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Evaluating and Diagnosing Selective Mutism
Ensuring an Accurate SM Diagnosis
How to Evaluate for SM
Only a trained professional familiar with SM or other anxiety disorders should evaluate an individual for SM. Evaluations generally begin with a thorough assessment of the child to accurately diagnose the condition, rule out similar or comorbid conditions, and formulate a treatment plan. The treating professional then gathers information about the child, which may include:
- Developmental history, including achievement of developmental milestones and whether or not there were any delays in hearing, speech, and motor and cognitive development
- Family history, including determining whether or not other anxiety disorders are present in the family
- Academic, social, and cognitive functioning
- Behavioral characteristics
- Medical history
- Significant life stressors, including divorce, frequent moves, or a death in the family
Additionally, the treating professional may want to speak with the child’s school, physician, and other significant people in their life to gain further insight. It can also be helpful for the professional to view a video of the child in a comfortable setting or observe them before they meet the professional so their behavior is not influenced by the professional’s presence.
Most children with SM will not speak to the treating professional; however, some may feel comfortable in the treatment setting and speak normally. This behavior does not rule out selective mutism, as the “selective” nature of the mutism varies from child to child and setting to setting. Depending on the setting, some evaluations may include observational tasks whereas others may have direct meetings with the treating professional.
Some children with SM have difficulties with expressive language or other communication disorders, so a speech and language evaluation may also be necessary. Additionally, a physical exam with a hearing test, standardized testing, psychological assessment, and developmental screenings are often recommended, especially if the diagnosis is not clear.
Clinical Requirements for a Selective Mutism Diagnosis
According to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, to be diagnosed with selective mutism, an individual must meet the following criteria:
- 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 one month (not limited to the first month of school).
- The failure to speak is not attributable to a lack of knowledge of, or comfort with, the spoken language required in the social situation.
- The disturbance is not better explained by a communication disorder (e.g., stuttering) and does not occur exclusively during the course of autism spectrum disorder disorder, schizophrenia, or another psychotic disorder.
A diagnosis of SM can only be made by a treating professional qualified to diagnose mental illness. While many parents and professionals unfamiliar with SM may identify many of the symptoms in their children, a formal diagnosis should be obtained to confirm that SM is present and not better accounted for by other disorders that also include the lack of speech as a presenting symptom.
SM Diagnosis Resources
If you think you know a child who needs an SM evaluation, connect with a treating professional through SMA. See our resources below and connect with our experts.
Online Library
General Info and Resources
Bilingual & Translated Resources
Speech and Language Resources
Treating Professionals Resources
Parent Resources
Teen and Young Adult Resources
School Resources
Webinars
S-CAT® Treatment and Strategies to Help Children/Teens with Selective Mutism Speak in School
My Journey Through Silence: A Young Adult’s Perspective on Selective Mutism
My PCIT: A Personalized Version of PCIT for Culturally Diverse Families
Practical Applications to Enhance Motivation in the Treatment of Adolescents with Selective Mutism
Your Questions Answered: Enhancing Motivation in the Treatment of Adolescents with Selective Mutism – Part II
Using Telehealth for Selective Mutism
Selective Mutism 101: Myths, Tips, and Treatment
Courage at Camp with Rachel Merson
Managing Anxiety in the Face of COVID-19
Other Resources
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