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DSM-III

In DSM-III, this disorder is called Elective Mutism

Diagnostic Criteria

A. Continuous refusal to talk in almost all social situations, including at school.

B. Ability to comprehend spoken language and to speak.

C. Not due to another mental or physical disorder.

Differential Diagnosis

Mental Retardation, Pervasive Developmental Disorder, and Developmental Language Disorder

In Severe or Profound Mental Retardation, Pervasive Developmental Disorder, or Developmental Language Disorder, there may be general inability to speak.

Major Depression, Avoidant Disorder of Childhood or Adolescence, Overanxious Disorder, Oppositional Disorder, and Social Phobia

In Major Depression, Avoidant Disorder of Childhood or Adolescence, Overanxious Disorder, Oppositional Disorder, and Social Phobia, there may be a general refusal to speak. However, in none of these disorders is the lack of speaking the predominant disturbance.

Unfamiliarity with the language

Children in families who have emigrated to a country of a different language may refuse to speak the new language. When comprehension of the new language is adequate but the refusal to speak persists, Elective Mutism should be diagnosed.

DSM-IV

Diagnostic Criteria

A. 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.

B. The disturbance interferes with educational or occupational achievement or with social communication.

C. The duration of the disturbance is at least 1 month (not limited to the first month of school).

D. The failure to speak is not due to a lack of knowledge of, or comfort with, the spoken language required in the social situation.

E. The disturbance is not better accounted for a by Communication Disorder (e.g., Stuttering) and does not occur exclusively during the course of a Pervasive Development Disorder, Schizophrenia, or other Psychotic Disorder.

Differential Diagnosis

Communication Disorders

Selective Mutism should be distinguished from speech disturbances that are better accounted for by a Communication Disorder, such as Phonological Disorder, Expressive Language Disorder, Mixed Receptive-Expressive Language Disorder, or Stuttering. Unlike Selective Mutism, the speech disturbance in these conditions is not restricted to a specific social situation.

Lack of knowledge of the language

Children in families who have immigrated to a country where a different language is spoken may refuse to speak the new language because of lack of knowledge of the language. If comprehension of the new language is adequate, but refusal to speak persists, a diagnosis of Selective Mutism may be warranted.

Pervasive Developmental Disorders, Psychotic Disorders, and Mental Retardation

Individuals with a Pervasive Developmental Disorder, Schizophrenia or other Psychotic Disorder, or severe Mental Retardation may have problems in social communication and be unable to speak appropriately in social situations. In contrast, Selective Mutism should only be diagnosed in a child who has an established capacity to speak in some social situations (e.g., typically at home).

Social Phobia

The social anxiety and social avoidance in Social Phobia may be associated with Selective Mutism. In such cases, both diagnoses may be given.

DSM-5

Diagnostic Criteria

A. 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.

B. The disturbance interferes with educational or occupational achievement or with social communication.

C. The duration of the disturbance is at least 1 month (not limited to the first month of school).

D. The failure to speak is not attributable to a lack of knowledge of, or comfort with, the spoken language required in the social situation.

E. The disturbance is not better explained by a communication disorder (e.g., childhood-onset fluency disorder) and does not occur exclusively during the course of autism spectrum disorder, schizophrenia, or another psychotic disorder.

Differential Diagnosis

Communication disorders

Selective mutism should be distinguished from speech disturbances that are better explained by a communication disorder, such as language disorder, speech sound disorder (previously phonological disorder), childhood-onset fluency disorder (stuttering), or pragmatic (social) communication disorder. Unlike selective mutism, the speech disturbance in these conditions is not restricted to a specific social situation.

Neurodevelopmental disorders and schizophrenia and other psychotic disorders

Individuals with an autism spectrum disorder, schizophrenia or another psychotic disorder, or severe intellectual disability may have problems in social communication and be unable to speak appropriately in social situations. In contrast, selective mutism should be diagnosed only when a child has an established capacity to speak in some social situations (e.g., typically at home).

Social anxiety disorder (social phobia)

The social anxiety and social avoidance in social anxiety disorder may be associated with selective mutism. In such cases, both diagnoses may be given.