Diagnosis of selective mutism is mostly on the basis of the patient’s clinical history. A speech-language pathologist (SLP) plays a key role in the diagnosis of the condition.

A child who shows signs of selective mutism should be taken to an SLP, apart from a pediatrician and a child psychologist. All of these health care professionals need to come together and work as a team with parents, teachers, and the affected child.

Most of the characteristics of children who suffer from selective mutism are linked to social anxiety. These children may be sensitive to crowds, sounds, touch, and lights.

Children with selective mutism may have a blank face without any expression, don’t make eye contact and show awkward body language when anxiety strikes.

At school, the kid may show withdrawal, look distracted, be reluctant to respond to queries, and have difficulty carrying out otherwise simple tasks.

These children can be very moody and stubborn, and have dramatic crying spells at home. They may also act silly or negatively in a social gathering in an attempt to cope with their anxiety.

Physically, the child might experience nervousness, nausea, tummy ache, headaches, and shortness of breath in uncomfortable situations. These are the signs and symptoms to watch out for during selective mutism diagnosis.

Being aware of these, and also keeping in mind that children with selective mutism function normally in other areas of life, will help health care workers steer clear of any uncertainty during diagnosis.

Other Disorders with Similar Symptoms

Care should be taken during diagnosis to make sure that the signs and symptoms are not confused with any other anxiety or sensory disorders. For example, most children affected by selective mutism want to have friends, which differentiates them from children affected by autism spectrum disorders.

Mutism history of the child or teen must be taken into account. People who have experienced trauma, such as loss of a loved one may exhibit signs of mutism, but that would be traumatic mutism and not selective mutism.

Cultural issues must be considered by counselors and teachers before coming to a decision. Children who speak another language or who move to other countries might take some time to get comfortable with a new environment or language. This should not be confused with selective mutism.

Comprehensive Assessment of the Child’s History

A complete history about the child should be gathered. It will include educational history, oral-motor examination results, hearing screening outcome, interview with parent or caregiver, and speech and language exam.

• Hearing screening provides information on the child’s hearing ability and potential infection in the middle ear that could interfere with hearing.
• Educational history gives valuable information about academic performance, comments from parents or teachers, and any previous psychological testing outcome.
• Interview with the parent or caregiver addresses questions about any suspected conditions such as schizophrenia or developmental disorders; environmental factors such as language stimulation and stress from being exposed to multiple languages; the extent of verbal expression by the child in different situations such as with his friends in the playground or with guests at home; behavioral history of the child; family history of psychiatric or personality issues; level of expression of the child or any speech and language issues.
• Oral-motor examination offers information on muscle strength and coordination in the jaw, lips, and tongue.
• Speech and language examination is done to assess the expressive language ability of the child. Sometimes the child may not speak up with the SLP and the parent may need to help the child in speaking up or record and bring a video of the child talking at home for the SLP’s reference. This assessment also employs standardized tests to assess language comprehension and verbal and non-verbal communication levels of the child. The SLP may look at a drawing done by the child or engage in non-verbal games with the child to understand the level of effective non-verbal expression the child can handle. Informal observations can also be used by the SLP to assess the communication patterns of the child.

References

• http://www.asha.org/public/speech/disorders/SelectiveMutism/#3
• https://www.nlm.nih.gov/medlineplus/ency/article/001546.htm
• http://www.selectivemutismcenter.org/aboutus/whatisselectivemutism

Further Reading

• Selective Mutism Anxiety Disorder
• Causes and Risk Factors for Selective Mutism
• Selective Mutism Prognosis
• Behavioral Therapy for Selective Mutism
• Support for Selective Mutism