The Diagnostic and Statistical Manual of Mental Disorders, fourth Edition (DSM-IV) defines selective mutism as:

• Consistent failure to speak in specific social situations (in which there is an expectation for speaking, e.g., at school) despite speaking in other situations.
• The disturbance interferes with educational or occupational achievement or with social communication.
• The duration of the disturbance is at least 1 month (not limited to the first month of school).
• The failure to speak is not due to a lack of knowledge of, or comfort with, the spoken language required in the social situation.
• The disturbance is not better accounted for by a Communication Disorder (e.g., Stuttering) and does not occur exclusively during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder.

Selective mutism was thought to affect less than one percent of all children until recent studies demonstrated that between one and two per cent of primary school childrem meet the above diagnostic criteria. Originally called elective mutism, the name was changed when the research of the 1990s determined that the condition is a response to a child's anxiety rather than willful election to be mute. Children with selective mutism are often shy and the anxiety involved in having to speak in certain situations creates panic so that a phobia associated with the given situation develops, with mutism becoming an avoidance behaviour or defence mechanism.

The condition appears to be genetic with over seventy per cent of diagnosed children having immediate family members who either have or have had social phobia or other anxiety disorders. At the diagnosis level, it is still sometimes mistaken for, on the one hand, autism and, on the other, shyness-which-the-child-will-grow-out-of. If a child speaks normally when comfortable in his/her surroundings, it is not autism. If concerned parental observation dictates that a selectively silent child is experiencing more than ordinary shyness, get another opinion. As the parent, you know your child best.

In addition to the misdiagnoses of autism and shyness, the other great hurdle for the parent of the selectively mute child is the traditional assumption, on the part of some general practitioners and mental health professionals, that the problem is caused by trauma or abuse. There is absolutely no support for this - it is firmly believed, by those who are experienced in treating the condition, that selective mutism is an extreme form of social anxiety with genetic roots.

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