Children who refuse to speak in situations where speech is expected or necessary, to the extent that their refusal interferes with school and making friends, may be suffering from selective mutism, thought to be a severe form of social anxiety disorder. Onset of selective mutism is usually before five years of age, but it often comes to a head when the child enters school. The average age of diagnosis is between 4 and 8 years old, but these children probably exhibited "extreme shyness" at a much earlier age. For selective mutism to be diagnosed, the behavior must persist for at least one month. These children can be very talkative, even boisterous at home, or in a place where they feel comfortable.
Children suffering from selective mutism may exhibit the following:
- Stand motionless and expressionless, turn his or her head, chew or twirl hair, avoid eye contact, or withdraw into a corner.
- Become anxious before entering an uncomfortable situation, common symptoms of anxiety before social events include stomachaches, headaches, and other physical ailments.
- Display additional signs of severe anxiety: separation anxiety, frequent tantrums and crying, moodiness, inflexibility, sleep problems, and extreme shyness. These can show up as early as infancy.
Reprinted with the permission of the Anxiety Disorders Association of America.
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