Why do so few teachers, therapists and physicians understand SM?
Research studies on SM are scarce. Most articles and textbooks descriptions are based on subjective findings of a very limited number of children. In some cases, medical and educational professionals have not been taught anything at all about SM and in other cases they have been given very little training on SM and even inaccurate and misleading information on the subject. When confronted with a child with SM, doctors, teachers and other professionals will often tell a parent that the child is just shy or that he/she with outgrow the behavior. Other professionals incorrectly interpret mutism as oppositional or defiant behavior where mutism is a means of manipulation and control. Still other professionals view SM as a variant of autism or an indication of severe learning disabilities. This misunderstanding leads to misdiagnosis and ineffective treatment strategies, as SM is best viewed as an anxiety disorder.
The diagnostic manual most widely used by treating professionals is the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, now in a Text Revision (APA, 2000). Of all the anxiety disorders, selective mutism and separation anxiety disorder are the only two listed in DSM-IV-TR under “Disorders Usually Diagnosed in Childhood.” All of the anxiety disorders listed in the “Anxiety Disorders” section, however, may also be applied to children. There is much more research available on the anxiety disorders classified as such in the DSM. Also, due to the current classification system, a clinician is less likely to encounter SM in the manual if they suspect anxiety in a child, as it does not fall into the anxiety category. To make SM even more isolated in the classification system, it is listed in a smaller sub-category of the childhood section of DSM called “Other disorders of Childhood.” This classification does not clearly suggest that SM is associated with anxiety, only that it is a childhood problem associated with not speaking. Thus, further research and education is needed to help more teachers and treating professionals to understand the symptoms of selective mutism, its association with social anxiety, and its treatment as an anxiety disorder.
