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Mutism is a rare childhood condition characterized by a consistent failure to speak in situations where talking is expected. The child has the ability to converse normally, and does so, for example, in the home, but consistently fails to speak in specific situations such as at school or with strangers. It is estimated that one in every 1,000 school-age children are affected.


Experts believe that this problem is associated with anxiety and fear in social situations such as in school or in the company of adults. It is therefore often considered a type of social phobia. This is not a communication disorder because the affected children can converse normally in some situations. It is not a developmental disorder because their ability to talk, when they choose to do so, is appropriate for their age level. This problem has been linked to anxiety, and one of the major ways in which both children and adults attempt to cope with anxiety is by avoiding whatever provokes the anxiety.
Affected children are typically shy, and are especially so in the presence of strangers and unfamiliar surroundings or situations. However, the behaviors of children with this condition go beyond shyness.

Causes and symptoms

Mutism is believed to arise from anxiety experienced in social situations where the child may be called upon to speak. Refusing to speak, or speaking in a whisper, spares the child from the possible humiliation or embarrassment of "saying the wrong thing." When asked a direct question by teachers, for example, the affected child may act as if they are unable to answer. Some children may communicate via gestures, nodding, or very brief utterances. Additional features may include excessive shyness, oppositional behavior, and impaired learning at school.


The diagnosis of mutism is fairly easy to make because the signs amd symptoms are clear-cut and easily observable. However, other social disorders effecting social speech, such as autism or schizophrenia, must be considered in the diagnosis.


There are two recommended treatments for mutism: behavior modification therapy and antidepressant medication. Treatment is most effective when individualized to each patient. It has been suggested that speech pathologists may also be able to help these children.


The prognosis for mutism is good. Sometimes it disappears suddenly on its own. The negative impact on learning and school activities may, however, persist into adult life.


Mutism cannot be prevented because the cause is not known. However, family conflict or problems at school contribute to the seriousness of the symptoms.



Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association, 1994.

Key terms

Behavior modification — A form of therapy that uses rewards to reinforce desired behavior. An example would be to give a child a piece of chocolate for grooming themselves appropriately.
Gale Encyclopedia of Medicine. Copyright 2008 The Gale Group, Inc. All rights reserved.


inability or refusal to speak, most often because deafness has prevented the person from hearing the spoken word. speech is learned by imitating the speech of others. The child who is born with normal hearing and then loses it may lose part or all of the power of speech through loss of contact with the speech of others. Mutism may also occur because the voice organs themselves have been damaged or removed, such as when a laryngectomy is performed for throat cancer. In other cases loss of speech may be psychogenic in nature. Called also aphonia.
akinetic mutism a state in which the person makes no spontaneous movement or vocal sound, because of either neurologic or psychologic reasons. Called also abulia.
selective mutism a mental disorder of childhood characterized by continuous refusal to speak in social situations when the child is able and willing to speak to selected persons.
Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, Seventh Edition. © 2003 by Saunders, an imprint of Elsevier, Inc. All rights reserved.


1. The state of being silent.
2. Organic or functional absence of the faculty of speech.
[L. mutus, mute]
Farlex Partner Medical Dictionary © Farlex 2012


The condition of being unable or unwilling to speak as a result of a physical or psychological disorder.
The American Heritage® Medical Dictionary Copyright © 2007, 2004 by Houghton Mifflin Company. Published by Houghton Mifflin Company. All rights reserved.


Neurology Inability or refusal to speak
McGraw-Hill Concise Dictionary of Modern Medicine. © 2002 by The McGraw-Hill Companies, Inc.


1. The state of being silent.
2. Organic or functional absence of the faculty of speech.
[L. mutus, mute]
Medical Dictionary for the Health Professions and Nursing © Farlex 2012


Inability or refusal to speak. There are many possible causes including deafness from birth, mental retardation, severe DEPRESSION, SCHIZOPHRENIA, HYSTERIA, brain tumour and HYDROCEPHALUS.
Collins Dictionary of Medicine © Robert M. Youngson 2004, 2005


1. State of being silent.
2. Organic or functional absence of faculty of speech.
[L. mutus, mute]
Medical Dictionary for the Dental Professions © Farlex 2012

Patient discussion about mutism

Q. clonex symptoms in Selective Mutism Syndrome children My son is 6.5 years old, with selective mutism syndrome - in a months time he shall be entering first grade. We have, the past 2 years been with therapists specializing in this field. He has improved outside a closed system i.e. within the kindergarten (primarily) we even see some regression. We have been at major dilemmas with giving him medication but due to the critical time - we were recommended to take 0.125 mg of Clonex medication. we are a little worried and would like to understand the possible symptoms

A. As a benzodiazepin, it can cause drowsiness, weakness and other changes in behavior. There may be some other side-effects, that you can read about here (

More discussions about mutism
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References in periodicals archive ?
Prevalence and description of selective mutism in a school-based sample.
Mutism, negativism, echolalia, echopraxia, and waxy flexibility are the most important clinical findings in catatonia.
A diagnosis of probable CJD requires rapidly progressive dementia, and two of four of myoclonus, visual or cerebellar symptoms, pyramidal/extrapyramidal symptoms, or akinetic mutism and a positive result on a supporting test (EEG, 14-3-3, or MRI) [14,15].
Selective mutism is a complex anxiety disorder characterized by a child's inability to speak and communicate effectively in select social settings, such as the school.
Synopsis: Often baffling to parents, teachers, and some therapists, the social anxiety disorder known as selective mutism prevents children from moving toward normal social communication, critical in the school-age years.
I was surprised we had a college student with selective mutism. I knew that pressuring such students to speak up would only make them retreat into their shells.
There are no reported stuttering phenomenons after GA however four cases of aphemia or mutism after GA have so far been published in the literature [1-4].
Catatonia is defined as immobility, rigidity, mutism, posturing, excessive motor activity, stupor, negativism, staring, and echolalia.
Persons with locked-in syndrome (LIS), akinetic mutism (AM), and spinal cord injury (SCI) can also have very similar presentation making differential diagnosis complex.