Specific Phobia 197
asking to use the restroom). Severe impairment  in school and social functioning, including
that resulting from teasing by peers, is co mmon. In certain instances, selective mutism
may serve as a compensatory strategy to decr ease anxious arousal in social encounters.
Differential Diagnosis
Communication disorders. Selective mutism should be di stinguished from speech dis-
turbances that are better explained by a communication disorder, such as language
disorder, speech sound disorder (previously phonological disorder), childhood-onset
fluency disorder (stuttering), or pragmatic (social) communication disorder. Unlike selec-
tive mutism, the speech disturbance in these cond itions is not restricted to a specific social
situation. 
Neurodevelopmental disorders and schizo phrenia and other psychotic disorders.
Individuals with an autism spectrum disord er, schizophrenia or another psychotic disor-
der, or severe intellectual disability may ha ve problems in social communication and be
unable to speak appropriately in  social situations. In contrast, selective mutism should be
diagnosed only when a child has an established capacity to speak in some social situations
(e.g., typically at home).
Social anxiety disorder (social phobia). The social anxiety and social avoidance in so-
cial anxiety disorder may be associated with selective mutism. In such cases, both diagno-
ses may be given.
Comorbidity
The most common comorbid conditions are other anxiety disorders, most commonly so-
cial anxiety disorder, followed by separation anxiety diso rder and specific phobia. Oppo-
sitional behaviors have been noted to occur in children with selective mutism, although
oppositional behavior may be limited to sit uations requiring speech. Communication de-
lays or disorders also may appear in  some children with  selective mutism.
Specific Phobia