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Demystifying the DSM: Selective Mutism

Little girl covering her mouth with her hands. Surprised or scared. On the light background indoors.

Cristi Bundukamara, Ed. D, PMHNP (aka, Dr. B.), founder and creator of the Mentally STRONG Method, explains selective mutism, how it is defined in the DSM-V, its causes, and treatment.

What Is Selective Mutism?

Selective mutism is a rare childhood anxiety disorder in which a child consistently fails to speak in specific social situations, despite being able to speak normally in other settings. It typically affects children under five and can persist into adolescence and adulthood if left untreated. Before deciding upon a diagnosis of selective mutism, it is essential to go through a differential diagnosis to determine whether there is an actual communication disorder. An evaluation by a speech therapist or an occupational therapist can help determine that no other issues are present.


The exact cause of selective mutism is unknown, but it is thought to be a combination of genetic, environmental, and psychological factors. Common triggers for selective mutism include social anxiety, separation anxiety, and trauma. There may be a comorbidity – a second diagnosis of generalized anxiety disorder, which like depression, results from low neurotransmission and should be treated with medication or, in some cases, diet, exercise, and sunlight may be sufficient.


In the case of selective mutism, however, the anxiety is typically remarkably high, and it becomes necessary to treat low neurotransmission with medication. Treatment for selective mutism typically involves a combination of therapy and medication. Cognitive-behavioral therapy (CBT) – the basis for the Mentally STRONG Method – is often used to help children overcome their anxiety and develop the confidence to speak in social situations. While selective mutism may start earlier in childhood, this treatment is appropriate for children aged 12 and up. Medications such as antidepressants or anti-anxiety medications may also be prescribed to help manage symptoms.

Teaching Children to be Mentally STRONG

Parents and caregivers must be patient and understanding when working with a child with selective mutism. Encouragement and positive reinforcement can go a long way in helping a child overcome their anxiety and learn to communicate effectively in all social situations. With the proper treatment and support, most children with selective mutism can overcome their fear, lead happy, healthy lives, and become Mentally STRONG.

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