Selective mutism: a review of the concept and treatment.

Selective mutism is the persistent failure of a child to speak in a specific social situation where speaking is expected, despite normal or near-normal speech in other situations [1,2]. Selective mutism is not a rare disorder, with an estimated prevalence of between 2/ 10,000 and 70/10,000 school-age children [3]. Until recently, selective mutism was considered difficult to treat and even ` intractable'' [4], requiring a variety of treatments such as behavioral techniques, psychodynamic approaches and combinations of family, art and speech therapies [4±8]. However, the conceptual basis of selective mutism has changed, the consensus being that social phobia and anxiety components are the major, or at least important, etiologic factors [2,9]. This concept bears important pharmacotherapy implications [2,9,10±12]. Since only one article has been published in the general English-language literature on the etiologic and therapeutic issues of selective mutism [13], we would like to draw particular attention to the pharmacotherapy ± of major importance in the management of selective mutism.