Editing Selective mutism (section)

==Causes==
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Selective mutism (SM) is an umbrella term for the condition of otherwise well-developed children or adults who cannot speak or communicate under certain settings. The exact causes that affect each person may be different and yet unknown. There have been attempts to categorize, but there are no definitive answers yet due to the under-diagnosis and small/biased sample sizes. Many people are not diagnosed until late in childhood only because they do not speak at school and therefore fail to accomplish assignments requiring public speaking. Their involuntary silence makes the condition harder to understand or test. Parents often are unaware of the condition since the children may be functioning well at home. Teachers and pediatricians also sometimes mistake it for severe shyness or common stage fright.{{fact|date=December 2022}}

Most children and adults with selective mutism are hypothesized to have an inherited predisposition to anxiety. They often have inhibited [[temperament]]s, which is hypothesized to be the result of over-excitability of the area of the brain called the [[amygdala]].<ref>{{cite web |title=What Is Selective Mutism |url=https://selectivemutismcenter.org/whatisselectivemutism/ |website=Selective Mutism Anxiety & Related Disorders Treatment Center }}</ref> This area receives indications of possible threats and sets off the [[fight-or-flight response]]. Behavioral inhibitions, or inhibited temperaments, encompass feelings of emotional distress and social withdrawals. In a 2016 study,<ref>{{cite journal |last1=Gensthaler |first1=Angelika |last2=Khalaf |first2=Sally |last3=Ligges |first3=Marc |last4=Kaess |first4=Michael |last5=Freitag |first5=Christine M. |last6=Schwenck |first6=Christina |title=Selective mutism and temperament: the silence and behavioral inhibition to the unfamiliar |journal=European Child & Adolescent Psychiatry |date=October 2016 |volume=25 |issue=10 |pages=1113–20 |doi=10.1007/s00787-016-0835-4 |pmid=26970743 |s2cid=12074063 }}</ref> the relationship between behavioral inhibition and selective mutism was investigated. Children between the ages of three and 19 with lifetime selective mutism, social phobia, internalizing behavior, and healthy controls were assessed using the parent-rated Retrospective Infant Behavioral Inhibition (RIBI) questionnaire, consisting of 20 questions that addressed shyness and fear, as well as other subscales. The results indicated behavioral inhibition does indeed predispose selective mutism. Corresponding with the researchers’ hypothesis, children diagnosed with long-term selective mutism had a higher behavioral inhibition score as an infant. This is indicative of the positive correlation between behavioral inhibition and selective mutism.

Given the very high incidence of social anxiety disorder within selective mutism (as high as 100% in some studies<ref name="pmid9136500"/><ref name="doi10.1007/s10862-005-3263-1"/><ref name="pmid7649954"/>), it is possible that social anxiety disorder causes selective mutism. Some children or adults with selective mutism may have [[sensory processing disorder|trouble processing sensory information]]. This could cause anxiety and a sense of being overwhelmed in unfamiliar situations, which may cause the child or adult to "shut down" and not be able to speak (something that some autistic people also experience). Many children or adults with selective mutism have some auditory processing difficulties.

About 20–30% of children or adults with selective mutism have speech or language disorders that add stress to situations in which the child is expected to speak.<ref>{{cite journal |last1=Cohan |first1=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. |title=Refining the Classification of Children with Selective Mutism: A Latent Profile Analysis |journal=Journal of Clinical Child & Adolescent Psychology |date=7 October 2008 |volume=37 |issue=4 |pages=770–784 |doi=10.1080/15374410802359759 |pmid=18991128 |pmc=2925839 }}</ref> In the DSM-4, the term “elective mutism” was changed to “selective mutism.” This name change intended to deemphasize this refusal and oppositional aspect of the disorder. Instead, it highlighted that in select environments, the child is unable to speak rather than choosing not to.<ref>{{cite web |url=https://digitalcommons.slc.edu/cgi/viewcontent.cgi?article=1027&context=child_development_etd|title=Selective Mutism: What it is and Approaches to Intervention |date=May 2019 |access-date =2023-02-14}}</ref> In fact, children with selective mutism have a lower rate of oppositional behavior than their peers in a school setting.<ref>{{cite journal |last1=Sharp |first1=William G. |last2=Sherman |first2=Colleen |last3=Gross |first3=Alan M. |title=Selective mutism and anxiety: A review of the current conceptualization of the disorder |journal=Journal of Anxiety Disorders |date=1 January 2007 |volume=21 |issue=4 |pages=568–579 |doi=10.1016/j.janxdis.2006.07.002 |pmid=16949249 |citeseerx=10.1.1.560.5956 }}</ref> Some previous studies on the subject of selective mutism have been dismissed as containing serious flaws in their design. According to a more recent systematic study it is believed that children or adults who have selective mutism are not more likely than other children or adults to have a history of early trauma or stressful life events.<ref>{{cite journal |last1=Steinhausen |first1=Hans-Christoph |last2=Juzi |first2=Claudia |title=Elective Mutism: An Analysis of 100 Cases |journal=Journal of the American Academy of Child & Adolescent Psychiatry |date=May 1996 |volume=35 |issue=5 |pages=606–614 |doi=10.1097/00004583-199605000-00015 |pmid=8935207 }}</ref> Many children or adults who have selective mutism almost always speak confidently in some situations.

Some people have suggested a connection between selective mutism and the [[freeze response]].{{cn|date=March 2025}}