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At home, your child is a lively chatterbox, always talking with you and the rest of the family about their interests and experiences. After school, they eagerly share stories about their day and what happened.

However, your child doesn’t speak at school when interacting with teachers or other adults. The closer they get to school, the quieter they become until they stop talking altogether.

If this scenario sounds familiar, you may have a child with selective mutism. Characterized by the inability to speak in specific social situations, selective mutism in kids is rare, with an estimated less than 1% of children diagnosed. Yet research has shown that around 70% of children diagnosed with selective mutism (SM) are likely to fit the diagnostic criteria for autism spectrum disorders (ASD). 

So, can one child have selective mutism and autism? The answer is complex, but Heartlinks is here to help clarify. 

What Is Selective Mutism?

Selective mutism occurs when children speak in comfortable or familiar situations with people they know but cannot communicate in specific settings with others. Unlike mutism, where a child cannot talk at all, selective mutism only occurs in certain situations. It’s important to note that selective mutism does not mean your child is unwilling to talk, nor may it be a lifelong condition.

Selective mutism is recognized as a disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the psychiatric Bible used to diagnose and classify mental health disorders. To be diagnosed, the following requirements have to be met:

• A child’s inability to speak is not due to a lack of language fluency.
• The condition lasts for at least a month, not including the first month of school (as it’s common for children to experience shyness during that time).
• The child’s lack of communication impacts their social, academic, or personal success.
• It cannot be explained by a fluency or communication disorder.
• It does not occur due to a diagnosis of autism, schizophrenia, or any other conditions.

Is selective mutism a neurodivergent condition? Yes, it is. Neurodivergent is a non-medical term that describes people whose brains process information differently than most, and that’s certainly the case with selective mutism.

What Causes Selective Mutism in Children?

Social anxiety is considered the primary cause of selective mutism. This type of anxiety disorder can result in excessive stress, fear of embarrassment, and self-consciousness. Some research has indicated that the most frequent comorbid condition with selective mutism is a social anxiety disorder. There have even been arguments suggesting that selective mutism is not a disorder unto itself but a form of social anxiety.

Can My Child Have Autism and Selective Mutism?

There has been tremendous confusion within the medical and research community about answering the question, can you have autism and selective mutism? 

The confusion lies in the DSM-5, which states that a person cannot have selective mutism if they’ve already been diagnosed as autistic. It stipulates that autism and selective mutism are not connected. Yet, research has indicated that 63% of those with selective mutism (SM) also had autism, while an additional 20% exhibited autistic traits. 

Research has shown there to be a genetic link between selective mutism and autism. It is the CNTNAP2 gene that has been shown to cause an increased susceptibility in children with autism and also to have selective mutism. 

What Are The Similarities and Differences Between Autism and Selective Mutism?

While selective mutism in kids with autism can occur, and they do share similar characteristics, they are still recognized as two separate diagnoses. The following is a brief overview of their differences and similarities.

Areas of Impact

Autism is a long-term developmental disability that affects how a person relates to the world around them, how they communicate and relate to others. Though there are many ways to improve an autistic person’s quality of life through ABA therapy, for example, there is no known cure for the diagnosis. Nor is there an understanding as to what causes autism. 

By contrast, selective mutism is a behavior that arises from underlying causes; therefore, if diagnosed early, it can be treated, and a child can grow up to be fully conversant regardless of the situation.

Communication Patterns 

Children with selective mutism cannot speak in specific social situations, such as school or around certain adults, but they remain talkative with familiar family members or friends. 

By comparison, children with autism spectrum disorder have similar difficulty with language and speaking, but it is regardless of the situation and, in some cases, might be completely non-verbal. Though there are ways to improve communication with an autistic child, raising a non-verbal child requires an entirely different variety of activities and approaches to day-to-day life. 

Social Interaction

Though selective mutism in kids affects children in specific settings, they still possess the social skills to establish solid family and friend relationships but in comfortable settings only. 

In contrast, ASD can cause tremendous challenges in social interactions and impair their overall social skills. Children with autism often cannot understand non-verbal cues, navigate social interactions, and maintain conversations. 

Anxiety

Anxiety is one of the most common comorbid conditions for children with SM or ASD. Symptoms of anxiety for both groups could include:

• freezing
• blushing
• trembling
• increased heart rate
• avoiding eye contact. 

Yet, for children with SM, their anxiety is often the result of an anxiety disorder leading to a fear of social interaction, judgment, and overwhelming social environments.

Many children with autism will suffer anxiety at some point in their lives, whether it’s ongoing or only during specific periods. The cause of an autistic child’s anxiety can have many more sources, such as sensory overload or overstimulation, which causes extreme stress and, in some instances, tantrums and or complete shutdowns. 

Development Milestones

Developmental delays are one of the crucial differences between children with autism and those with selective mutism. One of the hallmarks of autism is that children may experience a delay in reaching various developmental milestones. This is especially true if you have a child with low-functioning autism who, due to significant neurological impairments, experiences extreme difficulty in conducting day-to-day life. 

Children with selective mutism usually do not experience developmental delays in the general sense. Instead, they might be delayed academically because they can’t participate in classroom activities, oral presentations, and other group activities, which can affect learning.

Repetitive Behaviors and Restricted Movements

One of the most common autism symptoms is restricted behaviors or repetitive body movements. Most children on the spectrum engage in some sort of repetitive speech or motor movement known as stimming. These behaviors are designed to self-regulate or manage their emotions, including hand flapping, spinning, or finger flicking. Children with autism also exhibit restricted, obsessive interests and often adhere to strict routines. 

Children with selective mutism may develop rigid behavior patterns as coping mechanisms for their anxiety, such as consistently remaining silent in specific settings or routines that help them feel safe.

Selective Mutism Treatments

Selective mutism treatment and autism treatment share some similarities. 

For instance, kids with SM will require a focused approach to reduce their anxiety, improve communication, and help them feel more comfortable in a variety of social settings. How your child receives treatment, from cognitive behavioral therapy and medication to speech-language therapy, will depend on their challenges and what is recommended.

By comparison, children diagnosed with autism will usually undergo a form of applied behavioral analysis or ABA therapy. Regarded as one of the best therapies for autism, ABA can help improve the quality of a child’s life in several ways, including learning about emotional regulation and developing social skills. Similar to children with selective mutism, autistic kids may also require speech therapy, depending on their communication impediments.  

Children with one or both diagnoses will receive family therapy, encompassing various treatments. Parents might learn different therapy techniques they can use at home, how to incorporate positive and negative reinforcement,  

Heartlinks Can Help

It can be worrisome if your child only speaks in certain situations. Thinking it may be more than shyness. If you’re concerned with your child’s speech, consult their doctor as soon as possible to discuss your options. Early intervention is crucial to prevent these speaking challenges from becoming deeply ingrained.

It’s important to remember that selective mutism in kids does not necessarily mean they’re autistic. However, research does indicate that more children may have both conditions than initially thought. That’s why it’s worth asking for an ASD screening.

If your child is diagnosed with autism, we at Heartlinks have a variety of ABA services to help you and them.