Demystifying the DSM: Selective Mutism

SELECTIVE MUTISM – Are you wondering whether your child is showing signs of Selective Mutism? Dr. B discusses the diagnosis in the DSM-V. See below for a transcript of the video:

Dr. B here with our series on demystifying the DSM. Today I'm going to talk about Selective Mutism, which is also, I talked about with separation anxiety disorder, this is often a symptom of something else, but it does have its own diagnostic criteria because the treatment might be different. 

And it’s also super important, especially in children, to make sure that we go through the differential diagnosis and that there's not an actual communication disorder. They have been evaluated by a speech therapist or an occupational therapist, so that we know for sure that this is truly selective mutism. 

Just because a child will not speak in certain situations, it could be a choice, right? It could be a behavior. But if it's associated with significantly high anxiety and the child really doesn't feel like they have control of it, that is selective mutism, and it is, very specific to certain situations. Often, the school will notice it, and home will notice it.  

And it's treated with behavioral, some cognitive behavioral therapy. We can't really start cognitive behavioral therapy until the child is around 12. We can teach the concepts, which this is what I believe, we should be teaching the concepts of cognitive behavioral therapy so that our children know how to love themselves, talk positively to themselves and begin that process. But truly understanding the abstract connection between their thoughts and their choices is difficult for young children. 

So oftentimes the selective mutism happens at that age where we have to do a little more behavioral, reward-based therapy. You know and giving them time. It is an anxiety disorder. There's severe anxiety behind that, so look closely, because they probably also meet criteria for generalized anxiety disorder, which we should and can treat with medication, right? Because the theory behind both depression and anxiety is that there is low neurotransmission, right? We have 26 plus neurotransmitters and some you know we theoretically think are associated with depression and anxiety. But in general, if we can increase one or more of those neurotransmitters, all of them will follow. 

There are natural ways, with good food and exercise and sunlight, but if a person has gotten to the point of selective mutism, that anxiety is very very high and we should strongly be considering medication with either behavioral therapy or cognitive behavioral therapy, depending on the age and the ability of the child. But again, making sure that there's been adequate assessments from speech or occupational therapy to make sure that there's not an actual communication disorder which would be treated completely differently than selective mutism.