Mutism is a rare childhood condition characterized by a consistent failure tospeak in situations where talking is expected. The child has the ability toconverse normally, and does so, for example, in the home, but consistently fails to speak in specific situations such as at school or with strangers. It is estimated that one in every 1,000 school-age children are affected by mutism.

Experts believe that this problem is associated with anxiety and fear in social situations such as in school or in the company of adults. Therefore mutismis often considered a type of social phobia. This is not a communication disorder because the affected children can converse normally in some situations.It is not a developmental disorder because their ability to talk, when theychoose to do so, is appropriate for their age level. This problem has been linked to anxiety, and one of the major ways in which both children and adultsattempt to cope with anxiety is by avoiding whatever provokes the anxiety.

Affected children are typically shy, and are especially so in the presence ofstrangers and unfamiliar surroundings or situations. However, the behaviorsof children with this condition go beyond shyness. Refusing to speak, or speaking in a whisper, spares the child from the possible humiliation or embarrassment of "saying the wrong thing." When asked a direct question by teachers,for example, the affected child may act as if they are unable to answer. Somechildren may communicate via gestures, nodding, or very brief utterances. Additional features may include excessive shyness, oppositional behavior, and impaired learning at school.

The diagnosis of mutism is fairly easy to make because the signs and symptomsare clear-cut and easily observable. However, other social disorders effecting social speech, such as autism or schizophrenia, must be considered when making the diagnosis.

There are two recommended treatments for mutism: behavior modification therapy and antidepressant medication. Treatment is most effective when individualized to each patient. It has been suggested that speech pathologists may alsobe able to help these children.

The prognosis for mutism is good. Sometimes it disappears suddenly on its own. The negative impact on learning and school activities may, however, persistinto adult life. Mutism cannot be prevented because the cause is not known.However, family conflict or problems at school contribute to the seriousnessof the symptoms.

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