Selective mutism refers to the disinclination or refusal of an individual to speak in some social situations (eg, school), but not in others (eg, home). It is a condition most commonly seen in pediatric patients, with an estimated prevalence of less than 1% of children. Although it can occur in patients of all pediatric ages, it is most often diagnosed before age 5 years (typically between ages 2 and 4). Comorbid social phobia, depression, or anxiety disorder often exists with selective mutism. Notably, patients with selective mutism do not have an underlying speech deficit, a neurological or developmental disorder, or a lack of social language or subject knowledge.

Symptoms tend to be pronounced at the start of school or on introduction to new social settings. Patients typically have symptoms for at least 1 month, with most patients presenting with 6-7 months of persistent symptoms. Affected individuals often have poor outcomes in their respective learning environments due to poor engagement and participation.

Management options include psychotherapy, parent-child interaction therapy (PCIT), cognitive behavioral therapy, and antidepressant therapy if major depressive disorder or generalized anxiety disorder are present. There are mixed results for all therapeutic options.