There are many theories which attempt to explain the etiology of Selective Mutism. This concept node and its child relation nodes will explore theories for SM through these following lens/frameworks: 

1) Psychodynamic Theory
2) Behavioral Theory 
3) Social phobia and Social Anxiety 
4) Family Systems Theory 
5) Dissociative Identity Theory 
6) Post-traumatic Stress Theory
7) Developmental Psychopathology Theory 

A table from 'Wong, Priscilla. "Selective Mutism: A Review and Integration of Etiology, Comorbities, and Treatment." paper has provided a table that may be helpful (see image; cred: Wong, Theories on the Etiology of Selective Mutism). 

Theories on the Etiology and Emergence of Selective Mutism 

Definition: Selective Mutism (SM) is an anxiety disorder which often appears in early childhood, characterized by the PERSISTENT failure to engage in speech in specific social situations where speech is typically expected, despite technically possessing the full capability (the necessary physical structures and speech motor processes) to being able to speak and hear. 

Selective Mutism often co-exists with Social Anxiety Disorder (SAD). 

The DSM-IV-TR criteria for Selective Mutism specifies that this persistent failure to speak should not be attributed to these following reasons: 

1) An organic inability rooted in the individual's language capability (e.g. comprehension, in-fluency in language, etc) 
2) Another communication disorder (e.g. stuttering) 
3) A diagnosis of another psychotic disorder (e.g. Pervasive Development Disorder, Schizophrenia, etc) 

Please note that a comprehensive and uniform theory about the etiology, assessment, and treatment of SM does not exist; Historically, varying definitions and criteria have been applied to individuals with SM, and so this provided definition and diagnostic criteria may not be yet as inclusive as it can be. 

Image citation: Journal of American Academy of Psychology. Factors That May Influence Speech and Social Inhibition., 17 Feb. 1995, www.sciencedirect.com/science/article/abs/pii/S0890856709635930. Accessed 22 June 2023.

Definition and Diagnostic Criteria of Selective Mutism 

Prevalence estimates for SM range between 0.2% - 1.6%. SM Prevalence may be higher in immigrant children, individuals in a language-minority group, or individuals with speech/language delays. SM often occurs between ages 3-6, while diagnosis for this disorder often occurs during ages 5-8 -- about the time children enter school. 

Note that there is currently a lack of consensus regarding the population estimates of SM, as they are difficult to ascertain; this data has been gathered via various different diagnostic criteria and population samples which have been compared to one another. Additionally, there is no consensus on the relation between SM prevalence and gender assigned at birth. While most studies report that it affects females more than males, some studies find that it affects more males than females, or that there seems to be no difference by gender.  

Definitions: 

The INCIDENCE of Selective Mutism refers to the number of new cases identified in a specific time period. 

The PREVALENCE of Selective Mutism refers to the number of individuals who are living with Selective Mutism in a current time period. 

Incidence and Prevalence of Selective Mutism

Treatment for Selective Mutism for a long time has been considered difficult. Some approaches used for treating Selective Mutism include 

1) Behavioral Interventions, 
2) Psych-dynamic Therapy, 
3) Family Therapy, 
4) Speech Therapy,
5) Pharmacological Intervention (this is a relatively new approach). 

Please note that the majority of reports of Selective Mutism treatment is based off of case-studies. 

While case-studies can be beneficial to describe new approaches or interventions, generalizing from case-studies may problematic as they are often unable to be replicated (due to insufficiently described methodology, or it being an incredibly specific situation), having unstandardized outcomes measures, alternative symptoms not explored, or including cherry-picked data (where unsuccessful cases are unreported).  

Treatment & Management Methods for Selective Mutism

Here are all the citation references for the Selective Mutism nodes. 

Citation Reference for Selective Mutism Node

Limited speech can be a sign of selective mutism, an anxiety disorder characterized by lack of speech across settings. Selective mutism may develop among children with speech sound disorder due to embarrassment about their errors or impairment, but many children with selective mutism exhibit normal speech in settings they deem "safe."

Cleveland State University

Speech Sound Disorder may have features that overlap with other speech patterns, conditions, or disorders, including:

- Normal variations in speech

- Hearing or other sensory impairment

- Structural deficits

- Dysarthria

- Selective mutism

Differential Diagnosis to Speech Sound Disorder

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed., Text revision). https://doi.org/10.1176/appi.books.9780890425596

DSM-5-TR

Regional, social, and cultural considerations should be made before making a speech sound diagnosis. Bilingual children may demonstrate an overall lower intelligibility rating, make more overall consonant and vowel errors, and produce more error patterns than solely English-speaking children.

Normal Variations in Speech as a Differential Diagnosis to Speech Sound Disorder

Those who are deaf or hard of hearing may have speech sound production errors. A speech sound diagnosis may be made when deficits are in excess of those typically associated with these conditions.

Hearing or Other Sensory Impairment as a Differential Diagnosis to Speech Sound Disorder

Impairment in speech may be caused by a structural deficit present at birth, such as cleft palate.

Structural Deficits as a Differential Diagnosis to Speech Sound Disorder

Speech impairment and errors in speech sound production can be attributable to a motor disorder such as cerebral palsy. Neurological signs and distinctive features in voice differentiate these from speech sound disorder, but differentiation may be difficult before 3 years of age when there is minimal or no general body motor involvement.

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