Are selective mutism and autism related?
Selective mutism and autism…are they related? Can a child with selective mutism also be diagnosed with autism spectrum disorder (ASD)?
But what is selective mutism?
Selective mutism is described as a severe anxiety disorder, particularly social anxiety.The prominent feature in selective mutism is the inability to initiate speech or respond when spoken to (school or around unfamiliar people), though the child has no problems speaking in other settings (home).
The DSM-5 criteria for selective mutism:
- 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
1month (cannot be during 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. – childhood-onset fluency disorder) and does not occur exclusively during the course of autism spectrum disorder, schizophrenia, or another psychotic disorder
Selective mutism and autism share common comorbidities such as anxiety. So can selective mutism and autism overlap? According to one study, 63% of the study group had ASD, with the average age of onset of symptoms of selective mutism being 4.5 years, and the average age of diagnosis being 8.8 years. This study noted that girls were more likely to be diagnosed with selective mutism than boys.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5944454/
Another study summarized that selective mutism and autism, along with social anxiety disorder (SAD) are “allied clinical conditions and share communalities in the realm of social difficulties.” https://link.springer.com/article/10.1007/s10567-020-00342-0. The author goes on to note that selective mutism in some children may be more than an anxiety disorder, but, instead, may be a component of ASD.
So how do you treat selective mutism?
Intensive behavioral treatment has been known to help children with selective mutism. Some have found success with applied behavior analysis (ABA), while other kids responded well to group therapy with their peers. I have read where some children with selective mutism have responded well to low dosages of an SSRI, such as Prozac The first step in treatment, though, would be to talk to your pediatrician and get a referral for a qualified psychotherapist.
I have my own theory about what causes anxiety in a sub-set of children. Anxiety in Our Autistic Kids. My son had severe anxiety, which treatment for heavy metals toxicity resolved. Heavy metals may not be indicated for every child with anxiety, but it wouldn’t hurt to bring up the possibility that your child may have a heavy metals burden with a qualified practitioner.
Knowledge is power, and knowing the differences and similarities between selective mutism and autism gives us as parents the power to get our child the treatment they need to overcome selective mutism!
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