry'' estimated the incidence to be 0.71%.<ref>{{cite journal | pmid = 12162629 | doi=10.1097/00004583-200208000-00012 | volume=41 | issue=8 | title=Prevalence and description of selective mutism in a school-based sample | journal=J Am Acad Child Adolesc Psychiatry | pages=938–46 | last1 = Bergman | first1 = RL | last2 = Piacentini | first2 = J | last3 = McCracken | first3 = JT| year=2002 | s2cid=20947226 }}</ref>

===Other symptoms===
Besides lack of speech, other common behaviors and characteristics displayed by selectively mute people, according to Elisa Shipon-Blum's findings, include:<ref>{{Cite book |last1=Moini |first1=Jahangir |url=https://books.google.com/books?id=8AcWEAAAQBAJ |title=Global Emergency of Mental Disorders |author2=Justin Koenitzer |author3=Anthony LoGalbo |date=2021 |publisher=Academic Press |isbn=978-0-323-85843-4 |location=London |pages=82–84 |oclc=1252050397 |quote=However, there are some positive features of selective mutism. These include above average intelligence, inquisitiveness, or perception; a strong sense of right and wrong; creativity; love for the arts; empathy; and sensitivity for other people.}}</ref><ref>{{Cite journal |last=Muris |first=Peter |last2=Ollendick |first2=Thomas H. |date=January 19, 2021 |title=Selective Mutism and Its Relations to Social Anxiety Disorder and Autism Spectrum Disorder |url=https://pmc.ncbi.nlm.nih.gov/articles/PMC8131304/ |journal=Clinical Child and Family Psychology Review |volume=24 |issue=2 |pages=294–325 |doi=10.1007/s10567-020-00342-0 |issn=1573-2827 |pmc=8131304 |pmid=33462750}}</ref><ref>{{Cite journal |last=Cohan |first=Sharon L. |last2=Chavira |first2=Denise A. |last3=Shipon-Blum |first3=Elisa |last4=Hitchcock |first4=Carla |last5=Roesch |first5=Scott C. |last6=Stein |first6=Murray B. |date=August 23, 2010 |title=Refining the classification of children with selective mutism: a latent profile analysis |url=https://pmc.ncbi.nlm.nih.gov/articles/PMC2925839/ |journal=Journal of Clinical Child and Adolescent Psychology |volume=37 |issue=4 |pages=770–784 |doi=10.1080/15374410802359759 |issn=1537-4424 |pmc=2925839 |pmid=18991128}}</ref><ref>{{cite journal |id={{Gale|A288873877}} {{ProQuest|1013609961}} |last1=Perednik |first1=Ruth |title=An interview with Ruth Perednik: treating selective mutism |journal=North American Journal of Psychology |date=1 June 2012 |volume=14 |issue=2 |pages=365 |quote=Many are above average in intelligence, creative, and sensitive to others thoughts and feelings. }}</ref>

* Shyness, social anxiety, fear of social embarrassment or social isolation and withdrawal
* Difficulty maintaining eye contact
* Blank expression and reluctance to smile or incessant smiling 
* Difficulty expressing feelings, even to family members
* Tendency to worry more than most people of the same age
* Sensitivity to noise and crowds

On the flip side, there are some positive traits observed in many cases:

* Above average intelligence, inquisitiveness, or perception
* A strong sense of right and wrong
* Creativity
* Love for the arts
* Empathy
* Sensitivity for other people