Limited speech outside the home in a young girl who speaks normally at home

Selective mutism (SM) is a childhood anxiety disorder characterized by failure to speak in at least one specific social setting such as school, despite the ability to speak in other, more familiar settings. The symptoms must persist for at least one month. Many children with SM also have excessive shyness, poor eye contact, and fear of embarrassment. Despite the failure to speak, the child’s nonverbal communication ability is typically age appropriate and prosocial nonverbal communication such as nodding or giggling is often observed. Since SM frequently co-occurs with other communication disorders, the assessment should include a hearing and speech and language evaluation. Behavioral therapy and cognitive behavioral therapy (CBT) are the primary treatments for SM. Medications are most effective when combined with behavioral treatments and may include the use of selective serotonin reuptake inhibitors (SSRIs).