selective mutism

312.23 Selective Mutism Symptoms and Related DSM-V Diagnosis

Selective Mutism 313.23 (F94.0):

Selective mutism is a voluntary refusal to speak. Elective mutism was first described as a mental disorder in the DSM-III and then was changed to selective mutism in the DSM-IV-TR. It was then moved to the anxiety disorders chapter in the DSM-V due to a restructuring of the categories of mental disorders in the new diagnostic manual.

The primary features of selective mutism are a refusal to speak outside of the home or with other people who are not immediate family members due to choice rather than physical inability to speak. Children may sometimes use nonverbals such as nodding or may choose to speak only to immediate family members although they have the physical capability of speech. The most common age of onset is before five years old and may occur initially at school. It may be seen among adolescents and adults also but not as frequently as among children. A very high level of shyness is also seen among these children along with significant diagnostic comorbidity with other anxiety disorders such as social anxiety disorder. Obviously, children with selective mutism suffer severely in school and social settings and experience significant impairment and withdrawal in these environments.

When diagnosing a child with selective mutism, mental health clinicians need to consider the child’s developmental level and the context within which the symptoms are demonstrated. It is very important not to pathologize normal developmental transitions. With selective mutism the lack of communication is not specific to social environments and is much more widespread. It should be diagnosed only when the child has demonstrated the ability to speak in other situations such as in the home. It is common for children to also experience social anxiety disorder. In this case, both social anxiety disorder and selective mutism should be diagnosed. It is also important to differentially diagnose selective mutism from neurodevelopmental disorders, schizophrenia and other psychotic disorders.

Selective mutism coding:

The only diagnostic code for selective mutism is 313.23 (F94.0) with no specifiers.

Selective Mutism diagnostic criteria 312. 23 (F94.0):

A. 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.

B. The disturbance interferes with educational or occupational achievement or with social communication.

C. The duration of the disturbance is at least one month (not limited to the first month of school).

D. The failure to speak is not attributable to a lack of knowledge of, or comfort with, the spoken language required in the social situation.

E. 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 in another psychiatric disorder.

Diagnostic Information and Criterion adapted from the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition American Psychological Association By Paul Susic Ph.D. Licensed Psychologist

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