What are the signs and symptoms of SM?
Those with SM experience anxiety related to speaking and sometimes they may also be unable to make eye contact, nod their heads, point or make other nonverbal forms of communication when in a social situation that provokes anxiety. SM may be an extreme form of social phobia. Social anxiety and avoidance characteristic of social phobia may be associated with SM, and thus, both diagnoses may be given. More than 90% of children with SM also meet the diagnostic criteria for social anxiety disorder, now termed social phobia (Black et al., 1996). Diagnosis of other comorbid anxiety disorders is also commonly diagnosed with SM and social phobia (Biedel & Turner, 1998). The name change from ‘elective’ to ‘selective mutism’ in DSM-IV deemphasized the oppositional behavior connotation that a child elected not to speak and rather emphasized the characteristic of the disorder, that there are select environments in which speaking does not occur (APA, 1994). Thus a child’s reluctance to speak and en
